Relationship Between Heart Rate and Perceived Exertion in Neuromuscular Diseases: How do Laboratory-Based Exercise Testing Results Translate to Home-Based Aerobic Training Sessions?
DOI:
https://doi.org/10.2340/jrm.v55.4523Keywords:
Rehabilitation, exercise, physical exertion, physiologic monitoring, exercise test, neuromuscular disease, anaerobic threshold, heart rate, physical therapistsAbstract
Objective: To examine the heart rate-perceived exertion relationship between maximal exercise testing and home-based aerobic training in neuromuscular diseases.
Design: Multicentre randomized controlled trial, intervention group data.
Participants: Individuals with Charcot-Marie-Tooth disease (n = 17), post-polio syndrome (n = 7) or other neuromuscular diseases (n = 6).
Methods: Participants followed a 4-month, homebased aerobic training programme guided by heart rate. Heart rate and ratings of perceived exertion (6–20 Borg Scale) were assessed for each minute during a maximal exercise test, and at the end of each exercise interval and recovery period during training. Heart rate and corresponding ratings of perceived exertion values of individual participants during training were visualized using plots, together with the exercise testing linear regression line between heart rate and ratings of perceived exertion.
Results: High correlation coefficients (i.e. > 0.70) were found between heart rate and ratings of perceived exertion, in all participants during testing (n = 30), and in 57% of the participants during training. Based on the plots the following distribution was found; participants reporting lower (n = 12), similar (n = 10), or higher (n = 8) ratings of perceived exertion values for corresponding heart rates during training compared with testing.
Conclusion: Most participants had a different perception of effort for corresponding heart rates during training in comparison with exercise testing. Healthcare professionals should be aware that this may imply under- and over-training.
LAY ABSTRACT
Aerobic training, also called endurance training, is usually guided by target heart rate ranges based on exercise testing results. It is not known how the perception of effort for the same heart rate during a training programme relates to the perceived effort during exercise testing in people with neuromuscular diseases. This is important information for healthcare professionals. For instance, if patients report a higher perceived effort during training, this may explain their difficulties reaching target heart rate ranges. Maximal exercise testing and training data from 30 individuals with neuromuscular diseases were analysed. Most participants reported lower (10 participants) or higher (8 participants) perceived effort values for similar heart rates during training compared with exercise testing. Healthcare professionals in neuromuscular rehabilitation should be aware that this may indicate too low loads in some individuals and too high loads in others. This requires evaluation in further research.
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References
McDonald CM. Physical activity, health impairments, and disability in neuromuscular disease. Am J Phys Med Rehabil 2002; 81: S108-S120.
https://doi.org/10.1097/00002060-200211001-00012 DOI: https://doi.org/10.1097/00002060-200211001-00012
Phillips M, Flemming N, Tsintzas K. An exploratory study of physical activity and perceived barriers to exercise in ambulant people with neuromuscular disease compared with unaffected controls. Clin Rehabil 2009; 23: 746-755.
https://doi.org/10.1177/0269215509334838 DOI: https://doi.org/10.1177/0269215509334838
Abresch RT, Carter GT, Han JJ, McDonald CM. Exercise in neuromuscular diseases. Phys Med Rehabil Clin 2012; 23: 653-673.
https://doi.org/10.1016/j.pmr.2012.06.001 DOI: https://doi.org/10.1016/j.pmr.2012.06.001
Medicine ACoS. ACSM's clinical exercise physiology. Lippincott Williams & Wilkins; Philadelphia, United States of America, 2019.
Voorn EL, Koopman F, Nollet F, Brehm MA. Aerobic exercise in adult neuromuscular rehabilitation: a survey of healthcare professionals. J Rehabil Med 2019; 51: 518-524.
https://doi.org/10.2340/16501977-2567 DOI: https://doi.org/10.2340/16501977-2567
Al-Rahamneh HQ, Faulkner JA, Byrne C, Eston RG. Relationship between perceived exertion and physiologic markers during arm exercise with able-bodied participants and participants with poliomyelitis. Arch Phys Med Rehabil 2010; 91: 273-277.
https://doi.org/10.1016/j.apmr.2009.10.019 DOI: https://doi.org/10.1016/j.apmr.2009.10.019
Scherr J, Wolfarth B, Christle JW, Pressler A, Wagenpfeil S, Halle M. Associations between Borg's rating of perceived exertion and physiological measures of exercise intensity. Eur J Appl Physiol 2013; 113: 147-155.
