Borg Rating of Perceived Exertion (RPE)

The Borg Rating of Perceived Exertion (RPE) is a widely used outcome measure that evaluates a person’s subjective perception of physical exertion, breathlessness, and fatigue during exercise. The tool was developed by Gunnar Borg and has become a standard in clinical practice, research, and exercise prescription. The Borg scale is commonly used to assess exercise intensity in both healthy individuals and patients undergoing rehabilitation for various conditions【1】【2】.

Purpose

The primary purpose of the Borg RPE is to provide a simple and effective method for measuring perceived exercise intensity. This allows adjustments to activity levels based on subjective perception rather than objective physiological parameters such as heart rate or oxygen uptake【3】.

The Borg scale can be used across a wide range of patient populations, including those with:

• Cardiovascular disease

• Chronic Obstructive Pulmonary Disease (COPD)

• Parkinson’s disease

• Stroke

• Older adults【4】【5】

Versions and scoring

There are two main versions of the Borg RPE scale:

• Original scale (6–20):Designed to correlate with heart rate, where a score of 6 represents “no exertion” and 20 corresponds to “maximal exertion.” For example, a score of 13 (somewhat hard) corresponds approximately to a heart rate of 130 beats per minute【1】【6】.

• Modified CR-10 scale (0–10):Developed for more specific assessments such as breathlessness, muscle pain, or general fatigue. It is frequently applied in clinical settings, particularly for patients with respiratory or neurological conditions【7】【8】.

Advantages and limitations

Advantages

1. Universal applicability: Usable across age groups and patient populations, including children, adults, and older adults【9】.

2. Ease of administration: Requires minimal time and equipment—only a printed scale is needed【10】.

3. Cost-effective: Free for individuals, although larger organizations may be required to pay licensing fees【11】.

Limitations

• Subjectivity: Scoring may be influenced by individual differences in perception【12】.

• Language barriers: Instructions may be challenging for patients with cognitive or linguistic limitations【13】.

• Reduced validity in certain groups: Physiological prediction from the scale may be less reliable in specific populations, such as stroke patients【14】【15】.

Psychometric properties

Reliability

• High test–retest reliability has been demonstrated in older adults and neurological populations (ICC = 0.85–0.91)【16】.

• Consistent scores are observed across different assessment periods in healthy individuals【17】.

Validity

• Strong correlation with physiological parameters such as heart rate (r = 0.74–0.84), VO₂max, and blood lactate【18】.

• Cross-cultural validity confirmed in German, Japanese, and Chinese adaptations of the scale【19】【20】.

Applications

The Borg RPE scale has a broad range of applications:

• Clinical rehabilitation: Used to monitor exercise intensity in patients with COPD, Parkinson’s disease, and other chronic conditions【21】.

• Exercise prescription: Helps tailor training intensity in both sports and general fitness【22】.

• Research: Frequently used in studies evaluating subjective perception of physical activity【23】.

Examples of use

• Older adults: Used to monitor intensity and progression in physiotherapy programs【24】.

• Neurological conditions: In Parkinson’s disease, RPE correlates strongly with both heart rate and work rate (r = 0.61–0.77)【25】【26】.

• Children: Validity has been established in adolescents over 13 years, where the scale provides accurate estimates of exertion【27】.

Clinical recommendations

The Borg RPE scale is recommended by the American Thoracic Society and other professional organizations as a tool to evaluate exercise intensity and guide safe training protocols【28】. Correct communication of instructions is essential to ensure accurate scoring【29】.

Conclusion

The Borg Rating of Perceived Exertion (RPE) is a flexible, user-friendly, and validated instrument applicable in both clinical and non-clinical contexts. Despite certain limitations, such as subjectivity and potential language barriers, it remains an invaluable tool for healthcare professionals, researchers, and exercise specialists.

Sources:

1. Borg G. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377-381.

2. Williams N. The Borg Rating of Perceived Exertion (RPE) scale. Occupational Medicine. 2017;67(5):404-405. DOI: 10.1093/occmed/kqx063.

3. Chen MJ, Fan X, Moe ST. Criterion-related validity of the Borg ratings of perceived exertion scale in healthy individuals: a meta-analysis. J Sports Sci. 2002;20(11):873-899.

4. Philippa Svensson, Hellberg M, Zhou Y, Wisén A, Clyne N. The Borg scale is a sustainable method for prescribing and monitoring self-administered aerobic endurance exercise in patients with chronic kidney disease. European Journal of Physiotherapy. 2023;25(5):265-273.

5. Penko AL, Barkley JE, Koop MM, Alberts JL. Borg scale is valid for ratings of perceived exertion for individuals with Parkinson’s disease. International Journal of Exercise Science. 2017;10(1):76.

6. American College of Sports Medicine. ACSM's guidelines for exercise testing and prescription. Lippincott Williams & Wilkins; 2013.

