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  1. Shea, Meredith G. PhD
  2. Headley, Samuel PhD
  3. Mullin, Elizabeth M. PhD
  4. Brawner, Clinton A. PhD
  5. Schilling, Patrick BS
  6. Pack, Quinn R. MD, MSc


Purpose: Although ratings of perceived exertion (RPE) are widely used to guide exercise intensity in cardiac rehabilitation (CR), it is unclear whether target heart rate ranges (THRRs) can be implemented in CR programs that predominantly use RPE and what impact this has on changes in exercise capacity.


Methods: We conducted a three-group pilot randomized control trial (#NCT03925493) comparing RPE of 3-4 on the 10-point modified Borg scale, 60-80% of heart rate reserve (HRR) with heart rate (HR) monitored by telemetry, or 60-80% of HRR with a personal HR monitor (HRM) for high-fidelity adherence to THRR. Primary outcomes were protocol fidelity and feasibility. Secondary outcomes included exercise HR, RPE, and changes in functional exercise capacity.


Results: Of 48 participants randomized, four patients dropped out, 20 stopped prematurely (COVID-19 pandemic), and 24 completed the protocol. Adherence to THRR was high regardless of HRM, and patients attended a median (IQR) of 33 (23, 36) sessions with no difference between groups. After randomization, HR increased by 1 +/- 6, 6 +/- 5, and 10 +/- 9 bpm (P = .02); RPE (average score 3.0 +/- 0.05) was unchanged, and functional exercise capacity increased by 1.0 +/- 1.0, 1.9 +/- 1.5, 2.0 +/- 1.3 workload METs (effect size between groups, [eta]p2= 0.11, P = .20) for the RPE, THRR, and THRR + HRM groups, respectively.


Conclusions: We successfully implemented THRR in an all-RPE CR program without needing an HRM. Patients randomized to THRR had higher exercise HR but similar RPE ratings. The THRR may be preferable to RPE in CR populations for cardiorespiratory fitness gains, but this needs confirmation in an adequately powered trial.