Шаблоны LeoTheme для Joomla.
GavickPro Joomla шаблоны

banner physiotherapy


Use of Ratings of Perceived Exertion in Rehabilitation Services: Past and Present Researches

Jérémy Coquart1*, Roger Eston1
1Université de Rouen, Faculté des Sciences du Sport, EA 3832, Centre d›Etudes des Transformations des Activités Physiques et Sportives, Rouen, France.
2Sansom Institute for Health Research, School of Health Sciences, University of South Australia, Adelaide, Australia.

*Corresponding author:  Dr. Jérémy B.J. Coquart, Faculté des Sciences du Sport et de l’Education Physique, CETAPS, boulevard Siegfried,76821 Mont Saint Aignan Cedex, France, Tel: +33(0)232107797;
Fax: +33(0)232107793; E-mail: jeremy.coquart@voila.fr

Submitted04-28-2015 Accepted: 05-04-2015 Published: 06-02-2015

Download PDF





The concept of effort perception, introduced in the late 50’s from scales measuring local fatigue or breathlessness [1] is an area of extensive research and has been applied in numerous sporting, pedagogical, ergonomic and clinical applications [2]. Generally, effort perception can be defined as the intensity of subjective effort, stress, discomfort and fatigue that is felt during physical exercise [3]. It involves the collective integration of afferent feedback from physiological stimuli (e.g., heart rate: HR, oxygen uptake: VO2, ventilation, muscular acidosis, blood glucose, body temperature) and feed-forward mechanisms to enable an individual to evaluate how hard or easy an exercise task feels at any point in time [4]. However, although physiological stimuli dominate the perceptual process, the latter is moderated by situational (e.g., knowledge of the exercise end point) [5-8](and dispositional (e.g., cognitive style) psychological factors [9-12]. Consequently, effort perception is considered as a complex psychophysiological variable. To quantify effort perception, a number of scales have been developed and validated [13-18]. However, Borg’s Ratings of Perceived Exertion (RPE) Scale (1970) [4] has always been and remains the most commonly used scale in adults [8, 19- 23]. The RPE scale is frequently administered in hospital and healthcare centers during graded exercise tests (GXT) and rehabilitation programs in order to optimize patients’ care management [24]. The RPE scale is an easy tool to use. It is valid, reliable and sensitive during various exercise modalities and in various clinical populations. Indeed, the information  delivered by the RPE scale can facilitate design and management of each step of a patient’s rehabilitation program.

The RPE scale has been applied in a clinical context for over 50 years to evaluate the progression of a GXT [2-3]. Indeed, the higher the RPE, the closer the individual is to voluntary exhaustion. For example, a patient with chronic obstructive pulmonary disease (COPD) reporting RPE15 (effort considered as ‘hard’, equating to an exercise intensity of 85% of maximal aerobic capacity) during a GXT is closer to voluntary exhaustion than RPE13 (effort considered as ‘somewhat hard’, equating to 74% of maximal aerobic capacity) [25]. Consequently, the RPE score is considered as an indicator of exercise intensity and duration, independently of disease.

In a similar manner, in some clinical populations such as cardiac patients, it has been proposed that RPE between 15 and 17 during GXT, often implies cessation of the test at the next stage [2-3]. Consequently, from this information it is possible to anticipate the GXT end-point in cardiac patients. However, the identification of an accurate RPE score at the penultimate stage of a GXT remains to be determined, and is probably dependent on age, pathology and severity of the disease.

Similarly, a maximal RPE (i.e., close or equal to the theoretically maximal RPE: RPE20) provides additional confirmation of voluntary exhaustion during a GXT, as in the case of some physiological variables (e.g., high respiratory exchange ratio or HR close to the theoretical maximal HR). However, RPE20 seems be rarely reported at maximal exercise, especially in older individuals and patients [25-27]. Consequently, further studies are needed.

The linear relationship between HR and indicators of exercise intensity (e.g., power output, velocity or VO2) obtained during a GXT is frequently used to compare the cardiorespiratory fitness in patients. However, this relationship cannot be applied as effectively in patients on beta blockers because the pharmacological actions of these drugs alters HR and hemodynamic response to exercise [2]. In this case, the use of RPE is especially relevant as it is not significantly affected by these drugs as the relationship between absolute and relative exercise intensity (expressed as percentage of maximal intensity) and RPE is sustained [28]. Therefore, for the same absolute exercise intensity, the cardiac patient with the lower RPE (rather than HR) is the one that has the better physical fitness.

