Borg Rating Research Articles

STANDARDIZED ADAPTED CARDIAC REHABILITATION AT AN INPATIENT REHABILITATION FACILITY

https://youtu.be/hXlMMThneUU INTRODUCTION Inpatient rehabilitation facilities (IRFs) serve as an interim level of care for many patients with cardiac dysfunction but are not included among the three phases of cardiac rehabilitation (CR). The education on modifiable risk factors, cardiovascular exercise, and flexibility training given to patients with cardiac diseases are delivered in the acute hospital (phase I) and the outpatient setting (phase II). Our hypothesis was that adapting phase II components to this interim setting would improve outcomes and bridge the gap between phases. In this study, the feasibility of a standardized adapted CR protocol for IRFs and effect on functional outcomes was assessed. METHODS This prospective cohort study screened 60 patients over a 6-month period. Patients with primary cardiac diagnoses were screened for inclusion. Both surgical and non-surgical candidates were included. Exclusion criteria were based on the phase II CR criteria of the American College of Sports Medicine (ACSM). Patients received continuous ECG monitoring and physician clearance prior to participation. The standardized adapted CR protocol included individual prescription for cardiopulmonary endurance exercise consistent with ACSM Phase II CR guidelines, flexibility training, and education on modifiable risk factors. Standardized outcome measures included the 6-minute walk test, Borg rating of perceived exertion scale (6-20), EQ-5D-5L quality of life measure, and Section GG (mobility) scores of the Centers for Medicare & Medicaid Services Inpatient Rehabilitation Facility Patient Assessment Instrument. A one-month follow-up evaluated attendance to phase II CR, and quality of life (including maintenance of functional gains). Physical therapy staff were surveyed to identify limitations. RESULTS Forty-one patients were deemed eligible to participate. Thirty-two patients participated in at least one endurance session with an average of 3 (+ 1) 20-minute sessions completed. Borg scores (14 + 1) reached the recommended range (somewhat hard to hard) during sessions. Participants demonstrated a statistically significant improvement in their GG mobility scores. Sixty-nine percent reached the 6-minute walk minimal clinically important difference (MCID), and 59% met the quality-of-life MCID, despite their short length of stay in the IRF setting (11 + 4 days). Survey results indicated short length of stay, the need to address functional goals over exercise, inability to tolerate 20 minutes of cumulative aerobic exercise, and compliance of protocol amongst therapists were limiting factors to endurance protocol adherence. CONCLUSIONS A standardized adapted CR protocol was feasible within an IRF setting, providing targeted education, increased awareness of phase II CR options, and clear and specific guidelines for creation of individualized exercise programs. Patients demonstrated improvements in functional mobility, cardiovascular endurance, and quality of life.

Maximizing phonation: impact of inspiratory muscle strengthening on vocal durations and pitch range

BackgroundThis study investigated the acute effects of inspiratory muscle warm-up (IWU) on vocal performance in singers. Proper vocal and respiratory warm-up can enhance vocal range, quality, and endurance. The aim was to determine whether IWU improves maximum phonation time and pitch range, contributing to better voice production efficiency (vocal efficiency) and reduced fatigue.Materials and methodsSingers were selected from the Samsun State Opera and the Ballet Directorate (n = 16). This cross-sectional study aimed to investigate the acute effects. The singers in the control group (SC = 8) performed only one session of routine voice warm-up, and the experimental group (SE = 8) conducted an inspiratory muscle warm-up (IWU) of 2 sets, 30 times/set at 40% maximal inspiratory pressure (MIP) in addition to routine voice warm-up. Subsequently, All participants were then required to perform pre- and post- pulmonary function tests, maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP), and voice recordings (note high pitch, note low pitch, high pitch durations and low pitch durations sustained with one breath, and maximum phonation duration).ResultsAll pulmonary function and muscle strength parameters improved in the SE group, with the highest increases in MIP (22.9%) and MEP (14.7%). No significant improvements were noted in the SC group (p > 0.05). The Borg Rating of Perceived Exertion showed that the SE group experienced less difficulty with their vocal performance after IWU (-11.6%, p = 0.006), while no significant change was observed in the SC group (p = 0.316). Both warm-up methods used in the study significantly affected the frequencies of high-pitch sounds (SE = 17.8%, SC = 10.9%, p = 0.003); however, the frequency of low-pitch sounds was not significantly affected (p = 0.437). IWU significantly affected the high-pitched note duration (p < 0.001; 32.17%), low-pitched note duration (p < 0.001; 27.11%), and maximum phonation time (p < 0.001; 21%), while routine voice warm-up did not significantly affect any parameter (p > 0.05).ConclusionsThe combination of IWU with the general body and voice warm-up protocol can acutely improve vocal performance in terms of maximum phonation time, phonation times of the highest and lowest pitched sounds in a single breath, and vocal range levels.