https://doi.org/10.1007/s00421-012-2421-x DOI: https://doi.org/10.1007/s00421-012-2421-x
Brubaker PH, jack Rejeski W, Law HC, Pollock WE, Wurst ME, Miller Jr HS. Cardiac patients' perception of work intensity during graded exercise testing: do they generalize to field settings? J Cardiopulm Rehabil Prev 1994; 14: 127-133.
https://doi.org/10.1097/00008483-199403000-00008 DOI: https://doi.org/10.1097/00008483-199403000-00008
Buckley JP, Sim J, Eston RG. Reproducibility of ratings of perceived exertion soon after myocardial infarction: responses in the stress-testing clinic and the rehabilitation gymnasium. Ergonomics 2009; 52: 421-427.
https://doi.org/10.1080/00140130802707691 DOI: https://doi.org/10.1080/00140130802707691
Birk T, Jeffery K, Birk C, Theurer L, Johnson G. Relationship of perceived exertion and heart rate during exercise testing and training in cardiac patients. Med Sci Sports Exerc 1985; 17:199.
https://doi.org/10.1249/00005768-198504000-00085 DOI: https://doi.org/10.1249/00005768-198504000-00085
Gutmann M, Squires R, Pollock M, Foster C, Anholm J. Perceived exertion-heart rate relationship during exercise testing and training in cardiac patients. J Card Rehabil 1981; 1: 52-59.
Carroll JE, Hagberg JM, Brooke MH, Shumate JB. Bicycle ergometry and gas exchange measurements in neuromuscular diseases. Arch Neur 1979; 36: 457-461.
https://doi.org/10.1001/archneur.1979.00500440027003 DOI: https://doi.org/10.1001/archneur.1979.00500440027003
Willén CR, Cider ÅR, Stibrant Sunnerhagen KM. Physical performance in individuals with late effects of polio. Scand J Rehab Med 1999; 31: 244-249.
https://doi.org/10.1080/003655099444425 DOI: https://doi.org/10.1080/003655099444425
Oorschot S, Brehm MA, van Groenestijn AC, Koopman FS, Verhamme C, Eftimov F, et al. Efficacy of a physical activity programme combining individualized aerobic exercise and coaching to improve physical fitness in neuromuscular diseases (I'M FINE): study protocol of a randomized controlled trial. BMC Neur 2020; 20: 1-10.
https://doi.org/10.1186/s12883-020-01725-0 DOI: https://doi.org/10.1186/s12883-020-01725-0
Medicine ACoS. ACSM's guidelines for exercise testing and prescription. Lippincott Williams & Wilkins; Philadelphia, United States of America, 2013.
Borg G. Perceived exertion as an indicator of somatic stress. Scand J Rehabil Med 1970; 2: 92-98.
https://doi.org/10.1037/t58166-000 DOI: https://doi.org/10.1037/t58166-000
Voorn EL, Koopman FS, Nollet F, Brehm M-A. Individualized aerobic exercise in neuromuscular diseases: a pilot study on the feasibility and preliminary effectiveness to improve physical fitness. Phys Ther 2021; 101: pzaa213.
https://doi.org/10.1093/ptj/pzaa213 DOI: https://doi.org/10.1093/ptj/pzaa213
Wasserman K, Hansen JE, Sue DY, Whipp BJ, Froelicher VF. Principles of exercise testing and interpretation. J Cardiopulm Rehabil Prev 1987; 7:189.
https://doi.org/10.1097/00008483-198704000-00014 DOI: https://doi.org/10.1097/00008483-198704000-00014
Asuero AG, Sayago A, Gonzalez A. The correlation coefficient: an overview. Crit Rev Anal Chem 2006; 36: 41-59.
https://doi.org/10.1080/10408340500526766 DOI: https://doi.org/10.1080/10408340500526766
Chen MJ, Fan X, Moe ST. Criterion-related validity of the Borg ratings of perceived exertion scale in healthy individuals: a meta-analysis. J Sports Sci 2002; 20: 873-899.
https://doi.org/10.1080/026404102320761787 DOI: https://doi.org/10.1080/026404102320761787
Green JM, McLester JR, Crews TR, Wickwire PJ, Pritchett RC, Lomax RG. RPE association with lactate and heart rate during high-intensity interval cycling. Med Sci Sports Exerc 2006; 38: 167-172.
https://doi.org/10.1249/01.mss.0000180359.98241.a2 DOI: https://doi.org/10.1249/01.mss.0000180359.98241.a2
Arney BE, Glover R, Fusco A, Cortis C, de Koning JJ, van Erp T, et al. Comparison of rating of perceived exertion scales during incremental and interval exercise. Kinesiology 2019; 51: 150-157.
https://doi.org/10.26582/k.51.2.1 DOI: https://doi.org/10.26582/k.51.2.1
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