Rate perceived exertion (RPE) is a measure of an individual's physical activity intensity level (Centers for Disease Control and Prevention, 2017). Although RPE is a subjective exertion rating when compared with its more objective counterpart, heart rate (HR), it provides a good estimate of HR during physical activity (Borg, 1998). There are individuals under the care of home care therapists for which the use of RPE measures may be appropriate when monitoring and prescribing exercise intensity. For example, it may be advantageous to use an RPE scale for patients with a diagnosis that requires medications that blunt the HR response to exertion, such as with congestive heart failure or hypertension. Additionally, patients with diagnoses for which the autonomic nervous system has been disrupted, such as orthotopic heart transplantation, may benefit from the use of RPE measures.
The Borg RPE 15 grade scale (6-20) and the Borg CR10 grade scale (0-10) both measure somatic symptoms and require patients to self-rate how hard their body is working. The Borg RPE 15 grade scale is the original categorical scale estimating feelings of physical stress, effort, and fatigue during exertion; whereas, the Borg CR10 is a category-ratio intensity scale used to measure both exertion and pain (Borg, 1998). A unique feature of the Borg RPE 15 grade scale is its high correlation between a reported RPE times 10 and an individual's HR during physical activity (Borg). Although precise HR estimations vary depending on age and physical condition, the RPE measure does provide therapists a reference point during exercise training. For the purposes of establishing an exercise prescription, a value of 12-14 on the Borg RPE 15 grade scale suggests a moderate intensity and corresponds to 60% of an HR range; whereas, a value of 16 corresponds to 85% of a HR range (Hillegass, 2011).
A visual display of either scale is beneficial to improve the reliability of the self-reported exertion measure. As the ratings between the two scales are not interchangeable, consistent use of only one scale would be prudent. Additionally, use of a visual display may limit patient ambiguity in self-scoring exertion when considering the commonly used 0-10 pain rating scale. Although outpatient therapy clinics may be more apt to utilize posters for visual reference, a home care therapist may find it best to carry paper handouts of the scales for use during intervention and independent home exercise program prescription.
Recent evidence has reported successful use of RPE among populations frequently receiving care from home care therapists. Cleland et al. (2016) reported RPE to be valid and reliably reproduced in individuals with mild-to-moderate multiple sclerosis and suggested it may be useful in exercise prescription of this population. Furthermore, moderate-to-high correlation between RPE, HR, and VO2 has also been reported among older adults (Chung et al., 2015). Home care therapists should consider incorporating either the Borg RPE or the CR10 when prescribing exercise or measuring physical activity intensity as they may be valuable to monitor interventions in patients receiving home care.
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