RPE modes

The three modes of using RPE are: estimation, production and preferred exertion modes. Until 1980, studies evaluating the effectiveness of perceived exertion solely focused on RPE as a dependent response variable, described as estimation mode.

The first published report of RPE being used to actively control intensity, as the independent variable, known as production mode, was that of Smutok, et al. (1980). In this study they first assessed participants with a standardised graded exercise treadmill test, where speed was the independent variable and HR and RPE were dependent variables. In two subsequent tests they then asked participants to control treadmill speed from a target RPE that was previously related to a given percentage of maximal HR. A comparison was thus made between HR and treadmill speeds for a given RPE in estimation mode and production mode. RPE was found to reliably elicit the same HR and treadmill speed under production mode compared to the initial estimation mode, but only when the intensity was greater than 80% of maximal HR. This study therefore questioned the validity of RPE to regulate exercise intensity at lower intensities, which are those typically used in clinical populations such as cardiac patients.

Subsequently, Noble (1982) raised concern that the relationship between physiological strain and perceived exertion was altered depending on the mode in which RPE was used. Byrne and Eston (1998) and Whaley, et al. (1997) also reported mismatches in the heart rate-RPE relationship in estimation versus production mode protocols in their study involving cardiac patients. This provides a starting point for considering how RPE is taught to patients in order to improve the validity of RPE to represent a given safe and effective physiological strain.

Estimation mode, as stated above, is where RPE is a dependent variable to a given workload. For example, during testing, where the intensity or work rate (e.g. treadmill speed, cycle load or stepping rate) is predetermined and patients are asked to rate on the RPE scale how hard they feel they are working. Another example during an exercise session is where the exercise practitioner specifically dictates the intensity at which the patients exercise and then asks the patients to rate their level of exertion. To assess whether you are asking the patient to use RPE in estimation mode, the following example statement is helpful: I am now going to increase the pace or speed at which you are exercising and then I would like you to rate on the scale how hard an effort you are making.'

Production mode is where RPE is the independent variable. In this case the patient is asked to take command of regulating the exercise intensity (workload) to elicit a predetermined RPE. This can be more difficult during a circuit or exercise to music-type session. This is a scenario where, when there are no machine dials or monitors, it can become more difficult for the exercise leader to exact control over the individual patient's exercise intensity. Other chapters in this text cover the art of good instruction and teaching to ensure the patient is working to the correct intensity. To know if you are asking the patient to use RPE in production mode, the following example statement is helpful: I would now like you to increase the pace or speed at which you are working, so that you work to an RPE of 12 (an effort of between light and somewhat hard).'

In comparing the instructions above for estimation and production mode, respectively, notice the words used in bold above, I am now going to ... and I would like you to ...'. Furthermore, production mode RPE is when you give instructions to work to a specified RPE. These subtle differences in instructions can make an important distinction about who has the responsibility for controlling the exercise intensity; is it you the practitioner, or is it the patient?

The use of RPE in estimation or production mode should be dependent on where the patient is within the rehabilitation process. Are your patients psychologically and physiologically skilled with their exercise and perceptions of effort to use production mode? These are factors the practitioner needs to assess at each exercise session.

Preferred exertion is where the patients work to an RPE level they prefer. For unconfident or inexperienced anxious patients, this could be at a low rating because of the fear associated with causing an exertion-related cardiac event. In the early stages of rehabilitation this provides patients with some input and gives them some control over their exercise intensity. It has been demonstrated that individuals who have not been active feel more positive about their exercise when working at a moderate compared to a higher intensity (Parfitt and Eston, 1995; Parfitt, et al., 2000). Once it is recognised that the patient has gained confidence, the exercise leader can encourage them to work to higher levels of effort. This fits with the physiological progressions discussed earlier in the section on monitoring HR. When patients are happy working at the appropriate RPE in estimation mode, they can be moved towards using RPE in production mode. The use of RPE in this way ties in well with the important aspect of helping patients attain a sense of mastery, which is beneficial to their mental well-being (Soenstroem, 1984; Stephens, 1988; Buckley, 2003).

How To Keep Your Treadmill Running

How To Keep Your Treadmill Running

Buying a treadmill is hard enough. Choosing the best out of many treadmills in the market is nigh impossible. But once youve got the treadmill youve always wanted, are your worries truly over? Well, they certainly are, but only if you maintain your treadmill properly.

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