The feasibility of virtual reality therapy for upper extremity mobilization during and after intensive care unit admission.

Early mobilization reduces long-term muscle weakness after intensive care unit (ICU) admission, but barriers (e.g., anxiety, lack of motivation) may complicate patients' adherence to exercise. Virtual reality (VR) presents immersive stimuli, which may increase motivation and adherence. This study aimed to examine the feasibility of VR-therapy using a VR-headset during ICU- and subsequent general ward admission. Furthermore, physical parameters before and after training were explored. Ten adult ICU-patients with a median age of 71 [63-79], 70% of male registered birth sex, mechanically ventilated for ≥48h, and willing to participate, were included. VR-therapy was offered three times a week for 20 minutes in addition to standard care. To train upper extremity functionality, patients were instructed to complete puzzles with increasing level of difficulty. Feasibility was based on patient satisfaction, session efficiency, and adherence levels during the training. Fatigue was measured after each session using the Borg Rating of Perceived Exertion Scale. Patients' hand-grip strength and Morton Mobility Index (MMI) were evaluated at the start of VR-therapy and after four weeks of training or at hospital discharge. On average, patients followed three VR-therapy sessions of 20 min per week with 13 min of actual training time, over the course of 1 to 3 weeks depending on their length of stay. Session efficiency ranged from 25% to 93%. In total, patients adhered to 60% of the VR-therapy sessions. MMI scores increased significantly from the start (26 [24-44]) to the end of the VR-therapy training period (57 [41-85], p=0.005), indicating improved balance and mobility. VR-therapy for upper extremity rehabilitation in ICU-patients is feasible during stay in the ICU and general ward.

The Influence of Caffeine on Tolerance to Sport-Specific High-Intensity Exercise in Young Elite Soccer Players.

Modern elite football places extremely high demands on the athlete's body, so it is of practical interest to study the effect of various dietary supplements on load tolerance and postexercise recovery. Furthermore, there is a lack of research on the effects of caffeine on key measures of load tolerance in football such as delayed-onset muscle soreness (DOMS), rate of perceived exertion (RPE) and heart rate (HR) at different time points after the exercise. 54 young players aged 15-17 years from a leading Russian football academy took part in a randomised trial using the balanced placebo design. They were divided into 4 groups: 1 - told caffeine/given caffeine, 2 - told caffeine/given placebo, 3 - told placebo/given placebo and 4 - told placebo/given caffeine. All participants consumed two capsules 60 min before testing, each containing 200 mg of caffeine or placebo. Sprinting, counter-movement jump, change of direction run, dribbling, T-test and the repeated sprint ability test were used to create conditions for high-intensity sports-specific load. A visual analogue scale was used to assess the severity of muscle soreness. RPE was assessed using the Borg Rating of Perceived Exertion scale. HR immediately postexercise (HRpe), HR after 2 min of passive rest (HRrest) and recovery HR (HRrec = HRpe - HRrest) were obtained. The data demonstrated that a single caffeine intake of 400 mg had no statistically significant effect on RPE (p = 0.948), HRpe (p = 0.698) or HRrec (p = 0.920) across the groups. Additionally, the severity of DOMS 24 h postexercise did not differ significantly between the groups (p = 0.077). Acute caffeine ingestion does not affect the subjective and objective indicators of training load in young football players aged 15-17 years with low levels of anxiety and low levels of daily caffeine intake.

One minute of light-intensity stair-stepping decreases postprandial glycaemia in the evening in non-diabetic adults: A randomized controlled trial.

Prior studies have investigated the efficacy of a single 1min bout of stair-stepping on reducing postprandial blood glucose (BG)in the morning, but none have investigated this effect in the evening when glycaemic responses are larger due to circadian regulation and β-cell responsiveness. This work investigated the efficacy of a 1min bout of self-selected, low-intensity stair-stepping performed in the evening on reducing the change from baseline to the 60min time point postprandial BG. Thirty people (43% male, 29 (10) years) participated in a randomized crossover-controlled trial. Participants completed two separate evening trials following an oral glucose tolerance test (OGTT) (75g of dextrose dissolved in water): (a) 0min of stair-stepping seated control condition, and (b) 1 min of stair-stepping condition. One minute of stair-stepping attenuated the change from baseline to 60 min postprandial BG versus control condition (2.5 (2.8) vs. 4.3 (2.3) mmol/L (P<0.001). Area under the curve (AUC) and incremental area under the curve (iAUC) were lower for the 1 min condition versus control (mean difference = -0.4,95% CI: 0.1-0.8 (P=0.023) and (mean difference = -0.6, 95% CI 0.1-1.1 mmol/L-1 min-1 (P=0.043), respectively. The modified BORG rate of perceived exertion scale showed participants perceived the exercise as light intensity (1.9 (1.1)). A single, 1 min bout of low-intensity stair stepping at a self-selected pace reduced evening postprandial BG levels following an OGTT in young non-diabetic adults.

