Perceived Exertion - Springer Link

Sports Med 2006; 36 (11): 911-928 0112-1642/06/0011-0911/$39.95/0

LEADING ARTICLE

 2006 Adis Data Information BV. All rights reserved.

Perceived Exertion Influence of Age and Cognitive Development Alain Groslambert1 and Anthony D. Mahon2 1 2

Laboratory of Sport Sciences, FEMTO UFR STAPS de Besan¸con, Besan¸con, France Human Performance Laboratory, School of Physical Education, Sport, and Exercise Science, Ball State University, Muncie, Indiana, USA

Abstract

Because little is known about the effects of aging on perceived exertion, the aim of this article is to review the key findings from the published literature concerning rating of perceived exertion (RPE) in relation to the developmental level of a subject. The use of RPE in the exercise setting has included both an estimation paradigm, which is the quantification of the effort sense at a given level of exercise, and a production paradigm, which involves producing a given physiological effort based on an RPE value. The results of the review show that the cognitive developmental level of children aged 0–3 years does not allow them to rate their perceived exertion during a handgrip task. From 4 to 7 years of age, there is a critical period where children are able to progressively rate at first their peripheral sensory cues during handgrip tests, and then their cardiorespiratory cues during outdoor running in an accurate manner. Between 8 and 12 years of age, children are able to estimate and produce 2–4 cycling intensities guided by their effort sense and distinguish sensory cues from different parts of their body. However, most of the studies report that the exercise mode and the rating scale used could influence their perceptual responsiveness. During adolescence, it seems that the RPE-heart rate (HR) relationship is less pronounced than in adults. Similar to observations made in younger children, RPE values are influenced by the exercise mode, test protocol and rating scale. Limited research has examined the ability of adolescents to produce a given exercise intensity based on perceived exertion. Little else is known about RPE in this age group. In healthy middle-aged and elderly individuals, age-related differences in perceptual responsiveness may not be present as long as variations in cardiorespiratory fitness are taken into account. For this reason, RPE could be associated with HR as a useful tool for monitoring and prescribing exercise. In physically deconditioned elderly persons, a rehabilitation training programme may increase the subject’s ability to detect muscular sensations and the ability to utilise these sensory cues in the perception of effort. RPE appears to be a cognitive function that involves a long and progressive developmental process from 4 years of age to adulthood. In healthy middle-aged and elderly individuals, RPE is not impaired by aging and can be associated with HR as a useful tool to control exercise intensity. While much is known about RPE responses in 8- to 12-year-old children, more research is needed to fully under-

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Groslambert & Mahon

stand the influence of cognitive development on perceived exertion in children, adolescents and elderly individuals.

The perception of exertion can be considered as a configuration of sensations: strain, aches and fatigue involving the muscles and the cardiovascular and pulmonary systems during exercise. These sensations are generally classified as being derived from either cardiopulmonary or peripheral factors. Cardiopulmonary factors include variables such as heart ˙ 2), respiration rate and rate (HR), oxygen uptake (VO minute ventilation, while peripheral/metabolic factors include blood lactate concentration, blood pH, mechanical strain, skin and core temperature.[1] In Borg’s model,[2] it is observed that as exercise performance increases along an intensity-dependent continuum, there are corresponding and interdependent increases in response intensities along perceptual (i.e. perceived exertion) and physiological (e.g. ˙ 2) continua, demonstrating HR, respiratory rate, VO a positive relationship. From this relationship, different rating scales have been validated in adults, such as Borg 6-20 rating of perceived exertion (RPE) scale,[3] which was constructed to provide perceptual data that are linear with HR and power output. Borg[2] also developed a category-ratio scale (CR-10) that is appropriate for assessing sensations that may arise from physiological variables that grow exponentially, such as blood lactate or pulmonary ventilation. However, these rating scales have been validated only in adults not in children. For this reason, there are linear rating scales for children created on the basis of common expressions and familiarity with a limited number range (e.g. 1–10) such as the Children’s Effort Rating Table (CERT),[4] and pictures and expressions such as the OMNI,[5-7] Cart and Load Effort Rating (CALER),[8] Pictorial CERT (PCERT),[9] Bug and Bag Effort (BABE)[10] and Rating of Perceived Exertion in Children (RPE-C) Scales.[11] A pictorial curvilinear scale also has been proposed recently by Eston and Parfitt.[12] All of these rating scales have been used with varying degrees of success as a means of assessing exercise effort. At the present time, it is still not clear how the brain interprets afferent feedback to induce per 2006 Adis Data Information BV. All rights reserved.

ceived exertion. It has been suggested that an integration of these different cues may indirectly and unconsciously influence perceived exertion during exercise.[13] Ulmer[14] and more recently Hampson et al.[15] have suggested that exercise performance may be controlled by central calculations and efferent commands that attempt to couple the metabolic and biomechanical limits of the body to the demands of the exercise task in a process described as teleoanticipation. However, little is known about the components of the cognitive functions involved in perceived exertion. It is likely that these functions are developmental, expanding in scope and maturating in both precision and efficiency as the individual’s movement-related experiences become more varied. One interesting question is to know how these functions evolve in relation to aging and particularly between birth and adult age and after 50 years of age. The cognitive functions involved with perceived exertion are usually investigated by using two different paradigms: estimation (passive) and production (active). According to Eston and Parfitt,[12] these paradigms place different demands upon a three-effort continua (perceptual/psychological, physiological and performance/situational) with memory of exercise experience particularly relevant in the production paradigm. Following an exercise situation, memory will degrade and impact upon future active productions. In comparison, the estimation paradigm is based upon the interpretation of current stimulation. When using the estimation paradigm, the subject is first asked to describe or estimate his or her RPE at intervals dictated by the researcher.[1] The application of RPE in this manner is routinely used during graded exercise, but it is also employed during submaximal bouts of steadystate exercise. In the production protocol paradigm, the subject is asked to self-regulate exercise intensity by producing a pre-determined RPE, which is often anchored to a given exercise intensity determined from an estimation paradigm. During the production trial, the subject will self-adjust the exercise intensity to reproduce and maintain a given Sports Med 2006; 36 (11)