7. Dawes HN et al. Borg’s Rating of Perceived Exertion Scales: Do the Verbal Anchors Mean the Same for Different Clinical Groups? Archives of Physical Medicine and Rehabilitation. 2005;86(5):912-916.

8. Karla R. Kendrick, Sunita C. Baxi, Robert M. Smith. The usefulness of the modified 0–10 Borg scale in assessing the degree of dyspnea in patients with COPD and asthma. Journal of Emergency Nursing. 2000;26(3):216-222.

9. Crytzer TM, Dicianno BE, Robertson RJ, Yu-Ting C. Validity of a wheelchair perceived exertion scale (Wheel Scale) for arm ergometry exercise in people with spina bifida. Perceptual & Motor Skills. 2015;120(1):304-322.

10. Marriott HE, Lamb KL. The use of ratings of perceived exertion for regulating exercise levels in rowing ergometry. European Journal of Applied Physiology. 1996;72(3):267-271.

11. Pollock BS, Barkley JE, Potenzini N, Desalvo RM, Buser SL, Otterstetter R. Validity of Borg ratings of perceived exertion during active video game play. International Journal of Exercise Science. 2013;6(2):164-170.

12. Lamb KL, Eston RG, Corns D. Reliability of ratings of perceived exertion during progressive treadmill exercise. British Journal of Sports Medicine. 1999;33:336–339.

13. Scherr J, Wolfarth B, Christle JW, Pressler A, Wagenpfeil S, Halle M. Associations between Borg’s rating of perceived exertion and physiological measures of exercise intensity. European Journal of Applied Physiology. 2013;113:147-155.

14. O’Neill ME, Cooper KA, Mills CM, Boyce ES, Hunyor SN. Accuracy of Borg's ratings of perceived exertion in the prediction of heart rates during pregnancy. British Journal of Sports Medicine. 1992;26(2):121-124.

15. Pfeiffer KA, Pivarnik JM, Womack CJ, Reeves MJ, Malina RM. Ratings of perceived exertion in braille: validity and reliability in production mode. Medicine and Science in Sports and Exercise. 2002;34:2057–2061.

16. Hommerding P, Donadio M, Paim T, Marostica P. The Borg scale is accurate in children and adolescents older than 9 years with cystic fibrosis. Respiratory Care. 2010;55(6):729-733.

17. Eston RG, Faulkner JA, Mason EA, Parfitt G. The validity of predicting maximal oxygen uptake from perceptually regulated graded exercise tests of different durations. European Journal of Applied Physiology. 2006;97:535–541.

18. Cabral LL, Lopes PB, Wolf R, Stefanello JMF, Pereira G. A systematic review of cross-cultural adaptation and validation of Borg’s rating of perceived exertion scale. Journal of Physical Education. 2017;28(2853):2448-2455.

19. Hampson DB, St Clair Gibson A, Lambert MI, Noakes TD. The influence of sensory cues on the perception of exertion during exercise and central regulation of exercise performance. Sports Medicine. 2001;31(13):935-952.

20. Eston RG, Williams JG. Exercise intensity and perceived exertion in adolescent boys. British Journal of Sports Medicine. 1986;20:27–30.

21. Eston RG, Williams JG. Reliability of ratings of perceived effort regulation of exercise intensity. British Journal of Sports Medicine. 1988;22(4):153–155.

22. Hampton S, Armstrong G, Ayyar MS, Li S. Quantification of Perceived Exertion During Isometric Force Production With the Borg Scale in Healthy Individuals and Patients With Chronic Stroke. Topics in Stroke Rehabilitation. 2014;21(1):33–39.

23. Shigematsu R, Ueno LM, Nakagaichi M, Nho H, Tanaka K. Rate of perceived exertion as a tool to monitor cycling exercise intensity in older adults. Journal of Aging and Physical Activity. 2004;11:3–9.

24. Gillach MC, Sallis JF, Buono MJ, Patterson P, Nader PR. The relationship between perceived exertion and heart rate in children and adults. Pediatric Exercise Science. 1989;1:360–368.

25. Karavatas SG, Tavakol K. Concurrent validity of Borg’s rating of perceived exertion in African-American young adults, employing heart rate as the standard. The Internet Journal of Allied Health Sciences and Practice. 2005;3(1).

26. Eng JJ, Chu KS, Dawson AS, Kim CM, Hepburn KE. Functional walk tests in individuals with stroke: Relation to perceived exertion and myocardial exertion. Stroke. 2002;33:756–761.

27. Crytzer TM, Dicianno BE, Robertson RJ, Yu-Ting C. Validity of a wheelchair perceived exertion scale (Wheel Scale) for arm ergometry exercise in people with spina bifida. Perceptual & Motor Skills. 2015;120(1):304–322.

28. Joo KC, Brubaker PH, MacDougall A, Saikin AM, Ross JH, Whaley MH. Exercise prescription using resting heart rate plus 20 or perceived exertion in cardiac rehabilitation. Journal of Cardiopulmonary Rehabilitation. 2004;24(3):178–184.