Detection and perception of inspiratory resistive loads in older adults with and without chronic obstructive pulmonary disease.

Impairments in the detection and perception of resistive loads in healthy ageing and chronic obstruction pulmonary disease (COPD) have implications for airway protection and breathlessness. This study investigated load detection and perception in 18 participants with COPD, 17 older adults (i.e. age-matched controls; AMC) and 23 young adults (i.e. young controls; YC). Load detection was assessed as the minimal change in airway resistance that could be detected, and load perception as the perceived level of effort to breathe through a series of supra-threshold resistive loads, rated on a modified Borg scale. Young and older adults, with and without COPD, could detect similar changes in resistance (∼0.7 cmH2O/l/s) and inspiratory pressure (∼0.5 cmH2O), although this equated to a smaller proportion of predicted maximal inspiratory pressure (MIPpred) for young adults (∼0.5 %MIPpred) compared to older adults with and without COPD (∼1.0 %MIPpred; p<0.001). For load perception, the relationship between Borg ratings and resistance was steeper in older adult controls compared to both young adults (p<0.001) and older adults with COPD (p<0.01). Borg rating slopes were comparable across all participant groups with changes in inspiratory pressure. There was no correlation between load detection threshold and load perception. In older adults, heightened perception of loaded breaths with large changes in breathing resistance may be due to an increased effort to breathe at these loads.

Assessment of Exercise Capacity in Patients Diagnosed with Moderate and Severe Bronchial Asthma: Preliminary Prospective Observational Study.

The main objective of the study was to assess exercise capacity and physical activity levels in patients with bronchial asthma compared to a control group without asthma, as well as to investigate how asthma severity affects the results of the 6MWT and physical activity as measured by the IPAQ questionnaire. A total of 63 individuals were studied, divided into two groups: Group A, consisting of 33 individuals with bronchial asthma, and Group B, consisting of 30 individuals from the general population without bronchial asthma. In both groups, the following assessments were performed: The Six-Minute Walk Test (6MWT), The International Physical Activity Questionnaire (IPAQ) and the Borg rating of perceived exertion scale (the Borg RPE scale) ABB. It was demonstrated that patients with moderate asthma covered more distance during the 6MWT than patients diagnosed with severe asthma. The difference in metres covered between the two groups was statistically significant (p < 0.001), which could be observed during the walk test. The results indicate that a larger proportion of patients with asthma (76%) fall into the insufficient physical activity category compared to those without asthma (24%). Conversely, a higher percentage of non-asthmatic individuals (66.67%) report sufficient physical activity compared to asthmatic patients (33.33%)(P=0.005). This study demonstrated that asthma severity significantly impacts exercise capacity, as shown by shorter distances covered in the 6-minute walk test (6MWT) among patients with severe asthma. While overall physical activity levels (measured by the IPAQ) were not significantly different between asthma and non-asthma groups, asthma patients exhibited significantly more sitting time, suggesting a more sedentary lifestyle.

The chain-mediating effects of negative physical sensation and experiential avoidance on exercise anxiety in college students.

