PURPOSE:To examine the efficacy of an occupational therapy activity pacing intervention with deconditioned older adults in rehabilitation. METHOD:Randomised, single-blind controlled trial of deconditioned older adults admitted for rehabilitation following treatment of an acute medical condition, allocated to intervention [n = 51, males = 14, mean age = 80(8)] or control [n = 49, males = 12, mean age = 81(7)] group. The intervention group received individual and group activity pacing education with practice and application of techniques to daily activities and the home environment, while the control group received a typical occupational therapy program, which included brief activity pacing education. Outcomes included participation in daily living skills, health status (including pain and fatigue symptoms), self-efficacy in daily activities and activity pacing techniques using the Australian Therapy Outcome Measures-Occupational Therapy (AusTOMs-OT), Short Form-36 Health Survey (SF-36), Self-Efficacy Gauge and Activity Pacing Assessment. RESULTS:No differences in groups at admission. Comparison at discharge and three months post discharge using 2 × 2 mixed ANOVA demonstrated small differences in only one scale of the activity limitation domain of the AusTOMs-OT. No significant differences were found in other scales or domains of the AusTOMs-OT, nor secondary outcome measures. CONCLUSION:Activity pacing in addition to typical occupational therapy during inpatient rehabilitation did not demonstrate benefits to participants in the management of their daily activities on returning home post hospitalisation. Implications for rehabilitation Activity pacing has been identified as one of the commonly used occupational therapy interventions utilised with deconditioned older adults in rehabilitation. An activity pacing intervention in conjunction with typical occupational therapy demonstrated no benefits for deconditioned older adults over typical occupational therapy which included basic education on this topic. Continuation of the activity pacing intervention into the outpatient setting may be of benefit to older adults and requires further investigation.