5 Activity Tolerance Games to Play During OT Sessions to Make it FUN! | SeniorsFlourish.com #OT #occupationaltherapy

5 Standing and Activity Tolerance Ideas for OT

I am always looking for ideas to shake up my OT treatments and try to get creative with activity tolerance activities, because it is just NOT functional or occupation based to have our clients standing and putting in pegs into a board (unless they find this fun!).

Client centered care is so important in providing better outcomes, improvements in functional performance and quality of life (Choi, Yun, 2019), but further research is needed as even though it is recommended, it is not always implemented. It also helps patient motivation, as these are activities that the client has identified themselves as meaningful or fun per assessments such as the occupational profile or the modified interest checklist. 

So I am going to help you get creative, give 5 different treatment ideas to work on activity tolerance in your clinic and then give you a downloadable pdf with 20 More Free Standing and Activity Tolerance Treatment Ideas to keep your creative juices going!

5 Activity Tolerance Games to Play During OT Sessions to Make it FUN! | SeniorsFlourish.com #OT #occupationaltherapy

I love to use games as a means to:

1) work on OT goals,

2) be purposeful,

3) have FUN,

4) have a good time and laugh

Most can be put up and taken down due to limited clinic space which is an extra bonus!

5 OT interventions for activity tolerance | SeniorsFlourish.com #OT #occupationaltherapy

5 Activity Tolerance and Standing Tolerance Activities:

1. Vertical Card Match: 


5 Activity Tolerance Ideas for your OT Clinic | SeniorsFlourish.com

Pic via Pinterest, source unknown

Step 1: Gather supplies including:

  • 2 decks of playing cards,
  • Glue,
  • Velcro pieces with sticky backs, and a
  • Trifold cardboard display board

Step 2: Glue one deck of playing cards to the cardboard display board in random order, alternating colors

Step 3: Stick the soft side of the Velcro pieces in the middle and on the front of each playing card that is affixed to the display board

Step 4: Stick the rough side of the Velcro pieces on the back of each playing card in the new deck

Step 5: Play! Ideas are endless including matching colors, making patterns, putting them in order, games, etc

2. Life Sized Connect Four:


Working on activity tolerance in OT using games | SeniorsFlourish.com

Wall sized Connect 4 game via malloryinman.com


Step 1: Gather supplies including:

  • Bed sheet or large butcher paper,
  • Velcro
  • Permanent marker and
  • 2 colors (21 of each color) of disposable plastic plates

Step 2: Trace plates 7 across and 6 down on bed sheet or butcher paper

Step 3: Place velcro strips in middle of circles on the bed sheet

Step 4: Place velcro strips on the back of and in the middle of the disposable plates

Step 5: Play! Here are the rules for Connect 4

3. Scrabble:


Floor scrabble for activity tolerance and standing tolerance activity

Idea shared by Cori via Pinterest

This may be a little more involved, but after  it is set up, it would be a great activity to not only work on activity tolerance, but standing tolerance, visual scanning, adaptive equipment use, etc.

Step 1: Gather supplies including:

Step 2: Measure out and create 10x10 squares on the poster board

Step 3: Place "free" spaces on the board, laminate

Step 4: Put letters on each colored paper, laminate

Step 5: Play! Instructions here for rules

4. Checkers:


Working on activity tolerance in OT? Check out these 5 ideas | SeniorsFlourish.com

Lawn game checkers via jessiedaye.com/diy

Step 1: Gather supplies including:

  • Bed sheet or large astroturf rug
  • Paint
  • Red and black plastic plates (12 of each color)

Step 2: Paint 64 checker squares on the bed sheet or rug

Step 3: Play! Instructions here for rules

5. Tic Tac Toe:


Giant tic tac toe game (and 24 other great ideas!) to work on tolerance for activities in OT | SeniorsFlourish.com

Giant tic tac toe game (and 24 other great ideas!) to work on tolerance for activities in OT. Pic via livingwellspendingless.com

Step 1: Gather supplies including:

  • 2 poster boards or check out LivingWell.com's floor tic tac toe game with a drop cloth and bean bags)
  • Painters tape
  • Velcro strips with sticky back
  • 3 black and 3 red plastic plates

Step 2: Tape the poster boards together, laminate

Step 3: Measure out and create 3x3 squares (6 total)

Step 4: Stick velcro piece to the middle of each square on the board

Step 5: Stick velcro piece to the middle and the back of the plastic plates

Step 6: Play! Instructions here for rules

Looking for 20 More Standing and Activity Tolerance Activities?

Hidden Content

Looking for more fun and occupation based activities to do with your patients? Be sure to check out:

Treatment Ideas for Men 

Occupation Based Kits

I'd love to hear what you would add to the list! Share and comment below!