Use of the relationship between RPE and VO2 obtained during GXT has been recommended to predict maximal oxygen uptake ( VO2max) in paraplegic individuals [29-30], obese individuals [31], patients with type 2 diabetes [32] and patients with COPD [25]. In these studies, the linear relationship between RPE and VO2 is extrapolated to the VO2max, which often coincides with the theoretical maximal RPE (i.e., RPE20). However, to improve the accuracy of predictions, authors have recently proposed the use of a ‘perceptually regulated exercise test’ (PRET), rather than traditional GXT [33]. The PRET involves asking the patient to self-regulate and maintain a series of submaximal exercise intensities corresponding to some pre-set overall RPE levels (e.g., RPE9, RPE11, RPE13, and usually RPE15). In other words, during each stage of PRET, the individual must produce and maintain an exercise intensity corresponding to clamped RPE level according to sensations emanating from the whole body. Therefore, PRET requires focusing very strongly on internal signals, which is supposed to improve the relationship between RPE and VO2, thus leading to a more accurate prediction of VO2 max from the extrapolation of this relationship [34]. However, further studies are needed.

Similarly, due to the cost and availability of gas analysis, the power output elicited at specific RPEs during submaximal GXT can be used to predict some physiological variables [31,35]. For example, Coquart et al. [31] predicted VO2max from an equation including age and power output developed at RPE15 (i.e., effort considered as ‘hard’) in obese women. Estimation rather than measurement of actual VO2max is particularly relevant in clinical populations due to possible adverse events during a maximal GXT (e.g., arrhythmia, myocardial infarction or even death). To date, predictive equations using anthropometric variables and power output have been proposed at given  RPEs in healthy and obese individuals. Other specific equations should be developed according to disease.

It has long been known that the RPE alone may be used prescribe a personalized exercise intensity in healthy adults [36- 38]. Research is needed to assess the use of RPE-regulated exercise prescription in cardiac patients. Research has also shown that children are capable of using perceived exertion to regulate exercise intensity during cycling [39-40], although the prescriptive validity of RPE was not confirmed during walking/ running in obese children, suggesting an exercise modality effect. Consequently, even though the RPE scale seems a valid tool for the prescription of exercise intensity in the healthy individuals, additional studies should be conducted to clarify the circumstances in which RPE may be used to prescribe exercise intensity in patients.

Recently, on the basis of observations that effort perception may be use to quantify intensity during training session in athletes
[41-43] compared the use of Foster et al.’s [44] session RPE method (product of exercise duration in minutes by RPE score) to a HR method in men with post-infarction heart failure. They observed a significant relationship between methods in a continuous and intermittent exercise program, providing further evidence that effort perception may be used to quantify workload during rehabilitation. Again, further research is needed to explore the efficacy of this approach in clinical populations.

The RPE collected during a post intervention GXT may be compared to RPE values at the commencement of rehabilitation to evaluate the impact of the exercise program [2-3]. Indeed, if a decreased RPE score for a given exercise intensity is observed after the rehabilitation program, this provides further confirmation that the patient has improved his or her physical fitness.

Finally, further interest in the use of RPE relates to its use in the determination of perceptual preference. The latter corresponds to the lowest RPE score (i.e., the lightest perceived exertion) for a given exercise. For example, Coquart et al. [45] showed that obese women (with and without type 2 diabetes) preferred intermittent rather than continuous exercise. The authors suggested that an intermittent exercise approach could increase compliance to a rehabilitation program, although they failed to confirm these results during walking [14]. Further studies are therefore recommended.

In summary, the use of effort perception is known to have numerous applications in sedentary, healthy and athletic individuals. Fewer studies have confirmed the validity of RPE applications in clinical populations. Further research is needed in this area before the use of RPE can be routinely applied in rehabilitation programs.


COPD: Chronic Obstructive Pulmonary Disease
GXT: Graded Exercise Test
HR: Heart Rate
PRET: Perceptually Regulated Exercise Test
RPE: Ratings of Perceived Exertion
VO2: Oxygen Uptake
VO2max: Maximal Oxygen Uptake



1.Borg GA. Borg’s Perceived exertion and pain scales. Champaign, IL: Human Kinetics; 1998

2.Robertson RJ, Noble BJ. Perception of physical exertion: methods, mediators, and applications. Exerc Sport Sci Rev. 1997, 25: 407-452.

