An evaluation of training responses using self-regulation in a residential rehabilitation program

The efficacy of exercise training for patients with cardiovascular disease is well established. Given recent changes in reimbursement patterns for cardiac rehabilitation and therefore a greater need for self-monitoring, home programs, and the like, a need exists to determine the capability of patients to regulate their own exercise intensity and assess the efficacy of self-regulated exercise. This study assessed the training responses of a group instructed to train at an intensity they perceived as "somewhat hard," and compared their responses to standardized methods of exercise prescription.

A total of 78 patients (86% male; mean age, 56 +/- 10 years; mean ejection fraction, 64% +/- 12%) referred to a residential rehabilitation program after myocardial infarction or bypass surgery were randomized to three different groups, for which exercise intensity was prescribed using different methods. For group 1, 70% of heart rate reserve was maintained using precise, continuous electronic heart rate-controlled resistance on a cycle ergometer. Group 2 gauged their own exercise intensity according to a level they perceived as "somewhat hard" (13 on the Borg scale) and were given no feedback in terms of heart rate or work rate. For group 3, exercise intensity was determined using both objective (heart rate reserve and work rate targeted to 60% to 80% of maximal exercise) and subjective (Borg scale 12 to 14) indices. The subjects exercised daily for 1 month. Training frequency, duration, and mode were equivalent between the groups.

The exercise capacity of the three groups was increased significantly after the training period: 33.7% in group 1, 22.9% in group 2, and 31.2% in group 3 (P <.005 for all). Other measures of the training response also were similar between the groups, including a significant increase in work rate at a perceived exertion of 13 and maximal watts achieved. The magnitude of the training response was not different between the groups. There were no complications during training.

The training response was similar between the three methods used to monitor exercise intensity. Thus, patients are able to gauge their own exercise intensity reasonably when instructed to exercise at a perceived exertion of 13. This suggests that close heart rate monitoring may not always be necessary for many stable patients with cardiovascular disease to achieve the benefits of a rehabilitation program.