Comments 29

  1. Task for FM/GM coordination, standing balance & tolerance, AROM to multiple planes, strengthening of BUE’s and digits, weight shifting: Take 4-6 large towels and leave to one side of patient at same or varying heights unfolded in a pile. On other side of table have a chair or small table (or laundry basket) at height you want. Also, have a small container of rubber bands where they have to reach to get. Take one towel at a time and spread out on the table with length horizontally. Fold towel in half and half again the long way. Once folded, you can either have them tightly roll the towel, either from left to right crossing mid-line (or if working on forward flexion of trunk in preparation for ADL’s or transfers) until rolled up. Then take two rubber bands (great way to grade activity here by thickness or length of rubber bands) and place one around each end and place in basket. This can be done in sitting or standing and with or without weighted wrist weights. Patient’s, including men have enjoyed this activity with me.

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  2. Pingback: Occupational Therapy Treatment Ideas for Men | Seniors Flourish

  3. I like to play blackjack and have them gamble with it. I usually put 2 decks together and give them 10 chips to start with. For consistency, I’ll go through the deck twice to see how many chips they have left. (Have to have at least one chip per round, however they can gamble more..double down, etc) My biggest winner has ended with 74 chips… to give them a goal. The male patients seem to especially enjoy this and will be surprised to see how long they stand.

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  4. Tic tax toe on large floor grid. Use teachers to carry colored socks say…green socks for x’s and red socks for “o’s“. Grade with smaller or larger objects or clothing.

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  5. Mandy I love to do silk flower arranging with my ladies. Recently brought in a woven basket with handle, multiple colors of crocus, a small birds nest with little eggs, a fluffy fern and twig bird. Worked with 5 women today with this task and wound up with 5 very different arrangements. They loved the activity and stand longer than other standing activities. It can easily be graded for sitting and various deficits, with or without wrist weights, etc… Have even done this with flowers donated following funerals. Different colors, textures and shapes. Really awakens the senses. Even great for Dementia patients.

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      Thanks for sharing Debbie! I love flower arranging too. Great idea about the donated flowers – I have had some donated from grocery store floral areas as well. I think anything that is meaningful and creative is always a hit!

  6. I had a large US map laminated and hung on the wall. We use wipe off markers to make highway/ interstate routes for faux trips planned ahead. Men especially love the map and like reminiscing about past travels. I also picked up some smaller maps at AAA Travel to use for cognitive and seated activities, even homework on the weekends. Ie: travel route from Boise to Lawerence Ks, hotels, places to eat etc. it’s really functional and fun.

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  7. hanging clothes in closet/clothesline , match colors/numbers with a deck of cards, sorting silverware, matching pairs from memory card game, sorting socks

  8. I have patients perform Folding linens while standing at the table or folding clothes and placing in a laundry basket.

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  9. I’ve tried placing shaving cream in a mirror and have the patient clean it off. Or treasure hunt locating and reaching for items on shelf or around the room.

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  10. Almost everyone has to rinse a few dishes every day. A lot of my patients enjoy rinsing and drying plates, glasses and cups. They can put them away for an extra challenge. For my folks who are particularly weak, I help them stand at the sink and wash their hands.

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  11. I like to play tic-tac-toe using window markers while standing at a window or mirror. I’ve also done “who can draw the funniest face” and pictionary! Fun and makes the time fly by before they know it.

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      I think pictionary would be particularly fun… I can see a lot of laughs along the way 🙂 Thanks for sharing Alison

  12. I work in home care and have created a take-off on the card match game. It’s on a large hanging fabric/felt board attached to a long dowel and string. I use an over-door hook to hang it up in the client’s home. It’s easy to roll up and transport. I also made a felt dart board for it to use with ping pong balls wrapped with velcro (haven’t tried that yet). I had hopes of making other games to use with it, and now I have some more ideas. Thanks!

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  13. Faux Stain glass craft. I purchased mine from Oriental Trading or S&S Worldwide. The patients squeeze (hand strengthening) liquid into the compartments while standing (activity tolerance/strengthening/static standing balance) at a table.

    Oatmeal at the microwave. I also purchase sugar free banana pudding and the mini graham cracker pie shells. The patients measure out the milk and whisk the pudding. Pour it evenly into the 6 mini pie shells. Slice banana and place a few slices on each pie & enjoy! You could use chocolate sugar free pudding with dream whip cream.
    Measuring, mixing, clean up and nutritional discussion all while standing and/or working on work simplification/energy conservation techniques.
    I usually discuss using appliances such as crock pot, slow cooker, microwave, toaster oven or joint protection if appropriate/relevant.

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      I am on board with you – finding client centered activities that are both purposeful and FUN are great!

  14. My patients really like playing Kings in the Corner – 2 person solitare game. It is simple to learn and repetitive.

  15. My favorite standing tolerance activity in the SNF is straightening the closet. In home care, it can cleaning out a kitchen cabinets or a linen closet

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