Effort Sense and Aging

physiological effort. To avoid order effects, the subject is often asked by the researcher to produce different exercise bouts in an order selected randomly by an instructor.[1] Prescription congruence is tested by determining a physiological response (i.e. ˙ 2, percentage of maximal HR, or percentage HR, VO ˙ 2max]) equivalent to of maximal oxygen uptake [VO a target RPE. When the physiological response does not differ between estimation and production trials, prescription congruence is accepted.[16] Van den Burg and Ceci[17] have tested the accuracy of RPE in exercise prescription to achieve a HR target. The authors reported that the HR response equivalent to 13 did not differ significantly between the estimation (145 beats/min) and the production trials (149 beats/min). In addition, Robertson et al.[18] examined also the validity of a perceptually based cross-modal prescription using treadmill and stationary cycling. They found no exercise mode effect when the exercise intensity was set equal to ˙ 2max of the subjects tested. Moreothe relative VO ver, Dunbar et al.[19] reported in adults no significant difference between estimation and production trials ˙ 2max (mean error 50 years) according to Poortmans,[21] because as maximal HR decreases with age,[22,23] the RPE-HR relationship also might change. Furthermore, the loss of the sensibility of proprioceptors caused by sarcopenia, decreases the speed and quality of nervous propagation.[21] In addition, it has been reported that elderly persons could have degradation in cognitive performance, particularly for perception tasks.[24,25] All of these variables may affect perceived exertion in aged persons. Therefore, the aim of this article is to discuss how the cognitive functions involved in perceived exertion evolve consecutively during these six periods. 1. The Sensory-Motor Period: 0–3 Years Not surprisingly, there is little research on the utilisation of RPE during exercise in children in this age range (table I). In a study involving handgrip force,[26] children with an average age of 3.3 years were not able to produce, in graded or in randomised order, four handgrip force levels. According to Piaget,[20] the upper end of this age group corresponds to the end of the sensory-motor period where young children are unable to perform a relationship between the symbolic representation suggested by a picture and the different grip-force levels. Furthermore, children of this age are not able to rate their perceptions; therefore, it is not surprising that they cannot accurately reproduce a given effort based on RPE.[26] Overall, these findings suggest that the cognitive developmental level in children 0–3 years of age does not allow for the application of perceived exertion during physical activity. 2. The Pre-Operational Period: 4–7 Years Compared with the limited number of studies involving children in the 0- to 3-year age group, there are more studies that have examined perceived exertion responses during exercise in children whose ages fall within the pre-operational period (table I). Williams et al.,[4] using an estimation paradigm, examined young children (4–5 years of age) using the CERT, the first published scale to use a limited number range (1–10) in recognition of the limited cognitive ability of young children. They Sports Med 2006; 36 (11)

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Table I. Publications involving rating of perceived exertion (RPE) in 3- to 7-year-old children Study Defrasne[26]

Subjects (sex and age)a 4 children (1 M; 3 F; 3.3 ± 0.1y)

Rating scale RPE-C

Exercise mode

Protocol

Results

Handgrip force

Test and randomised retest (4 intensities: 8-12-16-20)

The RPE-handgrip force correlation was r < 0.25 (p > 0.05) on the test and randomised re-test. Children of this age do not discriminate different hand grip forces

5 children (2 M; 3 F; 4.5 ± 0.1y)

The RPE-handgrip force correlation was r = 0.47 (p = 0.03) on the test and r = 0.05 (p > 0.05) on the randomised re-test. Children of this age discriminate only extreme values of handgrip forces

5 children (4 M; 1 F; 5.5 ± 0.1y)

The RPE-handgrip force correlation was r = 0.53 (p = 0.01) on the test and r = 0.50 (p = 0.02) on the randomised re-test. Children of this age discriminate three levels of handgrip force

5 children (4 M; 1 F; 6.5 ± 0.1y)

The RPE-handgrip force correlation was r = 0.62 (p = 0.003) on the test and r = 0.65 (p = 0.001) on the randomised re-test. Children of this age discriminate four intensities of handgrip force

18 children (10 M; 8 F; 6.5 ± 0.5y)

RPE-C

Handgrip force

Estimation (test and randomised re-test at RPE-C = 7-11-15-19)

The RPE-handgrip force relationship was r2 = 0.62 (p < 0.0001) on the test and r2 = 0.48 (p < 0.0001) on the randomised re-test

Williams et al.[4]

56 children (kindergarten: 14 M; 14 F; 4.7 ± 0.6y) (grade 1: 14 M; 14 F; 6.7 ± 0.5y)

CERT

Stepping exercise with load increases (0%, 5%, 10%, 20% of individual body mass)

Estimation – production (2 intensities: 5 and 7)

During the estimation trials, the HR-RPE correlation was r = 0.73 (p < 0.01) in kindergarten children and r = 0.95 (p < 0.01) in grade 1 children During the production trial, kindergarten children were unable to produce the 2 exercise intensities and there was no significant correlation between HR and CERT in the children of grade 1

Groslambert et al.[11]

13 children (7 M; 6 F; 5.5 ± 1.0y)

RPE-C

Running (track)

Estimation

The RPE-HR relationship was r2 = 0.61 (p < 0.0001)


32 children (16 M; 6.6 ± 0.6y and 16 F; 6.7 ± 0.4y)

OMNI

Running (track)

Estimation-production (3 intensities: 2-6-10)

HR did not differ significantly between estimation and production trials at RPE-2 (124.1 ± 6 vs 125.3 ± 4 bpm), RPE-6 (164.9 ± 5 vs 166.2 ± 6 bpm) and RPE-10 (200.9 ± 8 vs 203.1 ± 8 bpm). HR at RPE-2 HR at RPE-6 < HR at RPE10 (p < 0.05). There was no significant sex difference. Children can discriminate between 3 running intensities

a

Age listed as mean ± SD unless otherwise indicated.

bpm = beats per minute; CERT = Children’s Effort Rating Table; F = females; HR = heart rate; M = males; OMNI = OMNI scale; RPE-C = rating of perceived exertion in children.

Groslambert & Mahon

Sports Med 2006; 36 (11)



reported reasonably good correlations (r = 0.73) between perceived exertion and HR across increasing exercise intensity. Groslambert et al.[11] using the RPE-C also found a significant HR-RPE correlation (r = 0.78), although reliability coefficients within different levels of exercise ranged from r = 0.17 to 0.77. Williams et al.[4] reported that children aged 4.7 years did not understand the procedures to be followed for a perceived exertion production trial using the CERT and therefore were unable to assess the accuracy for children of this age to use perceived exertion to determine exercise intensity. However, other researchers have reported that children in this age range are able to accurately produce four handgrip force levels during an incremental handgrip test.[26] In contrast, children in this study were not able to accurately reproduce four handgrip force levels in random sequence. This result also has been reported by Piaget[20] who observed that the cognitive development level of children of this age does not allow to compare together more than two objects of different sizes. As children advance through this developmental stage it appears that the ability to use RPE as an estimate of exercise exertion improves. Williams et al.[4] found that the correlation between perceived exertion using CERT and HR was r = 0.95 in children aged 6.7 years. However, when the children in this age group were asked to produce a given RPE (5 and 7 on the CERT), the HR assessed during an estimation trial was not significantly related to the HR observed during the production trial at both levels of effort. One hypothesis is that estimation and production protocols require two dissimilar psychological processes that are strongly related to the body experience and/or the cognitive development level of the children.[29] Another hypothesis is that these findings were related to the unique mode of exercise (stepping) and not necessarily to an inability in the children to use perceived exertion in this mode. At the end of the pre-operational period (5–7 years), it has been reported that children can produce accurately in random order three to four handgrip force levels from their perceived exertion.[26,27] Likewise, when children of this age performed a more familiar activity that resembles as ‘real world’ play experiences (e.g. outdoor running), they were  2006 Adis Data Information BV. All rights reserved.