The present study aimed to explore the potential mediating role of negative physical sensation and experiential avoidance in the association between endurance exercise and exercise anxiety among university students. In this study, a questionnaire method was employed to conduct the Adolescent Athlete Non-Intellectual Factors Survey Scale on 1,200 college students. From this sample, 287 individuals with exercise anxiety were identified through an endurance exercise test and the Acceptance and Action Questionnaire (AAQ-II) subsequently administered as well as The Borg Rating of Perceived Exertion (RPE). Subsequently, statistical analyses including correlation, regression, and mediation were performed using SPSS26 as the analytical tool. Additionally, the bias-corrected nonparametric percentile Bootstrap method was used to test for the mediating effects and estimate the confidence intervals with 5,000 iterations, and the confidence interval (CI) was set at 95%. Finally, in AMOS24, a mediating construct was established by incorporating exercise anxiety as the dependent variable, endurance exercise behavior as the independent variable, and negative physical sensations and experiential avoidance as the mediating variables (R = 0.619, R 2 = 0.384). A path analytic procedure was employed to test the hypotheses while percentile bootstrap analysis was conducted to examine the indirect effects. The results show that endurance exercise negatively predicts negative physical sensations (β = -0.48, p < 0.001), negative physical sensation positively predicts experiential avoidance (β = 0.36, p < 0.001) and exercise anxiety (β = 0.40, p < 0.001), and experiential avoidance positively predicts exercise anxiety (β = 0.26, p < 0.001). There were significant correlations among endurance exercise, negative physical sensation, experiential avoidance and exercise anxiety. Endurance exercise affects exercise anxiety through two ways: (1) endurance exercise → negative physical sensation → exercise anxiety; (2) endurance exercise → negative physical sensation → experiential avoidance → exercise anxiety. Negative physical sensations and experiential avoidance play mediating and chain-mediating roles between endurance exercise and exercise anxiety.

The long-term effects of different telerehabilitation programs on respiratory, exercise, and activity-related parameters in COVID-19 survivors: a randomized controlled trial in Türkiye.

The long-term outcomes of different telerehabilitation gains for discharged COVID-19 patients are largely uncertain, and this point needs to be explored. This study aimed to research the effectiveness of telerehabilitation and compare the long-term results of videoconferencing-guided synchronous telerehabilitation and mobile application-guided asynchronous telerehabilitation programs, as well as determine the correlation between clinical and hemodynamic parameters. Exercise programs including aerobic exercises, strengthening exercises, and pulmonary exercises were given to COVID-19 patients discharged from the Kartal Dr. L&uuml;tfi Kirdar City Hospital in Istanbul, T&uuml;rkiye between August 2021 and January 2022, by videoconferencing or mobile application telerehabilitation. All patients underwent programs three times per week for 8 weeks. Lower extremity strength and functional status were assessed using a 30-second sit-to-stand test (30 s STS); physical activity level was assessed using the International Physical Activity Questionnaire short form (IPAQ); pulse oximetry was used to determine oxygen saturation and heart rate; and dyspnea and fatigue were assessed using a modified Borg Rating of Perceived Exertion Scale. Baseline, post-treatment, and long-term data were analyzed. A total of 27 patients completed the study. Significant improvement was seen in all parameters in long-term results with telerehabilitation programs (p<0.05). Especially in the between-group effect at rest (p=0.031) and post-exertion oxygen saturation (p=0.004), there were significant differences in favor of videoconferencing. Oxygen saturation was negatively correlated with dyspnea and fatigue (p<0.05). Post-exercise, dyspnea showed a moderate positive correlation with fatigue (r=0.582, p=0.001) and heart rate (r=0.412, p=0.033), while it exhibited a moderate negative correlation with 30 s STS (r=-0.424, p=0.027) and IPAQ (r=-0.401, p=0.038). Both methods generally provide positive gains in clinical and hemodynamic parameters, but the videoconferencing results were slightly better. Saturation at rest and dyspnea after exertion can provide a brief prediction about the cardiopulmonary system. Our findings are important for individuals who have access problems to the clinic and city center, and can be used for follow-up and treatment approaches.

Effect of Properly Describing the Borg Rating of Perceived Exertion (RPE) Scale on Heart Rate Response

Introduction: The Rating of Perceived Exertion (RPE) scale is often used to guide intensity during exercise. The purpose of this study was to determine if a thorough explanation of the scale is necessary to achieve optimal heart rate during indoor group cycling. Methods: The study consisted of a familiarization visit and two 60-minute instructor-led group cycling classes. The cycling sessions were identical in procedure; the only difference was that during one session, there was no explanation of the RPE scale (RPE-NE), and in the other, it was fully described in detail (RPE-E). Heart rate (HR) was continuously monitored. Maximal and average HR were calculated for each stage of the class. Repeated measures ANOVAs (condition x stage) were used to compare the mean HR, HRmax and %HRmax between conditions. Paired-samples t-tests were used to compare session RPE between conditions. Results: There were no differences between conditions for average HR (p=.436), HRmax (p=.086), or %HRmax (p=.084). There was also no difference between conditions in session RPE (RPE-NE: 15.7±1.4; RPE-E: 16.0±1.3; p=.432) Conclusions: A detailed explanation of the RPE scale before a group cycling class elicits a HR response similar to simply having a poster of the RPE scale posted and referenced.

