At our centre in London, Ontario, Canada we use the Modified Borg Scale of Perceived Exertion as a way to direct a patient's exercise program after heart transplantation. (scale 0-10) This is important since the denervated heart responds differently to activity. Specifically, the resting heart rate is increased, the peak heart rate is decreased and the rate at which the heart rate changes is decreased. If you set a "target heart rate" as your goal for exercise, you might have achieved it even before the patient starts to exercise(since resting heart rate is higher). Conversly, if you set a target heart rate rather high, the patient might never achieve it and instead appear as if he's not working hard enough. The most important question (we have found) is 'how hard are you working?'. This will also help you to modify your program during times of rejection (at these times, patient's rating of perceived exertion often go up as compared with previous days doing the same activity).
Our centre uses the Borg Scale for pre-op heart patients as well, since cardiac meds often affect the heart rate response.
Nancy
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