When someone is off work due to injury or illness, it is easy for the structure of the working day to disappear. Wake-up times become less consistent, meals are pushed around, exercise can become an afterthought and daytime naps can creep in.
While this may seem like a natural response to having more flexibility, there is an important reason to encourage routine during rehabilitation: our bodies function best when they have a rhythm to follow.
Your body has its own 24-hour rhythm
Our circadian rhythm is an internal biological clock that helps coordinate many of the body’s processes across roughly a 24-hour cycle. It influences when we feel sleepy or alert, when we are hungry, how we digest food, our body temperature, metabolism and the release of hormones such as cortisol and melatonin.
This internal clock is strongly influenced by environmental cues, particularly light and darkness.
In the morning, exposure to natural light helps signal to the brain that the day has started. This helps suppress melatonin, the hormone associated with sleepiness, and supports alertness. Later in the evening, as light levels decrease, melatonin naturally begins to rise, helping prepare the body for sleep. This is one reason why getting outside into natural light in the morning can be helpful for maintaining a healthy sleep-wake cycle.
But the circadian system does more than regulate sleep.
Your body changes throughout the day
Hormones and other physiological processes follow predictable daily patterns.
Cortisol, for example, generally rises in the early morning, helping promote alertness and energy for the day before gradually declining towards the evening.
Melatonin typically remains low during daylight hours and increases in the evening, supporting the transition towards sleep.
Body temperature also follows a daily rhythm. It tends to be lower during the night and rises throughout the day, with body temperature generally reaching its peak in the afternoon or early evening.
Even digestion and metabolism are influenced by the time of day. Our bodies are generally better prepared to process food during the active part of the day, while eating very late at night is advised against, due to several metabolic processes that are naturally winding down.
These rhythms are not rigid schedules, but they demonstrate an important principle: our physiology is designed to anticipate and adapt to regular patterns.
Routine gives the body useful signals
This is where routine becomes particularly relevant during rehabilitation.
Consistent sleep and wake times provide a strong signal to the body about when the day starts and ends. Where possible, minimising long or irregular daytime naps can also help preserve sleep pressure for the night.
Similarly, eating meals at relatively consistent times provides predictable signals to the body’s metabolic systems. It also means that people are less likely to rely on convenience foods or grazing throughout the day.
Exercise can provide another useful anchor.
Rather than leaving exercise until “when there is time”, scheduling sessions into the calendar at a consistent day and time can help make physical activity part of the person’s normal routine. For some people, exercising in the morning can be particularly useful because it creates an early, predictable event around which the rest of the day can be structured.
Is there a “best” time to exercise?
There is ongoing research into whether exercise produces different benefits depending on the time of day. Some studies suggest that factors such as body temperature, hormonal patterns and exercise performance vary throughout the day, and there may be differences in how the body responds to exercise in the morning compared with the afternoon or evening.
However, these effects are relatively nuanced, and there is no universal “best” time to exercise for everyone.
For rehabilitation, a more practical question may be: “When is exercise most likely to actually happen?”
A theoretically optimal exercise time is of little value if it does not fit someone’s lifestyle or they consistently miss the session. A regular exercise session that someone can realistically maintain is likely to be far more valuable than an inconsistent attempt to exercise at a ‘supposedly’ optimal time.
Putting it into practise in occupational rehabilitation
In occupational rehabilitation, we often see people lose the structure that work previously provided. Picture this:
Simon was forced to stop working due to debilitating anxiety and low mood.
Without the routine of getting up for work each morning, his days gradually became less structured. He was sleeping at inconsistent times, napping during the day, spending more time at home and was finding it difficult to maintain regular exercise and meals. What had previously been automatic parts of his day had become things he had to consciously think about – and often, they simply weren’t happening.
With the introduction of Exercise Physiology, the initial focus wasn’t on completely transforming Simon’s lifestyle. Instead, it was about reintroducing structure through small, achievable and consistent behaviours.
Simon started by getting up at the same time each morning, regardless of whether he had anything planned for the day. Over time, this helped establish a more predictable sleep-wake pattern. With a consistent start to the day, an exercise session was then scheduled at the same time each morning.
As exercise became part of his routine, other behaviours began to follow. He was more motivated to prepare proper meals to fuel his body, rather than relying on convenience foods or skipping meals. He was more active during the day and, as his routine became more consistent, his sleep also became more settled.
One change began to make the next change easier.
This is the potential snowball effect of routine. We don’t necessarily need to change everything at once. Establishing one or two consistent anchors can provide the foundation for other healthy behaviours to develop around them.
Supporting Routines in RTW
Supporting someone to rebuild a consistent daily routine can be an important part of rehabilitation. It is not simply about being more organised. It is about giving the body regular cues that support the biological systems already working to a 24-hour rhythm.
For referrers, this can be a valuable consideration when developing rehabilitation goals that support the transition back towards the routines and demands of work.
Sometimes, helping the body get back into a routine starts with helping the person get their routine back.