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able to accurately estimate and produce three running intensities.[28] From these observations, it may be concluded that the pre-operational period is a developmental phase where children are able to progress from using peripheral sensory cues during handgrip tests to a reliance on their cardiorespiratory cues during outdoor running. This point is summarised in figure 1. 3. The Period of Concrete Operations: 8–12 Years It is generally recognised that at a given relative exercise intensity, measures of perceived exertion using the Borg 6-20 scale are typically lower in children versus adults either through direct comparison[30] or indirectly by comparing perceptual responses in children and adults at similar exercise intensities, but across different studies (table II).[31,32] In contrast, others have reported that perceived exertion responses using the Borg 6-20 scale are similar in children and adults when referenced to the ventilatory threshold.[33,34] In both of these studies, ventilatory threshold occurred at the same per˙ 2max in boys and men. Differences in centage of VO the perceptual responsiveness between children and adults may be due to the validity of the rating scale used, particularly the Borg 6-20 RPE scale and the exercise intensity at which the comparison is being made. Indeed, the original notion that exercise HR could be determined by multiplying Borg 6-20 RPE value by 10 may be valid only for middle-aged and older individuals. The ratio does not appear to be accurate for children, adolescents or young adults.[30] In support of this, it has been reported that the RPE-HR correlation for the Borg 6-20 scale is low in children aged 9–11 years (r = 0.45–0.79,[29,35] increases during adolescence (r = 0.74–0.87)[36-38] and is still higher (r = 0.89–0.95) in adults.[39,40] However, when perceived exertion is measured by a rating scale adapted for children (e.g. OMNI scale),[5] the perceived exertion-HR correlation values across increasing exercise intensity are quite similar between children aged 8–12 years (r = 0.87–0.94)[5] and adults (r = 0.81–0.90).[41] Likewise, Lamb[35,42] and Lamb and Eston[43] have highlighted the importance of using a rating scale adapted and validated for children. Their studies have shown the perceived exertion-HR relationship is Sports Med 2006; 36 (11)

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Perceived exertion capacities

Years 3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

Production of 2 handgrip forces in graded order Production of 3 handgrip forces in graded order Production of 4 handgrip forces in graded order Production of 4 handgrip forces in random order Estimation of 2 stepping exercise intensities Estimation of 3 running intensities Production of 3 running intensities Estimation of 3 cycling intensities Production of 3 cycling intensities Estimation of 4 cycling intensities Production of 4 cycling intensities Fig. 1. Evolution of the perceived exertion capacities from 3 to 20 years.

more pronounced when the children used the CERT (r = 0.69–0.79)[35,44] compared with the Borg 6-20 scale (r = 0.45–0.79).[35] In contrast to these results are the findings of Utter et al.[6] who reported correlations between OMNI perceived exertion and various physiological measures of effort that were considerably lower than the correlations reported by Robertson et al.[5] Explanations for this discrepancy are not fully apparent but may be due to differences in exercise modality (treadmill[6] vs cycle ergometer[5]) and age range (6–13 years[6] vs 8–12 years[5]). It is interesting to note that the children in this age group also can discriminate levels of exertion in different parts of their body (leg, chest and overall body) during both a graded exercise test[7,34,45] and steady-state submaximal exercise.[48] The studies by Robertson et al.[7,45] used the OMNI scale and the studies by Mahon et al.[34,48] utilised the Borg 6-20 scale. In these studies, the sensations arising from the legs, appears to have provided the dominant sensory signal in children of this age with the cardiorespiratory factors serving as a secondary cue. This suggestion also was made by Mahon et al.,[46] although they only assessed overall perceived exer 2006 Adis Data Information BV. All rights reserved.

tion. According to Piaget,[20] this period corresponds to the developmental level where the children are progressively able to accurately distinguish feelings in the different parts of their body. However, it appears that exercise intensity must be high because it has been reported that at slow-to-moderate walking speeds neither the respiratory-metabolic nor peripheral ratings of perceived exertion appeared to dominate the whole-body sensory-integration process in children of this age.[54] ˙ 2 In this age group, it has been reported that VO and HR did not differ significantly between estimation and production trials at two different levels (2 and 6) on the OMNI scale;[16] however, as should be ˙ 2 and HR differed between the two expected, VO perceived exertion levels. Williams et al.[49] reported that HR differed across three different Borg 6-20 RPE levels (9, 13 and 17) but not within each level in 11-year-old boys and girls; however, comparisons were restricted to a production trial only. Likewise, Eston et al.[44] using CERT levels of 5, 7 and 9 noted that the HR and power output measured during an estimation trial were significantly correlated to HR and power output during a production trial. HowevSports Med 2006; 36 (11)

Study

Subjects (sex and age)a

Rating scale

Exercise mode

Protocol

Results

Eston et al.[10]

18 children

CERT, BABE,

Stepping exercise

Production

The reliability of HR improved with practice for CERT, BABE

(range 7–10y)

CALER

with load increases

(3 random intensities: 3,

and was very high for CALER

(0%, 5%, 10%,

5 and 8)

15%, 20% and 25%



Table II. Publications involving rating of perceived exertion (RPE) in 8-to 12-year-old children

of individual body mass) Williams et al.[4]

56 children

CERT

(grade 2: 14 M;

Lamb[35]

Stepping exercise

Estimation – production

During the estimation trial, the HR-RPE correlation was r =

with load increases

(2 intensities: 5 and 7)

0.99 (p < 0.01) in grade 2 and grade 3 children. During the

14 F; 8.3 ± 0.4y)

(0%, 5%, 10%, 20%

production trial, there was no significant correlation between

(grade 3: 14 M;

of individual body

HR and RPE in these two groups of children

14 F; 9.1 ± 0.3y)

mass)

70 children (28

CERT and RPE

M; 42 F; range

6-20

Cycle (ergometer)

9–10y)

Estimation (maximal

The HR-RPE correlation ranged from r = 0.69–0.79 (p
9

0.01) with CERT, whereas the same correlations for the

or RPE > 18)

RPE-6-20 scale ranged from r = 0.45–0.79 (p < 0.01). For PO, the correlations involving CERT were r = 0.75–0.84 (p < 0.01) and with RPE 6-20 the correlations were r = 0.53–0.83 (p < 0.01)

Robertson et

36 children (18

al.[16]

M; 10.1 ± 1.7y

OMNI

Cycle (ergometer)


˙ 2 at RPE-2 (0.63 vs 0.66 L/min) and RPE-6 (1.27 vs 1.21 VO

(2 intensities: 2 and 6)

L/min) and HR at RPE-2 (104.1 vs 102.6 bpm) and RPE-6

and 18 F; 9.9 ±

(153.7 vs 154.5 bpm) did not differ between estimation and

1.5y)

production trials. Physiological responses at RPE-6 > RPE-2. Children can discriminate between 2 intensities

63 children (32 M; 31 F; range 6–13y)

OMNI walk-run

Walk–run (treadmill)

Estimation

Correlations within a given exercise test stage ranged from r

(maximal graded test)

˙ 2max and r = = 0.41–0.60 (p < 0.001) for RPE-%VO 0.26–0.52 (p < 0.01) for RPE-HR

