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The Borg Scale is a tool to measure a person’s perception of their effort and exertion, breathlessness, and fatigue during physical work.
11
15
5 minutes
Adolescents
13 - 18
yearsAdult
18 - 64
yearsOlder Adults
65 +
yearsInitially reviewed by Gayatri Mathur, PT; updated by Jill Smiley, MPH; reviewed by Patricia Kluding, PhD, PT of the StrokEdge task force, Neurology Section, APTA in 2010; updated by Jacqueline Kendona, 2016; updated by Dorian Rose, PhD, PT of the StrokEdge II task force, Neurology Section, APTA in 2017; updated by University of Illinois at Chicago Master of Science in Occupational Therapy students Gina Mulanthara, Annie Lee, and Chelsea Ebersole in 2018.
Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Stroke Taskforce (StrokEDGE), are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.
For detailed information about how recommendations were made, please visit: ANPT Outcome Measures Recommendations (EDGE)
Abbreviations: | |
HR | Highly Recommend |
R | Recommend |
LS / UR | Reasonable to use, but limited study in target group / Unable to Recommend |
NR | Not Recommended |
Recommendations for use based on acuity level of the patient:
| Acute (CVA < 2 months post) | Subacute (CVA 2 to 6 months) | Chronic (> 6 months) |
StrokEDGE | NR | R | R |
Recommendations based on level of care in which the assessment is taken:
| Acute Care | Inpatient Rehabilitation | Skilled Nursing Facility | Outpatient Rehabilitation | Home Health |
StrokEDGE | NR | R | R | R | R |
Recommendations for entry-level physical therapy education and use in research:
| Students should learn to administer this tool? (Y/N) | Students should be exposed to tool? (Y/N) | Appropriate for use in intervention research studies? (Y/N) | Is additional research warranted for this tool (Y/N) |
StrokEDGE | Yes | Yes | No | Yes |
Well-trained Males: (Doherty, Smith, Hughes, & Collins, 2001; n = 15; 30s of the subpraximal run for each test)
Male Rowers (Marriot & Lamb, 1996; n = 9; mean age = 28.6 (6.8) years)
Adolescent Girls (Pfeiffer, Pivarnik, Womack, Reeves, & Malina, 2002; n = 57; mean age = 15.3 (1.5) years)
Helsinki Participants (Scherr, Wolfarth, Christle, Pressler, Wagenpfeil, & Halle, 2012; n = 2,560; mean age = 24 (17-44) years; Helsinki, Finland participants)
Frail older adults: (Mendelssohn et al., 2008)
Healthy Male Athletes (Lamb, Eston, & Corns, 1999; n = 16; mean age = 23.6 (5.1))
Depression and Anxiety (Knapen et al., 2003)
Adolescent Girls (Pfeiffer et al., 2002)
Interrater Reliability:
In Braille:
Adolescent females: (Pfeiffer et al., 2002)
Intrarater Reliability:
Physically Active Men and Women (Eston et al., 2006; n = 19; male mean age = 21.6 (0.8); female mean age = 21.4 (1.4))
Healthy Men and Women: (Eston & Williams, 1988; n = 16; male mean age = 28.7 (12.5); female mean age = 31.8 (9.4))
Concurrent validity:
Male Rowers (Marriot & Lamb, 1996)
Young African-Americans (Karavatas & Tavakol, 2005; n = 12; mean age = 26.08 years)
RPE Across the Lifespan: (Groslambert & Mahon, 2006; n = 1,865)
Healthy Individuals: (Chen et al., 2002)
Range of mean validity coefficients with RPE:
Heart rate | Blood lactate | VO2max or VO2 | Ventilation | Resp rate |
0.47-0.61 | 0.42-0.69 | 0.31-0.76 | 0.53 | 0.67 |
Predictive validity
Pregnant Women: (O’Neill et al., 1992; Group 1 (Treadmill), n = 11; Group 2 (Bicycle), n = 12; Group 3 (Circuit-training), n = 24; Group 4 (Aerobics), n = 48; Group 5 (Aerobics), n = 29)
Helsinki Participants: (Scherr, Wolfarth, Christle, Pressler, Wagenpfeil, & Halle, 2012)
Convergent validity
Elite Swimmers (Psycharakis, 2011; males, n = 9; females, n = 8; males mean age = 23.4 (2.1); females mean age = 20.5 (1.9); male mean height = 186.6 cm (6.0 cm); female height = 170.1 cm (3.8 cm); male body mass = 83.7 kg (6.6 kg); female body mass 60.9 kg (5.6 kg)
Video Game Players (Pollock et al., 2013; n = 13; mean age = 53.5 (5.4))
Children and Adults (Gillach, Sallis, Buono, Patterson, & Nader, 1989; children, n = 283; adults, n = 295; children mean age = 11 (10-14); adults mean age = 36 (22-55))
Not reported in stroke, however, one study (Eng et al., 2002; n = 25; 4.4 ± 3.0 yrs) assessed RPE in people with stroke at minute 6 during a 6-minute walk test and a 12-minute walk test in the same subjects, with almost identical mean values (11.6 and 11.7) for the 2 assessments, as would be expected if test-retest reliability was high.
