Chris L. Wells, PhD, PT, CCS, ATC
How hard should you push yourself? Is that activity safe for you to complete? Are you getting the most from your exercise program? These are common questions my clients pose to me during their rehabilitation. Much of my time with clients is spent teaching them how to monitor themselves to safely complete various activities and exercise on their own.
When you work with a health care professional like a physical therapist, rehabilitation nurse, or an exercise physiologist time is spent monitoring your heart rate, blood pressure, and oxygen levels at rest and during exertion. They are determining if your heart, lungs, blood vessels and muscles are appropriately responding to the work. It is expected to see heart rate and systolic blood pressure (top number) rise with exertion. Blood oxygen levels should remain above 90% and if they fall below 90% the body is not receiving proper oxygen supplies (a condition called desaturation).
Another key benefit of working with an exercise specialist is to learn how to use a subjective scale to begin to monitor your physical condition. Your physical condition can be monitored by such things as your heart rate and blood pressure. Both increase with exertion and may trigger your perception of how hard your body is working to complete the activity. Ideally the relationship between how your body responds physically, how hard the activity is to complete and your perception of the energy you are using are associated with one another. Once you can understand how your body responds physically, you may be able to use a subjective scale to rate how much energy your body is using. Then the therapist can begin to reduce the medical monitoring and help you become more independent.
There are many types of subjective scales that you can use to monitor yourself. Based upon your symptoms the therapist can select the most appropriate scale for your use. There are scales that focus on level of shortness of breath, leg pain, angina (chest pressure or discomfort), and how hard you are working.
Using a subjective scale while you complete various activities like laundry, mowing the lawn, playing golf, swimming and walking can allow you to listen to your body, adjust how you exercise, or detect if something may not be right with your body. Another benefit of using a subjective scale is that you or with help from your therapist can objectively identify activities that may be too difficult or unsafe to engage in like jogging or mowing your lawn. This may imply you should avoid these stressful activities or begin to learn how to modify to allow you to complete the task with less stress to your body and keep you more active and independent. Finally, in my experience, when transplant candidates and recipients note a decrease in activity tolerance along with an increase in score on the subjective scale, it may be the first signs of an early infection or rejection. It is recommended to call your transplant coordinator or primary physician if you experience an increase in physical stress with activity. Many times this detection occurs prior to experiencing signs and symptoms at rest and permits early examination and treatment.
Below are two common subjective scales used during exercise along with a basic description for proper use. It is advised to talk to your therapist to receive proper instructions in the use of the scale. This should increase your safety during exercise and increase the benefits you gain by staying active.
Patient Education: Rate of Perceived Exertion
This is a scale to report how hard you feel your body is working. It is a scale that starts at 0 and ends at 10
“0” means that you are awake but not feeling any physical stress on your body while you sit or lay there.
“10” means you are under the most physical stress your body can take before your collapse
|0||Not working at all|
|.5||Just starting to notice the work|
|1||Work is a Very Light intensity|
|2||Work is a Light intensity|
|3||Work is a Moderate intensity|
|5||Work is Hard|
|7||Work is Very Hard|
|10||Extremely Hard “Strongest intensity”|
|*||Absolute maximum “Highest possible”|
This scale can be used during exercise. It is advised to work at an intensity that is a 2 to 3 out of 10.
This scale can also be used during daily activities to determine which activities you should complete or avoid. Most daily activities are light in intensity and it is advised to avoid activities that are very hard and unsafe. For example, while washing your dishes you feel you are working at a light intensity but carrying a laundry basket up the steps may be described as a “7” and be too hard for you to complete unless your doctor tells you it is safe.
Patient Education: Rate of Shortness of Breath
This is a scale to be able to report how hard you feel you are breathing.
It is a scale that starts at 0 and ends at 10
“0” means that you are awake but not feeling any shortness of breath at all. Your breathing is occurring without you thinking about it.
“10” means you are so short of breath, you need medical assistance to breathe
|0||Not short of breath at all|
|3||Moderately short of breath|
|5||Severely short of breath|
|7||Very severely short of breath|
|9||Very, Very severe|
|10||I can ‘t breath|
|*||Absolute maximum “Highest possible”|
This scale can be used during exercise. It is advised to work at an intensity that would cause a shortness of breath level of 2 to 3 out of 10.
This scale can also be used during daily activities to determine which activities you should complete or avoid. Most daily activities will cause you to feel slightly short of breath and it is advised to avoid activities that cause you to feel very severely short of breath. For example, while walking with a grocery cart you feel slightly short of breath but washing your car makes you feel very severely short of breath.