Continued next page

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Utter et al.[6]

918


Table II. Contd Study

Subjects (sex and age)a

Rating scale

Exercise mode

Protocol

Eston et al.[44]

16 children (8

CERT

Cycle (ergometer)

Estimation –production

During the estimation trial the RPE-HR correlation was r =

(3 intensities: 5-7-9)

0.76 (p < 0.01) and for RPE-PO the correlation was r = 0.75

M; 9.9 ± 1.2y and

Results

(p < 0.01). During the production trial, the correlation

8 F; 10.0 ± 1.0y)

between predicted and observed HR was r = 0.65–0.79 and between predicted and observed PO the correlation was r = 0.84–0.91 (p < 0.01). At a given RPE, PO and HR were significantly lower in production trial vs the estimation trial

Lamb[42]

64 children

CERT and RPE

(range 9–10y)

6-20

Cycle (ergometer)


For CERT, HR was higher (p < 0.05) at 3 levels (CERT 7 >

4 intensity levels: CERT:

CERT 5 > CERT 3) and PO was higher (p < 0.05) at across

3-5-7-9; RPE:

all 4 levels. The HR-RPE correlations were r = 0.37–0.61 (p

8-12-15-18

< 0.01) for CERT. For PO, the correlations were r = 0.59–0.75 (p < 0.01) For RPE 6-20, HR was higher (p < 0.05) at 3 levels (RPE 15 > RPE 12 > RPE 8) and PO was higher (p < 0.05) across all 4 levels. The correlations between HR and RPE 6-20 were r = 0.47–0.73 (p < 0.01) and for PO the correlations were r = 0.57–0.78 (p < 0.01)

Robertson et

48 children (24

OMNI (overall body,

al.[45]

M; 9.9 ± 1.7y

legs, chest)

Cycle (ergometer)

Estimation (maximal

RPE-overall (6.1), RPE-legs (7.2), RPE-chest (4.5) at the VT

graded test)

was similar between low- and high-fit children and between

and 24 F; 10.2 ±

sex

1.4y) Robertson et

80 children (40

OMNI (overall body,

al.[5]

M; 10.1 ± 1.7y

legs, chest)

and 40 F; 10.1 ±

Estimation (incremental

Correlations between HR and RPE were r = 0.87–0.93 (p
r = 0.90 in both groups across the two tests

Alekseev[37]

Children (range

RPE 6-20 (overall)

Cycle (ergometer)

10–14y) Rutkowski et

31 children (16

OMNI – treadmill

al.[54]

M; 15 F; 10y)

(overall, legs and

Walk (treadmill)

Estimation (maximal

The RPE-HR correlation was r = 0.84 (p < 0.01) and RPE

graded test)

vs %HRmax correlation was r = 0.87 (p < 0.01)

Estimation at 6 different

In both groups of subjects, there was no difference between

walking velocities

differentiated and undifferentiated RPE at any walking speed

chest) Age listed as mean ± SD unless otherwise indicated.

BABE = Bug and Bag Effort; bpm = beats per minute; CALER = Cart and Load Effort Rating; CERT = Children’s Effort Rating Table; F = females; HR = heart rate; HRmax = maximum heart rate; M = males; OMNI = OMNI scale; PCERT = Pictorial version of the Children’s Effort Rating Table; PO = power output; RPE 6-20 = rating scale of perceived ˙ 2 = oxygen uptake; VO ˙ 2max = maximal oxygen uptake. VT = ventilatory threshold. exertion; VO

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a

922

er, HR and power output during the production trial were significantly lower than the corresponding measurements obtained in the estimation trial. Ward et al.,[50] Lamb[42] and Eston et al.[8] also confirmed that children in this age range have some ability to perceptually discriminate various levels of exertion during production trials. Using a cycling protocol, Ward et al.[50] found that the percentage of peak aerobic power and percentage of predicted maximal HR increased significantly across four different Borg 6-20 RPE production trials (RPE 7, 10, 13 and 16). However, a similar response for velocity and percentage of predicted maximal HR were not observed in a walk/run trial.[50] There also were significant variations in the slope and intercept of the RPE-HR relationship between the estimation trial and both production trials.[50] Lamb[42] observed that power output during production trials differed significantly across four different CERT (3, 5, 7 and 9) and Borg 6-20 RPE (8, 12, 15 and 18) levels. HR also differed between perceived exertion levels with the exception of the HR between the two highest levels on each scale. Significant correlations between HR and power output were apparent for both scales, although the correlations involving the Borg 6-20 RPE scale tended to run higher than with the CERT,[42] a surprising finding considering that the CERT is designed for use with children. Based on this information, it appears that children of this age can discriminate up to four intensities during cycle exercise.[16,42,49,50] This finding is in line with Piaget[20] who observed that most 8-yearold children are able to accurately rate together more than three objects of different sizes. The author also reported that at the end of the concrete operations period, the level of psychological development allows the children to understand the constancy of the sizes. Indeed, the children of this age group are able to determine a ‘standard perception’ (e.g. item ‘tired’ in the OMNI-scale of Robertson et al.[5]) that allows from this standard perception to compare and to rate different perceptions (e.g. not tired at all, a little tired or very, very tired). Thus, the type of rating scales and the verbal and pictorial descriptors influence the perceptual responsiveness.  2006 Adis Data Information BV. All rights reserved.

Groslambert & Mahon

4. The Formal Intelligence Period: 13–18 Years The adolescent period corresponds to the beginning of the logical-mathematic meaning. Adolescents are progressively able to make hypotheses or to understand different mathematical concepts (table III).[20] Thus, children in this age range should have the cognitive ability to understand and accurately rate perceived exertion using the Borg 6-20 RPE scale.[3] However, the RPE-HR relationship found in this age group during a maximal incremental cycling exercise tends to be slightly lower (r = 0.74–0.87)[36-38] than the relationship observed in adults (r = 0.89–0.95).[39,40] This result may be due, such as in children, to the RPE-HR ratio that is not adapted for adolescents. In addition, Pfeiffer et al.[55] reported in adolescent girls very significant OMNI˙ 2max (r = 0.89) %HRmax (r = 0.86) and OMNI-%VO correlations, compared with the Borg 6-20 RPE˙ 2max (r %HRmax (r = 0.66) and Borg 6-20 RPE-%VO = 0.70) correlations. The intraclass and single-trial reliability estimates were higher for the OMNI (r = 0.95 and 0.91, respectively) compared with the Borg scale (r = 0.78 and 0.64). The authors concluded that the OMNI scale is more valid and reliable than the Borg 6-20 RPE scale for use in adolescent girls during treadmill exercise. The comparison of the correlations assessed in the study by Pfeiffer et al.[55] in adolescents girls (r = 0.89 and 0.86) and by Utter et al.[6] in 10-year-old children (r = 0.41–0.60 for ˙ 2max), suggest that cardiorespiratory facRPE-%VO tors involved in perceived exertion may increase in relation to aging. This finding has been recently reported by Yelling et al.[9] who observed that during estimation stepping trials using the PCERT, at each intensity level the RPE-HR relationships were higher in adolescents aged 15.3 years (r = 0.26–0.87) compared with children aged 12.4 years (r = 0.21–0.66). The RPE of adolescents also is affected by the protocol used. Marinov et al.[57] compared the RPE of adolescents at the end of a Balke and a Bruce protocol. The Balke protocol involves walking up progressively steeper grades while the Bruce protocol usually requires subjects to run. In this study, ˙ 2 was lower on the Balke (34.2 ± 1.8 mL/ peak VO min/kg) versus the Bruce (48.6 ± 2.7 mL/min/kg) Sports Med 2006; 36 (11)

