Use RPE - rate of perceived exertion which is now the scale that most health clubs are using because of rampant medication in members. It is the amount of exertion that the class participant is feeling. Outward appearances can help, shortness of breath, red in the face, sweat, and response to directions, but RPE is probably better. You should have a wall chart next to or instead of the heart rate chart - if not, you should request one. RPE is on a scale of 1 -20 with 1 being lying down at rest and 20 being exercising so hard that you are about to pass-out --no member should ever get past 18 and probably not much more that 16-17 at the highest peak and only there for a short time. This will vary, but in a class environment where you aren't able to continue assessing every individual you will probably even want to keep it a little lower. Google RPE and see what you come up with! Hope this helps.
If you patient really needs Beta Blockers then she should remain on them and there are a couple of other ways you can assess the workload. One is to ask the patient to judge how hard they are working, my phisio uses a scale of 10 to 20 (20 being the hardest) But the most efective, fo me, is to judge how breathless the person is by asking them to say their name address and telephone number.
I started taking Beta Blocker last September when I was diagnosed with Angina, had stents fitted in January and stopped taking the Beta Blockers at the end of May because they were causing problems when I exercised.
The medics told me that if I had had a heart attack or if the stents had not worked so well then I would have to remain on beta blockers and your patient could be the same.
Try the other methods of assessment I have mentioned nd see if that works.
Kind regards
Mike (UK)
I am so glad you addressed that question. I am also on a beta blocker and have gained 6 pounds. When I exercise, my heart rate doesn't go up like it used to. I also would like to hear any comments.