Physical training augmented with whole body electronic muscle stimulation favorably impacts cardiovascular biomarkers in healthy adults – A pilot randomized controlled trial

BackgroundPhysical activity is protective against cardiovascular disease (CVD) and favorably improves CVD risk profile. However, more than 25 % of American adults report no participation in physical activity. Whole body electronic muscle stimulation (WB-EMS) training is a novel FDA-cleared technology which offers a time-efficient and adaptable method for physical training by simultaneously stimulating the main muscle groups using percutaneous electrical impulse transmission. Studies have demonstrated increased muscle mass, reduced fat mass, and improved functional capacity in sedentary individuals after training with WB-EMS, but studies evaluating the role of WB-EMS training on CVD risk profile are lacking. MethodsWe performed a pilot randomized controlled trial in healthy adults randomized to physical training with versus without WB-EMS for one session of 20 min duration per week across 16-weeks. Study participants were asked to perform their usual activities but to abstain from any strength training during the study. During each training session, all study participants wore a specifically designed vest and arm and leg straps that were connected with electrical wires to the WB-EMS device (Miha Bodytec Gersthofen, Germany). Biphasic electrical stimulation was delivered through the vest and straps (4 s on, 4 s off) at a frequency that elicited a score of 5 or 6 on the Borg rating of perceived exertion scale from study participants when each of the following muscle groups was stimulated: thighs, buttocks, lower back, upper back, latissimus dorsi, abdomen, chest and arms. These frequencies were ‘titrated’ during the first 4 weeks and were then fixed at each muscle group for each participant. Individuals randomized to no WB-EMS wore the same equipment but received no electrical stimulation. Physical training sessions were provided by personal trainers certified for WB-EMS training and consisted of a fixed number of exercises and repetitions. We measured and compared several clinically important cardiovascular parameters at baseline and post-intervention. ResultsSeventy-eight participants were recruited between January 2021 and March 2022 with a mean age of 35.9 ± 11.2, 61.3 % females, median BMI 24.3 (21.8, 28.1); N = 46 were randomized to intervention group and N = 32 were randomized to the control group. Eighteen (23 %) participants dropped out of the trial, including 9 participants from the EMS arm (19.6 %), and 9 participants in control arm (28.1 %). There was no significant differences in the rate of dropping out of the WB-EMS and control groups (p = 0.27). Those in the intervention group compared to controls exhibited the following changes after 16-weeks of training: waist:hip ratio (∆ -0.03 ± 0.05, p = 0.01 vs. -0.01 ± 0.0, p = 0.1), peripheral endothelial function, measured using reactive hyperemia peripheral arterial tonometry (∆: 0.02 ± 0.1, p = 0.5 vs. -0.20 ± 0.3 p = 0.05), high-sensitivity C-reactive protein (∆: 0.06 ± 0.7, p = 0.3 vs. 0.20 ± 2.3 p = 0.02), total cholesterol (∆: −1.7 ± 25.1, p = 0.3 vs. 19.2 ± 26.5, p < 0.001), high density lipoprotein (∆: 2.02 ± 6.6, p = 0.2 vs. 3.6 ± 7.5 p = 0.01) and low density lipoprotein cholesterol (∆: 0.5 ± 26.7, p = 0.4 vs. 17.1 ± 23.2, p < 0.001). ConclusionOnce weekly physical training with WB-EMS in healthy adults resulted in either improved or stable biomarkers of cardiovascular risk, which either remained stable or worsened in those undergoing conventional training alone. Thus WB-EMS may provide an effective and time-efficient form of physical training that may be considered in those unable or unwilling to perform exercise conventionally.

Short-term efficacy of moderate-intensity rosuvastatin in coronavirus disease 2019 patients: A randomized clinical trial.

As the coronavirus disease 2019 (COVID-19) pandemic persists, the exploration of adjunct therapies to mitigate disease severity remains a priority. Statins, known for their pleiotropic effects, have been under investigation for their potential role in managing COVID-19 complications. The study was conducted in a single referral hospital and adhered to Consolidated Standards of Reporting Trials guidelines. Eligible participants were randomized in a 1:1 ratio into either the rosuvastatin group or the control group. Outcome measures included vital signs, laboratory data, clinical outcomes, and patient symptoms. Statistical analysis was performed using SPSS software (version 26.0, IBM Corp., Armonk, New York). A total of 100 patients were enrolled. No significant differences were observed between the rosuvastatin and control groups in terms of baseline characteristics and laboratory parameters, except for the fact that rosuvastatin-treated patients showed lower levels of C-reactive protein in comparison with the controls on both the 1st and 5th days (38.1 ± 16.3 vs 50.5 ± 25.3) compared to the control group. Clinical outcomes, including hospital length of stay, intensive care unit admission, need for intubation, and 1-month mortality, did not differ significantly between the two groups. Symptom scales, as assessed by the Borg Rating of Perceived Exertion and Leicester Cough Questionnaire, showed significant improvement in the rosuvastatin group compared to controls. Our study provides insights into the short-term efficacy of moderate-intensity rosuvastatin in COVID-19 patients. Further research is warranted to elucidate the long-term effects and optimal dosing of statins in COVID-19 management.