Study

Subjects (sex and age)a 50 children (25 M; 25 F; 10y) 50 adolescents (25 M; 25 F; 13y)

Rating scale CR-10 (overall)

Protocol

Results

Run (treadmill)

Estimation (submaximal test – Balke protocol)

RPE at peak exercise was higher (p < 0.05) in the adolescents (5.5 ± 1.4) vs the children (4.6 ± 0.9)

Marinov et al.[57]

60 adolescents (13.3 ± 0.2y)

CR-10 (overall)

Run (treadmill)

Estimation (Balke and Bruce protocols)

RPE was higher (p < 0.05) at peak exercise on the Bruce protocol (6.5 ± 0.4) vs the Balke protocol (4.5 ± 0.8)


18 adolescents (10 M; 8 F; 13.5 ± 1y)

RPE-C

Handgrip force

Estimation (test and randomised re-test at RPE-C = 7-11-15-19)

The RPE-handgrip force relationship was r2 = 0.53 (p < 0.0001) on the test and r2 = 0.48 (p < 0.0001) on the randomised re-test


12 adolescents (6 M; 6 F; 14.5 ± 1y)

RPE-C

Running (track)

Estimation

The RPE-HR relationship was r2 = 0.72 (p < 0.0001)

Pfeiffer et al.[55]

57 adolescents (57 F; 15.3 ± 1.5y)

OMNIscale, RPE 6-20

Walking, walking uphill and jogging (treadmill)

Estimation (maximal graded test)

Correlations between RPE and %HRmax and RPE and ˙ 2max were r = 0.86 and 0.89 (p < 0.05), %VO respectively. For RPE 6-20 the same correlations were r = 0.66 and 0.70 (p < 0.05), respectively

Yelling at al.[9]

24 adolescents (12 M; 15.3 ± 0.3y and 12 F; 15.3 ± 0.2y)

PCERT

Stepping

Estimation (4 exercise intensities) randomised production at PCERT 3-5-7 and 9

During the estimation trials at each intensity level the RPE-HR relationships were r = 0.66–0.87 (p < 0.05 at exercise level 1-2-3-4) for F and r = 0.26–0.52 (p < 0.05 only at intensity 1) for M During the production trials, HR and PO were different (p < 0.01) from the preceding level. Both variables were lower (p < 0.001) in adolescents compared with children aged 12.2y

Eakin et al.[38]

15 adolescents (8 M; 7 F; 13.3 ± 2.3y)

RPE 6-20

Walk/run (treadmill)


The correlation between HR and RPE was r = 0.87 (p ˙ 2 and RPE < 0.001) and r = 0.85 (p < 0.01) for VO

Eston and Williams[36]

30 adolescents (30 M; 16.0 ± 1.0y)

RPE 6-20 (overall)

Cycle (ergometer)

Estimation (maximal graded test corresponding to PO at 30-60-90% of predicted ˙ 2max) VO

The RPE-PO relationship was r = 0.78 (p < 0.01) and the RPE-HR relationship was r = 0.74 (p < 0.01)

Marinov et al.[56]

a

Age listed as mean ± SD unless otherwise indicated.

CR-10 = Category Rating 10; F = females; HR = heart rate; HRmax = maximum (age-related) heart rate; M = males; OMNI = OMNI scale; PCERT = Pictorial version of the ˙ 2max = ˙ 2 = oxygen uptake; VO Children’s Effort Rating Table; PO = power output; RPE-C = rating of perceived exertion in children; RPE 6-20 = rating scale of perceived exertion; VO maximal oxygen uptake.

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Exercise mode



Table III. Publications involving rating of perceived exertion (RPE) in 13- to 18-year-old adolescents

924

Groslambert & Mahon

protocol. However RPE, using the CR-10 scale, was significantly lower in the Balke protocol (4.5 ± 0.8) compared with the Bruce test (6.5 ± 0.4). The Balke protocol also averaged nearly 7 minutes longer to complete. Although the RPE values from both tests seem low for maximal level of exertion, the variation in RPE between protocols might have been due to the differing modes of exercise. A similar difference between the walking and running tests was noted by Mahon and Ray[47] in slightly younger children. It is also possible that RPE differences were due to the fact that different groups of children performed the tests, so in essence the difference between the two protocols represents not only a protocol difference, but also a subject difference. From these few observations, it seems that the cardiorespiratory factors involved in perceived exertion may increase in relation to aging. In addition, it appears that the Borg 6-20 RPE-HR relationship in adolescents is less pronounced than adults and RPE values may be influenced by the mode of protocol used. Alternatively, the OMNI scale seems to be more tightly coupled to physiological measures of strain than the Borg 6-20 scale in this age group. Surprisingly, little else is known about the RPE responses in adolescents and more research is needed to better understand the perceptual responses and the optimal rating scale to use in this age group. This is significant given that adolescence is usually a time when a child’s level of physical activity begins to decline.[58] Knowledge of a child’s perception of exercise and the physiological factors mediating perceived exertion in this age group and how it might change with further maturation may be important in promoting healthy physical activity and exercise recommendations.[59] 5. Middle-Aged (50–65 Years) and Elderly Persons (>65 Years) Bar-Or et al.,[60] using the Borg 6-20 scale, reported a good linearity and significant correlation (r = 0.77–0.80) between RPE and HR (table IV). However, it has been found that the age-related decline in maximal HR[23] would imply that the RPE-HR relationship also might change with age.[61] Bar-Or et al.[60] reported in 41- to 61-year-old subjects that when comparisons are made at the absolute exercise ˙ 2 or power intensity (i.e. the same work rate, VO  2006 Adis Data Information BV. All rights reserved.

