Energy Index Scale
Name
DATE:
| 0. | Bed-ridden, up to bathroom only |
| 1. | Out of bed 30 – 60 minutes a day (sitting in chair is out of bed) |
| 2. | Out of bed sitting, standing, walking 1 – 2 hours per day |
| 3. | Out of bed sitting, standing, walking 2 – 4 hours per day |
| 4. | Out of bed sitting, standing, walking 4 – 6 hours per day |
| 5. | Perform with difficulty sedentary job 40 hours a week, daily naps |
| 6. | Daily naps in bed, may maintain a 40 hour sedentary work week plus light, limited housekeeping and/or social activities |
| 7. | No naps in bed. Up 7:00 a.m. to 9:00p.m. Able to work a sedentary job plus light housekeeping |
| 8. | Full sedentary workweek, no naps, some social activities plus light exercise |
| 9. | Same as 8 above plus exercise approximately 1/2 to 2/3 normal without excessive fatigue, awakens next morning refreshed |
| 10. | Normal |