Perceived Rate of Exertion for Children (PCERT)
Perceived Rate of Exertion for Children
Descriptive Information
Title, Edition, Dates of Publication and Revision*
Pictorial Children’s Exertion Rating Table:
1. Perceived Rate of Exertion for Children
2. 1St edition, (revised)
3. CERT (Children’s exertion rating table) 1994
4. PCERT 2000
5. Pictorial Children’s Effort Rating Table 2002
Author (s)
1.Williams et al, 1994
2. Eston et al, 2000
3.Yelling et al, 2002
Source
Variation used in Marinov et al. article
Costs
N/A
Purpose
To provide a visual assessment scale for children to effectively self-report perceived rate of exertion during physical activity by means of a verbal, numerical, and pictorial representation scale.
Type of Test
Screening and evaluative tool for assessment of exertion during physical activity.
Target Population and Ages
Children under the age of 16.
Time Requirements – Administration and Scoring*
Assessment of exertion requires less than 30 seconds to assess. If the person being assessed is familiar with the scoring scale, then even less time is needed.
Time it takes to score the test is immediate.
Test Administration
- Administration
Children are sown the visual scale with exertion levels depicted with a number 1-10. Each level is paired with a pictorial progression of a child ascending stairs, and a matching description of effort. Child is asked to look at the scale and report their perceived rate of effort based on how they feel in relation to the scale. - Scoring
Scoring is based on a scale 1-10; 1 being “very, very easy” and 10 being “so hard I’m going to stop.” - Type of information, resulting from testing
During physical activity leading up to the use of the PCERT, the child’s heart rate, respiration rate, and oxygenation saturation are generally assessed throughout the activity. The objective information can be used in correlation with the self-report of perceived exertion to determine the trends based on exercise level of intensity, and/or child’s diagnosis. - Environment for Testing
Environment is variable. - Equipment and Materials Needed
Print out of the PCERT for visual use by participant. - Examiner Qualifications
N/A - Psychometric Characteristics
N/A - Standardization/normative data
Solely subjective data. - Evidence of Reliability
Higher reliabilities (ICCs) for the CERT (0.96) than the Borg 6-20 (0.89) in 69 Chinese children.1 - Evidence of Validity
1.Studies in young children (aged 8-11) using CERT have shown to have greater validity when compared with the traditionally Rate of perceived exertion (RPE) scale. 1
2. For concurrent validity, researchers found significant correlation coefficients for VO2, HR, VE and the RPE scales (ranges 0.512-0.878)
3. Intraclass correlations between CERT and HR at level 5 intensity: 0.72 (boys) and 0.96 (girls); Correlations between CERT and work output at level 5 intensity: 0.97 (boys) and 0.90 (girls)
4. Correlation Coefficients between PCERT and HR ages 14-15: 0.52 (boys) and 0.66 (girls) - Discriminative
N/A - Predictive
N/A
- Summary Comments
- Strengths
Provides a visual descriptor to assist in a child’s ability to self-report received rate of exertion during variable intensities of physical activity. The pictorial, numerical, and descriptors enable children to have a better comprehension of perceived exertion. The Pictorial-CERT is easy to administer, appears more reproducible, and more sensitive for children. - Weaknesses
This self-report exertion scale is highly subjective and is open to varying degrees of interpretation. - Clinical Applications
The PCERT is clinically relevant for the evaluation of patients to perceived their individual level of exertion during and following physical activity of varying intensities, specifically in participants <18 years. - References:
- Marinov B., Mandadjieva S., Kostianev S. 2008 Pictorial and verbal category-ratio scales for effort estimation in children. Child: care, health, and development. 34 (1) 35-43.
2. Eston RG, Et Al. “Validity of Perceived Exertion Scale for Children: A Pilot Study” Perceptual and Motor Skills. 1994. 78: 691- 697. - Yelling M, Lamb K, Swaine I. “Validity of a Pictorial Perceived Exertion Scale for Effort Estimation and Effort Production During Stepping Exercise in Adolescent Children” Euro Phys Edu Review. 2002. 8(2):157-175.
- Strengths
Article Summary:
Marinov B., Mandadjieva S., Kostianev S. 2008 Pictorial and verbal category-ratio scales for effort estimation in children. Child: care, health, and development. 34 (1) 35-43.
This study compared the effort estimation by both the Pictorial-CERT and the Borg Category-Ratio Perceived Exertion (CR-10) scales in children and to assess the long-term repeatability of the two scales. The study had fifty healthy children (25 boys and 25 girls; initially aged 10.4+/- 0.5 years) who all completed three incremental treadmill tests. The first two tests were at the interval of one month, and the third test took place three years later and used the same protocol.
The study found that perceived exertion correlated significantly with the intensity of the exercise measured by–minute ventilation, heart rate, and oxygen uptake. The correlations between minute ventilation, HR, and oxygen uptake were significantly higher for the Pictorial-CERT (r=0.62-0.88) than for the CR-10 ( r=0.59-0.79). Intraclass correlation coefficients between test one and test two were significantly higher for the Pictorial-CERT in comparison to the CR-10 (0.77 vs. 0.54, respectively; z=-2.07, P=0.038). The conclusion was the Pictorial-CERT is more appropriate and reproducible than the Borg CR-10 scale for children of this age range.
6 responses to “Perceived Rate of Exertion for Children (PCERT)”
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I did not realize that there was an RPE for kids! Awesome! I love how they incorporate the use of pictures in the administration of it because I think sometimes these scores can be hard to explain verbally. I think that this score can definitely be used in practice for pediatrics because it is simple and quick to administer and it can be a good way to track progress for these patients! I am definitely going to have to google it and get a visual.
I think this is awesome!! I am excited to know this is available to kids and plan to use it with our pediatric clients. I wonder if there are age ranges that have been studied for accuracy of response. I would think below a certain age the reporting might be less accurate. I also think this is a useful tool for those children who have a hard time verbally communicating so this gives them a picture and somewhere they can point for RPE.
I feel like this is an awesome tool for people who are going into a setting where they will be working with kids! This will hopefully be a useful tool for us to use for our upcoming pediatric lab where we will be working with a child who is at risk for over fatiguing. I like how it gives the kids a visual option while rating their exertion, which may be useful for children with various cognitive deficits. Overall, I feel this is a very useful tool to have. Thanks for the post!
This seems to be a great way to measure intensity when working with children. I think having different exertion measure for kids is great since their response to exercise is not always the same as an adult’s response to the same activity. The pictures are a great addition to the original RPE for adults and it would be nice to have those pictures on the adult RPE scale to help adults better rate themselves during activity.
Kandra, I enjoyed reading the information regarding the PCERT. I have never thought about using perceived rate of exertion for children, mainly because I have not worked with pediatric patients, but I know that it is heavily used for patients with cardiac issues. I think this is a great tool to use especially if an accurate HR cannot be obtained. I enjoyed reading your summary as well, especially since it was in support of using the PCERT over the BORG, which is what I am more familiar with. Thanks Kandra!
This seems like a great assessment tool to utilize in an orthopedic clinic, where patient demographics and age may vary substantially. It appears easy to use and the pictures are a great way for kids to relay how they are feeling. Often times, even adults have a hard time orally reporting their perceived exertion, with this assessment tool, the use of pictures seems to help the patient more accurately report their perceived exertion. I look forward to using this tool on my next clinical rotation to help track progression in a pediatric patient, throughout their length of care