(Eng et al., 2002; n = 25; 4.4 ± 3.0 yrs)
(Tseng et al., 2010; n = 21; 4.1 ± 3.5 yrs)
Post-Stroke: (Sage et al., 2013. 37 patients post-stroke (14.5 ± 10.2 days post-stroke))
Adolescent Girls: (Pfeiffer et al., 2002; n = 57)
Pediatric: (Hommerding et al., 2010; n = 41, mean age = 11.1)
Concurrent validity
Adolescent Girls: (Pfeiffer et al., 2002; n = 57)
Adolescent Boys (Eston & Williams, 1986; n = 30; mean age = 16 (1))
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Convergent validity
Adolescent Girls (Pfeiffer et al., 2002)
● Excellent validity (%HRmax;rₓᵧ) = 0.66, p < 0.05
● Excellent validity (%V0₂max;rₓᵧ) = 0.70, p < 0.05
Lumbar Disc Herniation (Dedering et al., 2010)
Patients’ characteristics, median and range, n = 15
| All, n = 15 | Men, n = 8 | Women, n = 7 |
Age (years) | 46 (27–65) | 42 (27–65) | 45.5 (37–55) |
Height (m) | 1.69 (1.60–1.92) | 1.80 (1.65–1.92)* | 1.66 (1.60–1.72)* |
Weight (kg) | 77 (55–102) | 87.5 (63–102)* | 72.5 (55–88)* |
BMI (kg/m^2) | 25.8 (20.7–33.1) | 26 (22.7–31.6) | 25.8 (20.7–33.1) |
Pain duration (months) | 8 (3–108) | 7.5 (3–108) | 9 (3–72) |
Physical activity Roland-Morris (max score 20) | 3 (1–6) | 3 (1–4) | 3 (2–6) |
Oswestry (max score 60) | 10 (3–20) | 11 (6–16) | 9 (3–20) |
Self-efficacy (max score 64) | 22 (14–38) | 20.5 (18–38) | 26 (14–37) |
SF-36 | 44 (17–51) | 46 (17–51) | 34 (21–48) |
–Physical Functioning | 65 (25–75) | 65 (60–75) | 60 (25–75) |
–Role Physical | 20 (0–100) | 20 (0–100) | 10 (0–50) |
–Bodily Pain | 41 (22–74) | 37 (22–64) | 41 (41–74) |
–General Health | 65 (25–87) | 59 (35–87) | 67 (25–77) |
–Vitality | 40 (5–85) | 33 (5–85) | 50 (30–70) |
–Social Functioning | 63 (38–100) | 69 (50–100) | 63 (38–100) |
–Role Emotional | 66 (0–100) | 66 (0–100) | 100 (0–100) |
–Mental Health | 72 (40–92) | 74 (48–92) | 64 (40–80) |
Lumbar Disc Herniation: (Dedering et al., 2010)
Chronic low back pain: (Armstrong et al., 2005)
Spina Bifida: (Crytzer et al., 2015)
Frail Older Adults (Mendelsohn et al., 2008; n = 18; mean age = 82 (5) years; women, n = 3; men, n = 15)
Concurrent validity:
Older Japanese Adults: (Shigematsu, Ueno, Nakagaichi, Nho, & Tanaka, 2004; older group, n = 29; middle-aged group, n = 24; older group mean age = 75.5 (3.8); middle-aged group mean age = 46.9 (7.0); Toride City, Ibaraki prefecture, Japan participants)
Armstrong, M., McDonough, S., & Baxter, D. (2005). Reliability and repeatability of shuttle walk test in patients with chronic low back pain...including commentary by Eiser N, Lemmink KAP, and Walsh DA. International Journal Of Therapy & Rehabilitation, 12(10), 438-443.