output), RPE is generally lower in young than in middle-aged persons. Nevertheless, when comparisons are made at the same relative exercise intensity ˙ 2max), no significant difference of per(i.e. %VO ceived exertion was found between young and 50- to 65-year-old healthy persons.[61,62] In addition, Ceci and Hassmen[63] observed that healthy 33- to 65-year-old men were able to accurately discriminate three running exercise intensities confirming the use of RPE as a means of regulating exercise intensity in this population. With aging, some authors have reported that cerebral flow will diminish, which may lead to a decrease in cognitive functions that may affect perceived exertion in elderly persons.[24,25] To our best knowledge, only four studies carried out on perceived exertion have been performed in elderly persons. Borg and Linderholm[22] reported in 18- to 79year-old healthy male subjects that HR at a given rating decreased with increasing age. More recently, Shigematsu et al.[67] reported a very strong RPE-HR relationship (r = 0.95) in elderly women (75.5 years) during a maximal graded cycle ergometer test. A recent study involving physically deconditioned persons 75.2 years of age showed no significant relationship between RPE and HR during the course of a graded arm test to maximal exertion.[68] However, following 6 weeks of arm training, a significant HR-RPE relationship was found in most of the subjects. This result suggests that training may have increased the subject’s ability to detect muscular sensations and the ability to utilise these sensory cues in the perception of effort. In addition, physical exercise may enhance cerebral perfusion and oxygen delivery, and also increase the level of essential neurotransmitter (serotonin, noradrenaline [norepinephrine] and dopamine) responsible for memory capacities.[69] Finally, Dunbar and Kalinski[66] reported that 70-year-old women can accurately use RPE to regulate exercise intensity during a 20-week training programme. However, at intensities >40% ˙ 2max, an acclimation period is needed. Thereof VO fore, according to Hughes et al.,[70] it may be possible that in elderly persons, perceived exertion is more affected by the physical fitness and the health status of the subject than by aging alone. Sports Med 2006; 36 (11)

Study

Rating scale RPE 6-20 (overall)

Exercise mode

Protocol

Results

Cycling (ergometer) and running (treadmill)


The correlation between RPE and HR was r = 0.77–0.80 during cycling and running, respectively

Aminoff et al.[61]

10 adults (10 M; 26.3 ± 2.3y) 9 older adults (9 M; 56.9 ± 1.5y)

RPE 6-20 (overall)

1- and 2-arm cranking, 2-leg cycle (ergometer)


There was no significant age effect in RPE at peak exercise across the three modes of exercise

Aminoff et al.[64]

10 young adults (10 M; 26.3 ± 2.3y) 9 older adults (9 M; 56.9 ± 1.5y)

RPE 6-20 (overall)

2-arm cranking and 2-leg cycling Cycle (ergometer)

Estimation (30 min at ˙ 2max 50% and 75% of VO for both modes of exercise)

Both HR and RPE increased significantly (p < 0.01 and p < 0.001, respectively) during all the tests. The increases in HR and RPE were similar for both age groups

Ceci and Hassmen[63]

11 healthy adults (11 M; 42.9 ± 11y; range 33–65y)

RPE 6-20

Running on (treadmill and track)

3 production trials at RPE intensity 11–13 and 15 performed on treadmill and in track conditions

HR, blood lactate and running velocity were significantly different between the 3 RPE intensities and between the two running conditions

Miller et al.[23]

202 elderly adults (97 M; 64.3y and 105 F; 64.8y)

RPE 6-20

Walking

Estimation (timed 600m walk, 2 min on-the-spot walk)

Sidney and Shephard[62]

56 elderly adults (26 M; 65.2 ± 5.4y and 30 F; 64.8 ± 4.3y)

RPE 6-20 (overall)

Cycle (ergometer), walk (treadmill)

Estimation (submaximal exercise at 90% of aerobic power)

For M, the HR-RPE correlation was r = 0.25 (p < 0.05) in 2 min on-the-spot walk and there was no significant correlation with 600m walk (r = 0.17). For F, the HRRPE correlation was r = 0.43 (p < 0.002) for 2 min onthe-spot walk and r = 0.48 (p < 0.0003) in 600m walk. HR is a better indicator of dangerous stress than perceived exertion. F are more acute than M to rate their perception in relation to HR ˙ 2 in F vs M and RPE was higher at a given HR and VO older vs younger subjects (previous studies). Differences abated when RPE was related to ˙ 2max. Endurance training decreased HR at a given %VO work load, but did not affect RPE in elderly subjects

Grant et al.[65]

12 elderly adults (6 M; 6 F; 68 ± 7.0y)

RPE 6-20 (overall)

Running on treadmill, walking and aerobic dancing

Estimation (maximal graded test, aerobic dance and walking)

Aerobic dance was performed at 67 ± 17% of peak ˙ 2 and 74 ± 12% of HRmax, which corresponded to VO an RPE of 11 ± 2. Walking was performed at 52 ± 10% ˙ 2 (60 ± 8% of HRmax), which corresponded to peak VO an RPE of 10 ± 2

Borg and Linderholm[22]

61 lumber workers (61 M; 45y; range 27– 63y) Mixed group (213 M; range 18–79y)

RPE 21 points

Cycle ergometer

Estimation at 0, 300, 600, 900, 1200, 1500 (kpm/min), 6 min/wk

In the lumber working group, HR at the same work intensity decreased with decreasing age, while RPE was quite constant. In the mixed group, HR at the same work intensity was quite constant, while RPE increased with increasing aging. In both groups, HR at equal rating decreased with increasing age

Bar-Or et al.[60]

Continued next page

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Subjects (sex and age)a 70 adults (M; range 41–60y)



Table IV. Publications involving rating of perceived exertion (RPE) in 54- to 75-year-old adults


Age listed as mean ± SD unless otherwise indicated. a

F = females; HR = heart rate; HRmax = maximum (age-related) heart rate; M = males; RPE 21 points = rating scale of perceived exertion 21 points; RPE 6-20 = rating scale of ˙ 2max = maximal oxygen uptake. ˙ 2 = oxygen uptake; VO perceived exertion; VO

˙ 2 ranged Individual correlation between RPE and VO from r = 0.774–0998. In middle-aged subjects, the ˙ 2-RPE and HR-RPE correlations were r = mean VO 0.963 and 0.964 (p < 0.05), respectively. In the older subjects the mean correlations were r = 0.954 and 0.956 (p < 0.05), respectively Estimation (maximal graded test) Cycle ergometer Shigematsu et al.[67]

RPE 6-20

˙ 2max) At week 2 of the training programme (40% of VO the mean HR produced did not differ from target HR. ˙ 2max), During weeks 4–10 (target 50% and 60% of VO the mean HR produced was < target HR (p < 0.05). At ˙ 2max), the mean HR produced week 20 (target 80% VO did not differ from target HR Estimation: cycle ergometer (maximal graded test). Production of exercise intensity during a 20wk training programme performed at target RPE = to 40%, 50%, 60% and 80% ˙ 2max VO Treadmills, stairclimbing, cycle ergometer Dunbar and Kalinski[66]

24 middle-aged adults (24 F; 46.9 ± 7.0y) 29 elderly adults (29 F; 75.59 ± 3.8y)

Results Protocol

Rating scale RPE 6-20 Subjects (sex and age)a 6 elderly adults (6 F; 70 ± 7.1y)

Exercise mode

Groslambert & Mahon

Study

Table IV. Contd

926

Overall, these findings suggest that there is a good linearity between RPE and HR in middle-aged and elderly healthy persons. In addition, when comparisons are made at the same relative exercise intensity, no significant difference of perceived exertion was found between young and 50- to 75-yearold healthy persons. Furthermore, when the level of aerobic fitness is controlled, age differences in perceptual responsiveness may be not present. In summary, RPE is not impaired by aging in healthy middle-aged and elderly persons and could be associated with HR as a useful tool for the monitoring and prescription of exercise. 6. Conclusions RPE appears to be a cognitive function that reflects a long and progressive developmental process from 4 years of age to adult. Before 4 years, children are not able to rate their perceived exertion with a high degree of accuracy. From 4 years, it seems that the peripheral cues provided from muscles and joints are at first involved in perceived exertion. After 5 years, the cardio-respiratory factors are progressively involved and allow 6-year-old children to estimate and produce accurately three levels of running intensity from their perceived exertion. From 8 to 12 years of age, children are able to discriminate up to four levels of exertion but are sensitive to the exercise mode and also the rating scale used. In adolescents, it appears that the RPE-HR correlation is less pronounced than adults and RPE values are influenced, like in children, by the mode of protocol used. In middle-aged and elderly healthy persons, RPE is not impaired by aging and could be associated with HR as a useful tool to control exercise intensity. While much is known about 8- to 12-yearold children, more research is needed to better understand the perceived exertion developmental steps in 4- to 7-year-old children, but also in adolescents and elderly persons. Further research involving these different populations is recommended. Acknowledgements No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this manuscript.