Rating of perceived exertion as a tool for managing exercise intensity during pregnancy: a scoping review

ObjectiveDuring pregnancy, international guidelines recommend ≥150 min of moderate-intensity aerobic physical activity per week, with an intensity perceived as fairly light to somewhat hard on the Borg Rating of Perceived...

Sleep Quality and Its Predictors among Dyspnea, Fatigue and Exercise Capacity in Pulmonary Arterial Hypertension.

Poor sleep quality is an overlooked symptom in patients with pulmonary arterial hypertension (PAH), however it may significantly contribute to disease burden. The aim of this study was to assess the sleep quality of patients with PAH and investigate its association with dyspnea, fatigue, and exercise capacity. Forty-five patients were included. Sleep quality of the patients was assessed by the Pittsburgh Sleep Quality Index (PSQI), dyspnea levels were assessed by the UCSD-Shortness of Breath Questionnaire (UCSD-SOBQ), Baseline Dyspnea Index (BDI), Modified Medical Research Council (MMRC) dyspnea scale and Modified Borg Dyspnea scale, fatigue levels were evaluated with the Fatigue Severity Scale and Borg Rating of Perceived Exertion, and functional exercise capacity was evaluated with the 6-minute walk test (6MWT). Among the patients with PAH, 64% had poor sleep quality (PSQI > 5). PSQI score was significantly correlated with MMRC scale (r = -0.561), UCSD-SOBQ (r = 0.497), BDI (r = -0.468), and 6MWT (r = -0.412) (p < 0.05). There was no significant relationship between sleep quality and fatigue. A regression model including MMRC and 6MWT could explain 32% of variance in PSQI (p < 0.05), and MMRC score was an independent predictor for PSQI (p < 0.05). In addition, MMRC score had a greater influence on PSQI than 6MWT (β = 0.548 vs. 0.019). Poor sleep quality is common in patients with PAH and is associated with poor exercise capacity and dyspnea. Patients with severe dyspnea are particularly at higher risk of poor sleep quality. Consideration of sleep-related complaints and underlying mechanisms when planning symptomatic treatments for these patients may help provide better management for PAH.

Exercise intensity prescription in cardiovascular rehabilitation: bridging the gap between best evidence and clinical practice.

Optimizing endurance exercise intensity prescription is crucial to maximize the clinical benefits and minimize complications for individuals at risk for or with cardiovascular disease (CVD). However, standardization remains incomplete due to variations in clinical guidelines. This review provides a practical and updated guide for health professionals on how to prescribe endurance exercise intensity for cardiovascular rehabilitation (CR) populations, addressing international guidelines, practical applicability across diverse clinical settings and resource availabilities. In the context of CR, cardiopulmonary exercise test (CPET) is considered the gold standard assessment, and prescription based on ventilatory thresholds (VTs) is the preferable methodology. In settings where this approach isn't accessible, which is frequently the case in low-resource environments, approximating VTs involves combining objective assessments-ideally, exercise tests without gas exchange analyses, but at least alternative functional tests like the 6-minute walk test-with subjective methods for adjusting prescriptions, such as Borg's ratings of perceived exertion and the Talk Test. Therefore, enhancing exercise intensity prescription and offering personalized physical activity guidance to patients at risk for or with CVD rely on aligning workouts with individual physiological changes. A tailored prescription promotes a consistent and impactful exercise routine for enhancing health outcomes, considering patient preferences and motivations. Consequently, the selection and implementation of the best possible approach should consider available resources, with an ongoing emphasis on strategies to improve the delivery quality of exercise training in the context of FITT-VP prescription model (frequency, intensity, time, type, volume, and progression).

Effects of patient-based self-assessed fatigue intervention on early postoperative ambulation following gynaecological oncology surgery: a randomised controlled non-inferiority trial

ObjectivesTo assess the impact of a patient-based self-assessed fatigue intervention aimed at promoting early postoperative ambulation.DesignProspective randomised controlled trial.SettingSingle-centre, conducted at the Obstetrics and Gynaecology Department of the Xiangyang Central...