Borg, G. (1998). Borg’s perceived exertion and pain scales. Champaign, IL: Human Kinetics.
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Cabral, L. L., Lopes, P. B., Wolf, R., Stefanello, J. M. F., & Pereira, G. (2017). A systematic review of cross-cultural adaptation and validation of Borg’s rating of perceived exertion scale. Journal of Physical Education, 28(2853), 2448-2455. https://doi.org/10.4025/jphyseduc.v28i1.2853
Chen, M., Fan, X., Moe, S. Criterion-related validity of the Borg rateings of perceived exertion scale in healthy individuals: a meta-analysis. J Sports Sci. 2002;20:873-899. Find it on PubMed
Cleland, B. T., Ingraham, B. A., Pitluck, M. C., Woo, D., & Ng, A. V. (2016). Reliability and Validity of Ratings of Perceived Exertion in Persons With Multiple Sclerosis. Archives Of Physical Medicine & Rehabilitation, 97(6), 974-982. doi:10.1016/j.apmr.2016.01.013
Crytzer, T. M., Dicianno, B. E., Robertson, R. J., & Yu-Ting, C. (2015). Validity Of A Wheelchair Perceived Exertion Scale (Wheel Scale) For Arm Ergometry Exercise In People With Spina Bifida. Perceptual & Motor Skills, 120(1), 304-322. doi:10.2466/15.08.PMS.120v12x8
Dedering, &., Gnospelius, &., & Elfving, B. (2010). Reliability of measurements of endurance time, electromyographic fatigue and recovery, and associations to activity limitations, in patients with lumbar disc herniation. Physiotherapy Research International, 15(4), 189-198. doi:10.1002/pri.457
Doherty, M., Smith, P.M., Hughes, M.G., Collins, D. (2001). "Rating of perceived exertion during high-intensity treadmill running." Medicine and Science in Sports and Exercise 33:1953-8. Find it on PubMed.
Eng, J.J., Chu, K.S., Dawson, A.S., Kim, C.M., Hepburn, K.E. "Functional walk tests in individuals with stroke: Relation to perceived exertion and myocardial exertion." Stroke. 2002;33:756-761. Find it on PubMed
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Eston, R.G. & Thompson, M. (1997). "Use of ratings of perceived exertion for predicting maximal work rate and prescribing exercise intensity in patients taking atenolol." British Journal of Sports Medicine 31:114-119. Find it on PubMed
Eston, R. G., & Williams, J. G. (1986). Exercise intensity and perceived exertion in adolescent boys. British Journal of Sports Medicine. 20, 27-30. Find it on PubMed
Eston, R. G., & Williams, J. G. (1988). Reliability of ratings of perceived effort regulation of exercise intensity. British Journal of Sports Medicine. 22(4),153-155. Find it on PubMed
Gillach, M. C., Sallis, J. F., Buono, M. J., Patterson, P., Nader, P. R. (1989). The relationship between perceived exertion and heart rate in children and adults. Pediatric Exercise Science. 1, 360-368. https://doi.org/10.1123/pes.1.4.360
Groslambert, A. & Mahon, A.D. (2006). "Perceived exertion : influence of age and cognitive development." Sports Medicine 36:911-28. Find it on PubMed
Hampton, S., Armstrong, G., Ayyar, M. S., & Li, S. (2014). Quantification of Perceived Exertion During Isometric Force Production With the Borg Scale in Healthy Individuals and Patients With Chronic Stroke. Topics In Stroke Rehabilitation, 21(1), 33-39. doi:10.1310/tsr2101-33
Hommerding, P., Donadio, M., Paim, T., & Marostica, P. (2010). The Borg scale is accurate in children and adolescents older than 9 years with cystic fibrosis. Respiratory Care, 55(6), 729-733.