Sports Med 2006; 36 (11)


References 1. Noble BJ, Robertson RJ. Perceived exertion. Champaign (IL): Human Kinetics, 1996 2. Borg GV. Perceived exertion and pain scales. Champaign (IL): Human Kinetics, 1998 3. Borg GV. Perceived exertion as an indicator of somatic stress. Scand J Rehabil Med 1970; 2: 92-8 4. Williams JG, Eston RG, Furlong B. CERT: a perceived exertion scale for young children. Percept Mot Skills 1994; 79: 1451-8 5. Robertson RJ, Goss FL, Boer NF, et al. Children’s OMNI scale of perceived exertion: mixed gender and race validation. Med Sci Sports Exerc 2000; 32: 452-8 6. Utter AC, Robertson RJ, Nieman DC, et al. Children’s OMNI scale of perceived exertion: walking/running evaluation. Med Sci Sports Exerc 2002; 34: 139-44 7. Robertson RJ, Goss FL, Andreaci JL, et al. Validation of children’s OMNI RPE scale for stepping exercise. Med Sci Sports Exerc 2005, 298 8. Eston RG, Parfitt G, Campbell L, et al. Reliability of effort perception for regulating exercise intensity in children using a Cart and Load Effort Rating (CALER) scale. Pediatr Exerc Sci 2000; 12: 338-97 9. Yelling M, Lamb KL, Swaine IL. Validity of a pictorial perceived exertion scale for effort estimation and effort production during stepping exercise in adolescent children. Euro Phys Educ Rev 2002; 8: 157-75 10. Eston RG, Parfitt G, Shepherd P. Effort perception in children: implications for validity and reliability. In: Papaionnou A, Goudas M, Theodorakis Y, editors. Proceedings of 10th World Congress of Sport Psychology. Vol. 5. 2001 May 28-Jun 2; Skiathos, Greece, 104-6 11. Groslambert A, Hintzy F, Hoffman MD, et al. Validation of a rating scale of perceived exertion in young children. Int J Sports Med 2001; 22: 116-9 12. Eston RG, Parfitt CG. Perceived exertion. In: Armstrong N, editor. Paediatric Exercise Physiology. London: Elsevier, 2006 13. Mihevic PM. Sensory cues for perceived exertion: a review. Med Sci Sports Exerc 1981; 13: 150-63 14. Ulmer HV. Concept of extracellular regulation of muscular metabolic rate during heavy exercise in humans by psychological feedback. Experientia 1996; 52: 416-20 15. Hampson D, Saint Clair Gibson A, Lambert MI, et al. The influence of sensory cues on the perception of exertion during exercise and central regulation of exercise performance. Sports Med 2001; 31: 935-52 16. Robertson RJ, Goss FL, Bell JA, et al. Self-regulated cycling using the children’s OMNI Scale of Perceived Exertion. Med Sci Sports Exerc 2002; 34: 1168-75 17. Van Den Burg M, Ceci R. A comparison of a psychophysical estimation and a production method in a laboratory and in a field condition. In: Borg G, Ottoson D, editors. The perception of effort in physical work. London: Macmillon Publisher Inc., 1986: 35-46 18. Robertson R, Goss R, Auble T, et al. Cross-modal exercise prescription at absolute and relative oxygen uptake using perceived exertion. Med Sci Sports Exerc 1990; 22: 653-9 19. Dunbar C, Robertson R, Baun R, et al. The validity of regulating exercise intensity by ratings of perceived exertion. Med Sci Sports Exerc 1992; 24: 94-9 20. Piaget J. La Psychologie de l’Intelligence. Paris: Armand Colin, 1966 21. Poortmans J. Recovery in elderly persons. In: Rieu M, Bailliere JB, editors. Recovery and physical aptitudes. Paris: MD Communication, 2001: 77-9 22. Borg GV, Linderholm H. Perceived exertion and pulse rate during graded exercise in various age group. Acta Med Scand 1967; 472: 194-204


927

23. Miller GD, Bell RD, Collis ML, et al. The relationship between perceived exertion and heart rate of post 50 year-old volunteers in two different walking activites. J Hum Mov Stud 1985; 11: 187-95 24. Boutcher SH. Cognitive performance, fitness, and aging. In: Biddle SJH, Fox KR, Boutcher SH, editors. Physical activity and psychological well-being. London: Routledge, 2000: 118-30 25. Chodzko-Zazko WJ, Moore KA. Physical fitness and cognitive functioning in aging. Exerc Sports Sci Rev 1994; 22: 195-22 26. Defrasne E. Developmental study of hand grip and perceived exertion in children [dissertation in French]. Besan¸con: DEA Psychology, University of Franche-Comt´e, 2003 27. Groslambert A, Nachon M, Rouillon JD. Influence of the age on self-regulation of static grip forces from perceived exertion values. Neurosci Lett 2002; 325: 52-6 28. Groslambert A, Monnier-Benoit P, Grange CC, et al. Selfregulation running by using perceived exertion in 5-7 year old children. J Sports Med Phys Fitness 2005; 45: 20-5 29. Eston RG, Lamb KL. Effort perception. In: Armstrong N, van Mechelen W, editors. Paediatric exercise science and medicine. Oxford: Oxford University Press, 2000: 85-91 30. Bar Or O. Age related changes in exercise perception. In: Borg GV, editor. Physical work and effort. New York: Pergamon Press, 1977: 33-49 31. Duncan GE, Mahon AD, Gay JA, et al. Physiological and perceptual responses to graded treadmill and cycle exercise in male-children. Pediatr Exerc Sci 1996; 8: 251-8 32. Mahon AD, Marsh ML. Reliability of rating of perceived exertion relative to ventilatory threshold in children. Int J Sports Med 1992; 13: 567-71 33. Mahon AD, Duncan GE, Howe CA, et al. Blood lactate and perceived exertion relative to ventilatory threshold: boys versus men. Med Sci Sports Exerc 1997; 29: 1332-7 34. Mahon AD, Gay JA, Stolen KQ. Differentiated ratings of perceived exertion at ventilatory threshold in children and adults. Eur J Appl Physiol Occup Physiol 1998; 78: 115-20 35. Lamb KL. Children’s ratings of effort during cycle ergometry and examination of the validity of two effort rating scales. Pediatr Exerc Sci 1995; 7: 107-21 36. Eston RG, Williams JG. Exercise intensity and perceived exertion in adolescent boys. Br J Sports Med 1986; 20: 27-30 37. Alekseev VM. Correlation between heart rate and subjectively perceived exertion during muscular work. Hum Physiol 1989; 15: 39-44 38. Eakin BL, Finta KM, Serwer GA, et al. Perceived exertion and exercise intensity in children with and without structural heart defects. J Pediatr 1992; 120: 90-3 39. Skinner JS, Hustler R, Bergsteinova V, et al. The validity and reliability of a rating scale of perceived exertion. Med Sci Sports Exerc 1973; 5: 97-103 40. Gamberale F. Perceived exertion, heart rate, oxygen uptake and blood lactate in different work operations. Ergonomics 1972; 15: 545-4 41. Robertson RJ, Goss FL, Dub´e J, et al. Validation of the adult OMNI scale of perceived exertion for cycle ergometer exercise. Med Sci Sports Exerc 2004; 36: 102-8 42. Lamb KL. Exercise regulation during cycle ergometry using the children’s effort rating table (CERT) and rating of perceived exertion (RPE) scales. Pediatr Exerc Sci 1996; 8: 337-50 43. Lamb KL, Eston RG. Effort perception in children. Sports Med 1997; 23: 139-48 44. Eston RG, Lamb KL, Williams AM, et al. Validity of a perceived exertion scale for children: a pilot study. Percept Mot Skills 1994; 78: 691-7