Cognitive interference of respiratory versus limb muscle dual tasking in healthy adults.

Inspiratory threshold loading (ITL) and associated dyspnoea have been shown to interfere with cognition during cognitive-motor dual tasking. However, ITL has not been compared with another rhythmic muscle activity, such as lower limb pedalling. While ITL has been shown to interfere with cognition, the mechanism of the prefrontal cortex (PFC) during ITL or other rhythmical muscle dual tasking, has not been elucidated. Given the cognitive interference that arises during ITL, we hypothesise that ITL cognitive-motor dual tasking will result in greater cognitive decrements and increased PFC activity compared with the pedalling cognitive-motor dual task. 30 healthy participants (16 females; median age 23 (interquartile range 23-24) years) were recruited. They performed five 3-min tasks in a single visit in a random order: single tasks were ITL, pedalling and Stroop task and dual tasks were ITL-Stroop and pedalling-Stroop. Participant's PFC activity was assessed bilaterally using functional near-infrared spectroscopy throughout each task. Single- and dual-task cognitive performance was evaluated by measuring Stroop task reaction time and accuracy. Dyspnoea and rating of perceived exertion were evaluated at the end of each task. ITL-Stroop resulted in greater impairments in reaction time (p<0.001), accuracy (p<0.01) and increased medial/dorsolateral PFC activity (p≤0.006) than pedalling-Stroop. ITL-Stroop elicited greater Borg dyspnoea and rating of perceived exertion than pedalling-Stroop (p<0.001), despite pedalling-Stroop having a greater heart rate response (p<0.001). The heightened cognitive decrements, perceptual response and PFC activity suggest that inspiratory muscle loading and its accompanied dyspnoea results in greater cognitive interference than rhythmic pedalling.

#596 The Borg Scale—efficient and safe for exercise prescription in self-administered balance and strength exercise in patients with CKD

Abstract Background and Aims With the continued rise in chronic kidney disease (CKD), there is a critical need for sustainable, home-based exercise interventions. While supervised, centre-based exercise improves physical performance in CKD patients, unsupervised, self-administered exercise poses challenges in ensuring adherence, safety, and efficacy. This study investigates the Borg Rating of Perceived Exertion (RPE) scale, a subjective measure of exertion, as a method for prescribing and monitoring the intensity of balance and strength exercise in non-dialysis dependent CKD patients. The aims of this study were: Method This sub study of the RENEXC-trial included 148 patients with CKD stages 3-5, with a mean age of 66 ± 14 years and mean measured GFR of 22 ± 8 ml/min/1.73 m2. Patients were prescribed 90 minutes/week of balance or strength exercise at a Borg RPE of 13-17 (corresponding to an exercise intensity of somewhat hard to very hard), along with 60 minutes/week of endurance exercise. Exercise programs were individually prescribed by a physiotherapist according to randomization and each patient's baseline performance and were performed at home or in a gym according to the patient's preference. Duration and RPE of the performed exercise were reported in an exercise diary. Progress was monitored by the physiotherapist through phone contact, every week for the first three months of the study and every other week for the rest of the study year. The continuous follow up provided motivation and enabled adjustments of the exercise program to maintain the goal RPE, adapt intensity and the weekly duration of exercise. Outcome measures included the Berg Balance Scale (BBS) and Functional Reach Test (FRT), the 30-second sit-to-stand test (30STS) and isometric quadriceps strength (IQS). Balance and strength measures were evaluated at baseline and after 12 months of exercise. Previous publications of the RENEXC-trial showed no difference between patients who performed balance exercise and patients who performed strength exercise; therefore, this sub-study analysed all included patients as one group. Results Of 148 participants, 112 completed the study. At 12 months, 79% reported performed exercise, with 86% of these patients adhering to the prescribed intensity. The median (25th-75th percentile) exercise intensity was a RPE of 14 (13-15) on the Borg scale, and the median (min-max) exercise duration was 48 (0-241) minutes/week. Only 18% of the patients reached the 90-minute/week target. No exercise-related incidents were reported. Significant improvements were noted in BBS (p = 0.0464), FRT (p = 0.009), 30STS (p = 0.047), and IQS (right/left p = 0.022 / p = 0.049). Conclusion The Borg RPE scale is an effective and safe method for prescribing and monitoring self-administered balance and strength exercise in patients with CKD. Using the Borg scale for prescribing and monitoring exercise intensity during balance and strength exercise resulted in a good level of adherence to the 12-months exercise program and the prescribed exercise intensity. As no exercise related incidents were reported, we conclude that the self-administered exercise was safe to perform. Significant improvements in balance and strength were observed with a moderate to high exercise intensity prescription within a wide range of performed weekly duration of exercise, suggesting the Borg scale's value in exercise prescription in both well- and deconditioned patients with CKD. These findings show that the integration of the Borg scale into routine exercise prescription in people with CKD can promote patient autonomy and efficient resource utilization in healthcare.