Joo, K. C., Brubaker, P. H., MacDougall, A., Saikin, A. M., Ross, J. H., & Whaley, M. H. (2004). Exercise prescription using resting heart rate plus 20 or perceived exertion in cardiac rehabilitation. Journal of Cardiopulmonary Rehabilitation, 24(3), 178-184. Find it on PubMed
Karavatas S. G., & Tavakol K. (2005). 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. 3(1). Find it Here
Knapen, J., van de Vliet, P., van Coppenolle, H., Peuskens, J., & Pieters, G. (2003). Evaluation of cardio-respiratory fitness and perceived exertion for patients with depressive and anxiety disorders: a study on reliability. Disability & Rehabilitation, 25(23), 1312-1315.
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Lamb, K. L., Eston, R.G. & Corns, D. (2006). "Reliability of ratings of perceived exertion during progressive treadmill exercise." British Journal of Sports Medicine 33:336-339. Find it on PubMed
Marriott, H. E. & Lamb, K. L. (1996). The use of ratings of perceived exertion for regulating exercise levels in rowing ergometry. European Journal of Applied Physiology. 72(3), 267-271. Find it on PubMed
Mendelsohn, M.E., Connelly, D.M., Overend, T.J., & Petrella, R.J. (2008). "Validity of values for metabolic equivalents of task during submaximal all-extremity exercise and reliability of exercise responses in frail older adults." Physical Therapy 88:747-56. Find it on PubMed
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Penko, A. L., Barkley, J. E., Koop, M. M., & Alberts, J. L. (2017). Borg scale is valid for ratings of perceived exertion for individuals with Parkinson’s disease. International Journal of Exercise Medicine, 10(1), 76-86. Find it on PubMed
Pfeiffer, K.A., Pivarnik, J.M., Womack, C.J., Reeves, M.J., & Malina, R.M. (2002). "Ratings of perceived exertion in braille: validity and reliability in production mode." Medicine and Science in Sports and Exercise 34:2057-61. Find it on PubMed
Pollock, B. S., Barkley, J. E., Potenzini, N., Desalvo, R. M., Buser, S. L., Otterstetter, R., & Juvancic-Heltzel, J. A. (2013). Validity of Borg ratings of perceived exertion during active video game play. International Journal of Exercise Science. 6(2), 164-170. Find it on PubMed
Psycharaksi, S. G. (2011). A longitudinal analysis on the validity and reliability of ratings of perceived exertion for elite swimmers. Journal of Strength and Conditioning Research. 25(2), 420-426. Find it on PubMed
Sage et al., 2013. "Validity of Rating of Perceived Exertion Ranges in Individuals in the Subacute Stage of Stroke Recovery." Top Stroke Rehabil 20(6): 519-527. Find it on PubMed
Scherr, J., Wolfarth, B., Christle, J.W., Pressler, A., Wagenpfeil, S., & Halle, M. (2012). Associations between Borg’s rating of perceived notion and physiological measures of exercise intensity. European Journal of Applied Physiology, 113, 147-155. Find it on PubMed
Shigematsu R., Ueno, L. M., Nakagaichi, M., Nho, H., & Tanaka, K. (2004). Rate of perceived exertion as a tool to monitor cycling exercise intensity in older adults. Journal of Aging and Physical Activity, 11, 3-9. Find it on PubMed
Tseng, B.Y., Gajewski, B.J., & Kluding, P. "Reliability, responsiveness, and validity of the Visual Analog Fatigue Scale to measure exertion fatigue in people with chronic stroke: A preliminary study." Stroke Res Treat. 2010;2010:7 pages. Find it on PubMed
We have reviewed more than 500 instruments for use with a number of diagnoses including stroke, spinal cord injury and traumatic brain injury among several others.