3.Noble BJ, Robertson RJ. Perceived exertion. Champaign, IL: Human Kinetics; 1996.

4.Eston RG. Use of ratings of perceived exertion in sports. Int J Sports Physiol Perform. 2012, 7 (2):175-182.

5.Coquart JB, Garcin M. Knowledge of the endpoint: effect on perceptual values. Int J Sports Med. 2008, 29(12): 976- 979.

6.Coquart JB, Raul P, Garcin M. Influence of instructions on perceptually-based ratings. Int J Sports Med. 2008, 29 (2):151-157.

7.Coquart JB, Stevenson A, Garcin M. Causal influences of expected running lenght on ratings of perceived exertion and estimation time limit scales. Inter J Sport Psychol. 2011, 42 (2):149-166.

8.Eston R, Stansfield R, Westoby P, Parfitt G. Effect of deception and expected exercise duration on psychological and physiological variables during treadmill running and cycling. Psychophysiology. 2012, 49 (4):462-469.

9.Morgan WP. Psychological factors influencing perceived exertion. Med Sci Sports 1973, 5 (2):97-103.

10.Morgan WP. Psychological components of effort sense. Med Sci Sports Exerc. 1994, 26 (9):1071-1077.

11.Hall EE, Ekkekakis P, Petruzzello SJ. Is the relationship of RPE to psychological factors intensity-dependent? Med Sci Sports Exerc. 2005, 37 (8):1365-1373.

12.Coquart JB, Dufour Y, Groslambert A, Matran R, Garcin M. Relationships between psychological factors, RPE and time limit estimated by teleoanticipation. The Sport Psychologist. 2012, 26 (3):359-374.

13.Borg GA. Perceived exertion as an indicator of somatic stress. Scand J Rehabil Med. 1970, 2 (2): 92-98.

14.Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982, 14 (5):377-381.

15.Eston RG, Lamb KL, Bain A, Williams AM, Williams JG. Validity of a perceived exertion scale for children: a pilot study. Percept Mot Skills. 1994, 78 (2):691-697.

16.Groslambert A, Hintzy F, Hoffman MD, Dugue B, Rouillon JD. Validation of a rating scale of perceived exertion in young children. Int J Sports Med. 2001, 22 (2):116-119.

17.Robertson RJ. Perceived exertion for practitioners: rating effort with the OMNI picture system. Champaign, USA: Human Kinetics; 2004.

18.Eston RG, Lambrick DM, Rowlands AV. The perceptual response to exercise of progressively increasing intensity in children aged 7-8 years: validation of a pictorial curvilinear ratings of perceived exertion scale. Psychophysiology. 2009, 46 (4):843-851.

19.Mihevic PM. Sensory cues for perceived exertion: a review. Med Sci Sports Exerc. 1981, 13 (3):150-163.

20.Pandolf KB. Advances in the study and application of perceived exertion. Exerc Sport Sci Rev. 1983, 11 :118-158.

21.Watt B, Grove R. Perceived exertion. Antecedents and applications. Sports Med. 1993, 15 (4): 225-241.

22.Robertson RJ. Development of the perceived exertion knowledge base: an interdisciplinary process. Int J Sp Psy. 2001, 32 :189-116.

23.Coquart JB. Perception de l’effort dans l’entraînement et la réhabilitation. Saarbücken, Deutschland: Presses Academiques Francophones; 2013.

24.Coquart JB, Tourny-Chollet C, Lemaitre F, Lemaire C, Grosbois J-M et al. Relevance of the measure of perceived exertion for the rehabilitation of obese patients. Ann Phys Rehabil Med. 2012, 55 (9-10):623-640.

25.Coquart JB, Eston RG, Lemaitre F, Bart F, Tourny C et al.Prediction of peak oxygen uptake from ratings of perceived exertion during a sub-maximal cardiopulmonary exercise test in patients with chronic obstructive pulmonary disease. Eur J Appl Physiol. 2015, 115 (2): 365-372.

26.Ainsworth BE, McMurray RG, Veazey SK. Prediction of peak oxygen uptake from submaximal exercise tests in older men and women. J Aging Phys Activ. 1997, 5 (1): 27-38.

27.Smith AE, Eston RG, Norton B, Parfitt G. A perceptually- regulated exercise test predicts peak oxygen uptake in older active adults. J Aging Phys Act. 2015: 23(2): 205-211.