Sports Med 2006; 36 (11)

928

45. Robertson RJ, Goss FL, Boer N, et al. OMNI scale perceived exertion at ventilatory breakpoint in children: response normalized. Med Sci Sports Exerc 2001; 33: 1946-52 46. Mahon AD, Plank DM, Hipp MJ. The influence of exercise test protocol on perceived exertion at submaximal exercise intensities in children. Can J Appl Physiol 2003; 28: 53-63 47. Mahon AD, Ray ML. Ratings of perceived exertion at maximal exercise in children performing different graded exercise test. J Sports Med Phys Fitness 1995; 35: 38-42

Groslambert & Mahon

60. Bar-Or O, Skinner JS, Buskirk ER, et al. Physiological and perceptual indicators of physical stress in 41-60 year-old-men who vary in conditioning level and body fatness. Med Sci Sports 1972; 2: 96-100 61. Aminoff T, Smolander J, Korhonen O, et al. Physical work capacity in dynamic exercise with differing muscle masses in healthy young and older men. Eur J Appl Physiol 1996; 73: 180-5

48. Mahon AD, Stolen KQ, Gay JA. Differentiated perceived exertion during submaximal exercise in children and adults. Pediatr Exerc Sci 2001; 13: 145-53

62. Sidney SH, Shephard RJ. Perception of exertion in the elderly, effects of aging, mode of exercise and physical training. Percept Mot Skills 1977; 44: 999-1010

49. Williams JG, Eston RG, Strech C. Use of perceived exertion to control exercise intensity in children. Pediatr Exerc Sci 1991; 3: 21-7

63. Ceci R, Hassmen P. Self-monitored exercise at three different intensities in treadmill vs field running. Med Sci Sports Exerc 1991; 23: 732-8

50. Ward DS, Jackman JD, Galiano FJ. Exercise intensity reproduction: children versus adults. Pediatr Exerc Sci 1991; 3: 209-18

64. Aminoff T, Smolander J, Korhonen O, et al. Cardiorespiratory and subjective responses to prolonged arm and leg exercise in healthy young and older men. Eur J Appl Physiol 1997; 75: 363-8

51. Ueda T, Kurokawa T. Validity of heart rate and ratings of perceived exertion as indices of exercise intensity in a group of children while swimming. Eur J Appl Physiol 1991; 63: 200-4 52. Ueda T, Choi TH, Kurokawa T. Ratings of perceived exertion in a group of children while swimming at different temperatures. Ann Physiol Anthropol 1994; 13: 23-31 53. Gillach MC, Sallis JF, Buono ML. The relationship between perceived exertion and heart rate in children and adults. Pediatr Exerc Sci 1989; 1: 360-8 54. Rutkowski J, Robertson RJ, Tseh W, et al. Assessment of RPE signal dominance at slow-to-moderate walking speeds in children using the OMNI perceived exertion scale. Pediatr Exerc Sci 2004; 16: 334-42 55. Pfeiffer KA, Pivarnik JM, Womack CJ, et al. Reliability and validity of the Borg and OMNI rating of perceived exertion scales in adolescent girls. Med Sci Sports Exerc 2002; 34: 2057-61 56. Marinov B, Kostianev S, Turnovska T. Ventilatory response to exercise and rating of perceived exertion in two pediatric age groups. Acta Physiol Pharmacol Bulg 2000; 25: 93-8 57. Marinov B, Kostianev S, Turnovska T. Modified treadmill protocol for evaluation of physical fitness in pediatric age group-comparison with Bruce and Balke protocols. Acta Physiol Pharmacol Bulg 2003; 27: 47-51 58. Sallis JF. A North American perspective on physical activity research in children and adolescents. In: Blimkie CJR, Bar-Or O, editors. New horizons in pediatric exercise science. Champaign (IL): Human Kinetics Publishers Inc., 1995: 221-34 59. Eston RG. A discussion of the concepts: exercise intensity and perceived exertion with reference to the secondary school. Phys Educ Rev 1984; 7: 19-25


65. Grant S, Corbett K, Davies C, et al. Comparison of physiological responses and rating of perceived exertion in two modes of aerobic exercise in men and women over 50 years of age. Br J Sports Med 2002; 36: 276-80 66. Dunbar CC, Kalinski MI. Using RPE to regulate exercise intensity during a 20-week training program for postmenopausal women: a pilot study. Percept Mot Skills 2004; 99: 688-90 67. Shigematsu R, Ueno LM, Nakagaichi M, et al. Rate of perceived exertion as a tool to monitor cycling exercise intensity in older adults. J Aging Phys Act 2004; 12: 3-9 68. Grange CC, Maire J, Groslambert A, et al. Perceived exertion and rehabilitation with arm crank in elderly patients after total hip arthroplasty: a preliminary study. J Rehabil Res Dev 2004; 41: 611-20 69. Fabre C, Chamari K, Mucci P, et al. Improvement of cognitive function by mental and/or individualized aerobic training in healthy elderly subjects. Int J Sports Med 2002; 23: 415-21 70. Hughes JR, Crow RS, Jacobs DR, et al. Physical activity, smoking, and exercise induced fatigue. J Behav Med 1984; 7: 217-30

Correspondence and offprints: Dr Alain Groslambert, Laboratory of Sport Sciences, place Saint Jacques, Bat. Bichat, 25030 Besan¸con, France. E-mail: [email protected]

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