1. Introduction
2. Learning Objectives
3. Pre-Test
4. Meet Your Patient
5. Indications and Contraindications
6. Benefits and Risks
7. Risk Assessment
8. FITT Principle
9. Exercise Rx 1 - No Stress Test

   9.1 Walking Program

   9.2 Target Heart Rate

   9.3 Rate of Perceived Exertion

10. Indications for Stopping Exercise
11. Exercise Rx 2 - With Stress Test

    11.1 Using Stress Test

    11.2 Walking Program

    11.3 Target Heart Rate

12. Patient Education Aids

    12.1 Exercise Prescription

    12.2 Important Points

    12.3 Patient Log

13. Special Considerations

    13.1 Patients with Diabetes

    13.2 Patient Motivation

14. Post-Test

Although Table 2 and THR are useful, they do not give enough guidance for patients. You should also tell them about RPE, a scale that asks patients to rate how strenuously they feel they are exercising. The RPE scale has been found to correlate well with objective measures of exercise exertion such as oxygen uptake and blood lactate in approximately 90% of people. RPE refers to the total amount of exertion or fatigue felt by the patient, not just a single factor such as leg fatigue or shortness of breath. Advise them to keep their RPE between 3 and 4.

Modified Borg RPE Scale^*

0	Nothing		The feeling you have at rest. There is no feeling of fatigue
0.5	Very, very light		Working at a desk, reading, listening to music or watching tv while physically at rest.
1	Very light		Getting dressed. Little or no fatigue.
2	Fairly moderate		Feeling you might get while slowly walking across your yard.
3	Moderate		Comfortable but slightly elevated breathing. You should be able to talk while walking.
4	Somewhat hard		Walking briskly to the store. Aware breathing is deeper and slight feeling of fatigue.
5	Hard		Rushing for an appointment. General fatigue but you could maintain this level. Breathing is somewhat deep.
6
7	Very hard		Vigorous exercise. Definite feeling of fatigue and breathing hard.
8			Vigorous exercise. Definite feeling of fatigue and breathing hard. Difficult to maintain.
9	Very, very hard		Extremely vigorous exercise. Very definite feeling of fatigue and laboured breathing. You could not exercise at this level for long.
10	Maximal		All out exercise/exhaustion.

^* Adapted from "You and Your Heart", Atlantic Health and Wellness Institute

Patients should exercise at RPE of 3 to 4.

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Talk Test

Another useful guideline is to advise patients that they should be able to talk comfortably while exercising.

Warm-up and Cool-down

It is also very important to include a warm-up and cool-down. Patients do not need to do a warm-up until they are exercising for 20 minutes continuously. For the warm-up, advise patients to walk at a slightly slower pace than normal for the first 5 minutes. For the cool down, advise patients to walk at a slower than normal pace for the last 2 to 3 minutes and then do these stretching exercises. Failure to do the warm up and cool down can result in angina, dysrhythmia, or musculoskeletal injury.

The time for the warm-up and cool-down should be added to the aerobic exercise time. For example, when a patient is doing 20 minutes of areobic exercise, add extra time for the warm-up and cool-down.

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