28.Eston RG, Connolly D. The use of ratings of perceived exertion for exercise prescription in patients receiving beta- blocker therapy. Sports Med. 1996, 21 (3):176-190.

29.Al-Rahamneh HQ, Eston RG. Prediction of peak oxygen consumption from the ratings of perceived exertion during a graded exercise test and ramp exercise test in able-bodied participants and paraplegic persons. Arch Phys Med Rehabil. 2011, 92 (2):277-283.

30.Al-Rahamneh HQ, Eston RG. The validity of predicting peak oxygen uptake from a perceptually guided graded exercise test during arm exercise in paraplegic individuals. Spinal Cord. 2011, 49 (3):430-434.

31.Coquart JB, Eston RG, Grosbois J-M, Lemaire C, Dubart AE et al. Prediction of peak oxygen uptake from age and power output at RPE 15 in obese women. Eur J Appl Physiol. 2010, 110 (3):645-649.

32.Coquart JB, Garcin M, Grosbois J-M, Wibaux F, Dubart A-E, Lemaire C. Estimation de la consommation pic d’oxygène par la perception de l’effort chez des patients obèses et diabétiques de type 2. Obésité. 2011a, 6 (2): 98-104.

33.Eston RG, Lamb KL, Parfitt G, King N. The validity of predicting maximal oxygen uptake from a perceptually-regulated graded exercise test. Eur J Appl Physiol. 2005, 94 (3): 221-227.

34.Coquart JB, Eston R, Nycz M, Grosbois J-M, Garcin M. Estimation of maximal oxygen uptake from ratings of perceived exertion elicited during sub-maximal tests in competitive cyclists. Arch Sci Med. 2012, 171 (2):165-72.

35.Okura T, Tanaka K. A unique method for predicting cardiorespiratory fitness using rating of perceived exertion. J Physiol Anthropol Appl Human Sci. 2001, 20 (5):255-261.

36.Smutok MA, Skrinar GS, Pandolf KB. Exercise intensity: subjective regulation by perceived exertion. Arch Phys Med Rehabil. 1980, 61(12): 569-574.

37.Eston RG, Davies BL, Williams JG. Use of perceived effort ratings to control exercise intensity in young healthy adults. Eur J Appl Physiol Occup Physiol. 1987, 56 (2):222- 224.

38.Parfitt G, Evans H, Eston R. Perceptually regulated training at RPE13 is pleasant and improves physical health. Med Sci Sports Exerc. 2012, 44 (8):1613-1618.

39.Ward DS, Bar-Or O. Use of the Borg scale in exercise prescription for overweight youth. Can J Sport Sci. 1990, 15 (2):120-125.

40.Eston RG, Parfitt G, Campbell L, Lamb KL. Reliability of effort perception for regulating exercise intensity in children using the cart and load effort rating (CALER) scale. Pediatr Exerc Sci. 2000, 12(4) 388-397.

41.Haddad M, Chaouachi A, Castagna C, Hue O, Wong DP et al. Validity and psychometric evaluation of the French version of RPE scale in young fit males when monitoring training loads. Sci & Sports 2013, 28 (2): 29-35.

42.Tabben M, Sioud R, Haddad M, Franchini E, Chaouachi A et al. Physiological and perceived exertion responses during international karate kumite competition. Asian J Sports Med 2013, 4 (4):263-271.

43.Iellamo F, Manzi V, Caminiti G, Vitale C, Massaro M et al. Validation of rate of perceived exertion-based exercise training in patients with heart failure: insights from autonomic nervous system adaptations. Int J Cardiol. 2014, 176 (2):394-398.

44.Foster C, Florhaug JA, Franklin J, Gottschall L, Hrovatin LA et al. A new approach to monitoring exercise training. J Strength Cond Res. 2001, 15 (1):109-115.

45.Coquart JB, Lemaire C, Dubart A-E, Luttembacher D-P, Douillard C et al. Intermittent versus continuous exercise: effects of perceptually lower exercise in obese women. Med Sci Sports Exerc. 2008, 40 (8):1546-1553.

Cite this article: Coquart J. Use of Ratings of Perceived Exertion in Rehabilitation Services:Past and Present Researches. J J Physiother Exercise. 2015, 1(1): 003.


Contact Us:
TRAIL # 150 W
E-mail : info@jacobspublishers.com
Phone : 512-400-0398