Comparison of Ratings of Perceived Exertion and Target Heart Rate–Based Exercise Prescription in Cardiac Rehabilitation: A RANDOMIZED CONTROLLED PILOT STUDY. Issue 5 (31st March 2022)

• Record Type: Journal Article
• Authors: Shea, Meredith G.; Headley, Samuel; Mullin, Elizabeth M.; Brawner, Clinton A.; Schilling, Patrick; Pack, Quinn R.
• Is Part Of: Journal of cardiopulmonary rehabilitation and prevention. Volume 42:Issue 5(2022)
• Page Start: 352
• Page End: 358
• Publication Date: 2022-03-31
• Subjects: cardiac rehabilitation -- METs -- ratings of perceived exertion -- stress test target heart rate; Cardiopulmonary system -- Diseases -- Patients -- Rehabilitation -- Periodicals; Cardiopulmonary system -- Diseases -- Prevention -- Periodicals; 616.103
• DOI: 10.1097/HCR.0000000000000682
• Languages: English
• ISSNs: 1932-7501

Abstract

Abstract : Both target heart rate ranges (THRR) and ratings of perceived exertion (RPE)-based exercise prescriptions are widely used in cardiac rehabilitation (CR), but it is unclear whether one method leads to better outcomes in CR. We found that patients randomized to THRR had higher exercise HR but similar RPE ratings. It appears THRR is preferable to RPE in CR populations for fitness gains. Abstract : 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, η p 2 = 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.