title: Validation of rate of perceived exertion-based exercise training in patients with heart failure: insights from autonomic nervous system adaptations.
abstract: BACKGROUND
  Exercise prescription in cardiac patients is based on heart rate (HR) response to exercise. How to prescribe long-term exercise training outside medically-supervised settings also considering changes in individual physical capacity over time is unknown. In this study we hypothesized that in patients with chronic heart failure (CHF) the session-rate of perceived exertion (RPE), a subjective-based training methodology, provides autonomic and functional capacity changes superimposable to those observed with HR-based Training Impulses (TRIMPi) method.
  
  
  METHODS
  Twenty patients with stable CHF were randomized to either aerobic continuous training (ACT) or aerobic interval training (AIT) for 12 weeks. For each TRIMPi-guided exercise session, the session-RPE was recorded. By this method, internal training load (TL) is quantified by multiplying the RPE of the whole training session, using the Borg CR10-scale, by its duration. Heart rate variability (HRV), and baroreflex sensitivity (BRS) were assessed at baseline and at 3 weeks intervals.
  
  
  RESULTS
  Significant correlations were found between TRIMPi and individual session-RPE, for both ACT and AIT (r=0.63 to 0.81), (P<0.05). The same occurred when ACT and AIT groups were pooled together (r=0.72; P<0.01). R-R interval, HRV and BRS were significantly and very highly correlated with weekly RPE-session (r(2) ranged from 0.77 to 0.97; P<0.001). A significant relationship between session-RPE and performance at the 6MWT was also found.
  
  
  CONCLUSIONS
  Session-RPE is an easy-to-use, inexpensive and valid method for exercise prescription and health maintenance, consistent with objective physiological indices of training, that could be used for long-term physical activity in patients with CHF.
authors.affiliation: Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Pisana, Roma, Italy; Dipartimento di Medicina dei Sistemi, Università Tor Vergata, Roma, Italy. Electronic address: iellamo@med.uniroma2.
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Iellamo
authors.affiliation: Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Pisana, Roma, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Manzi
authors.affiliation: Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Pisana, Roma, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Caminiti
authors.affiliation: Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Pisana, Roma, Italy.
authors.forename: Cristiana
authors.initials: C
authors.lastname: Vitale
authors.affiliation: Dipartimento di Medicina dei Sistemi, Università Tor Vergata, Roma, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Massaro
authors.affiliation: Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Pisana, Roma, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Cerrito
authors.affiliation: Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Pisana, Roma, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rosano
authors.affiliation: Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Pisana, Roma, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Volterrani
mesh_terms: D000222:Adaptation, Physiological / Q000502:physiology*; D000368:Aged; D001341:Autonomic Nervous System / Q000502:physiology; D017704:Baroreflex / Q000502:physiology*; D015444:Exercise / Q000502:physiology* / Q000523:psychology; D006333:Heart Failure / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010465:Perception / Q000502:physiology; D005082:Physical Exertion / Q000502:physiology*
keywords: Baroreflex sensitivity; Cardiac rehabilitation; Exercise training; Heart failure; Heart rate variability; Rate of perceived exertion