Exoskeletal-Assisted Walking During Acute Inpatient Rehabilitation Enhances Recovery for Persons with Spinal Cord Injury-A Pilot Randomized Controlled Trial.

Spinal cord injury (SCI) negatively impacts individuals' functional independence, and motor and sensory function. Intense walking training has been shown to facilitate recovery for individuals with chronic SCI. Powered robotic exoskeletons provide therapists with a tool that allows them to conduct walking training with less therapist effort as compared to conventional walking training. Exoskeletal-assisted walking (EAW) has been studied in the chronic SCI population with preliminary reports showing benefits in mobility, health, and quality-of-life outcomes. However, few reports have studied EAW's benefits in the acute (<90 days post) SCI population at a time when neural plasticity is most dynamic and modifiable. The purpose of the study was to conduct a pilot randomized controlled trial (RCT) to understand the effects of incorporated EAW in acute inpatient rehabilitation (AIR) for individuals with SCI on functional, motor, and sensory recovery. The study outcomes included the Spinal Cord Independence Measure (SCIM) III and International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) motor and sensory scores that were assessed by unblinded assessors. We also recorded EAW session data, including adverse events, walking and up time, step counts, Borg Rating of Perceived Exertion (RPE), and compliance with scheduled EAW training. From August 2019 to July 2022, 16 participants completed the AIR with incorporated EAW, and 12 completed the standard AIR, all with SCI and preserved leg function within 90 days post-injury. During each session, the AIR with incorporated EAW group averaged 34.3 (±9.4) min of up time, 25.4 (±7.7) min of walk time, and 536 (±157) steps. Analysis via two-by-two mixed-effects models showed significant increases in the SCIM total score and ISNCSCI total motor and sensory scores over time for the AIR with incorporated EAW group [SCIM total score: F(1, 26) = 5.59, p = 0.03; total motor score: F(1, 26) = 8.06, p < 0.01; total sensory score: F(1, 19.2) = 5.08, p = 0.04], outperforming the standard AIR group. The AIR with incorporated EAW group showed 13, 14, and 22 points higher changes in the SCIM total score, total motor score, and total sensory score (respectively) by discharge compared with the standard AIR group. Incorporating EAW into AIR may facilitate functional, motor, and sensory recovery for individuals with SCI during AIR better than standard AIR. However, the study had a limited sample size. Further studies are needed to clarify the effects of EAW in AIR.

The Relationship Between Self-Efficacy and Functional Capacity Among Discharged Heart Failure Patients in Jordan.

Self-efficacy is an important factor associated with healthy lifestyle changes in heart failure treatment. Functional capacity testing of heart failure patients (HFPs) can stratify prognosis. Reduced functional capacities in HFPs are linked to a poor heart failure prognosis. Limited research has examined the potential relationship between self-efficacy and functional capacity. The aims of this study were to assess self-efficacy level and functional capacity among HFPs after hospitalization, and examine whether there is a relationship between them. A descriptive correlational design was used. A convenience sample of 220 HFPs was recruited from 2 hospitals in Jordan. The Arabic version of Cardiac Self-Efficacy Questionnaire was used to assess self-efficacy, the 6-Minute Walking Test (6-MWT) was used to assess functional capacity, and the Borg rating of perceived exertion scale (Borg Scale) was used to assess exertion during 6-MWT. The sample included 46.8% male (n = 103) and 53.2% female (n = 117). The mean age was 52.66 ± 8.91 years. Most of the HFPs were categorized based on New York Heart Association classification as class I, 35.9% (n = 79), and class II, 41.4% (n = 91). The mean ejection fraction was 41.46 ± 9.44. The global self-efficacy was moderate (32.98 ± 9.92), and the mean score for the 6-MWT was 494.35 ± 143.37. The Borg Scale mean was 10.94 ± 3.34. In addition, there was a positive relationship between self-efficacy and 6-MWT (r = 0.63, n = 220, P = .01). This study provides baseline data for further research on treatment of HFPs, and the development of evidence-based tailored health interventions to maintain and improve self-efficacy and functional capacity among these service users. Moreover, replicated researches can test the study results considering different methodologies, such as using objective functional capacity tool and longer follow-up periods.