Summary Of Key Points For The Effective Use Of

The following points include the key instruction statements recommended by Maresh and Noble (1984).

1. Make sure the patient understands what an RPE is. Before using the scale see if they can grasp the concept of sensing the exercise responses (breathing, muscle movement/strain, joint movement/speed).

2. Anchor the perceptual range, which includes relating to the fact that no exertion at all is sitting still, and maximal exertion is a theoretical concept of pushing the body to its absolute physical limits. Patients should then be exposed to differing levels of exercise intensity (as in an incremental test or during an exercise session) so as to understand what the various levels on the scale feel like. Just giving them one or two points on the scale to aim for will probably result in a great deal of variability.

3. Use the above points to explain the nature of the scale and explain that the patient should consider both the verbal descriptor and the numerical value. Many practitioners simply state, 'choose a number'. That is the last thing they should do. They should first concentrate on the sensations arising from the activity, look at the scale to see which verbal descriptor relates to the effort they are experiencing and then link it to the numerical value.

4. Make sure the patient is not just concentrating on singular sensations, known as differentiated ratings (see Figure 3.7). For aerobic exercise they should pool all sensations to give one rating. If there is an overriding sensation, note the differentiated rating for this. Differentiated ratings can be used during muscular strength activity or where exercise is limited more by breathlessness or leg pain, and not cardiac limitations, as in the case pulmonary or peripheral vascular disease, respectively.

5. Confirm that there is no right or wrong answer: it is what the patient perceives. There are three important cases where the patient may give an incorrect rating:

a. When the patient already has a preconceived idea about what exertion level is elicited by a specific activity (Borg, 1998). He/she is not aware that what is required is to rate the amount of effort at this very moment, not what they think a typical level of exertion is for that activity.

b. When patients are asked to recall the exercise and give a rating. Similar to heart rate, RPEs should be taken while the patient is actually engaged in the movements, not after they have finished or in the break between stations.

c. Simply pleasing the exercise practitioner by stating what should be the appropriate level is a regular observation in the author's experience. This is typically the case when patients are told ahead of time (e.g. in education sessions or during the warm-up) to what RPE level they should work. In the early stages of rehabilitation, the patient's exercise intensity should be set by HR or workrate (e.g. in METs), and patients need to learn to match their RPE reliably to this level in estimation mode. Once it has been established that the patient's rating concurs with the target heart rate or MET level reliably, moving them on to production mode can be considered.

6. Keep RPE scales in full view at all times (e.g. on each machine or circuit station) and keep reminding patients throughout their exercise session to think about what sort of sensations they have while making their judgement rating. It is known that endurance athletes in a race situation work very hard mentally to concentrate (cognitively associate) on their sensations in order to regulate their pace effectively (Morgan, 2000).

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