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Recent exercise guidelines recommend a generalized rating of perceived exertion (RPE) range of 12 to 16 (15-point Borg scale) as the perceptual range associated with a physiological training effect. However, whether an individual who selects an RPE within the generalized range during an graded exercise test or exercise training, is actually within the correlated physiological range (50 to 85% maximum oxygen consumption [VO2max]) has not been studied in large samples of apparently healthy individuals or cardiac patients. The purpose of the present study was to assess the validity of the generalized RPE recommendations in a large heterogeneous group of apparently healthy subjects and cardiac patients.Subjects included apparently healthy adults (N = 463) and cardiac patients (N = 217) who presented for a sign-symptom limited maximal graded exercise test (SSLMGXT). Ratings of perceived exertion associated with relative exercise intensities of 60 and 80% of maximal heart rate reserve (MHRR) and peak exercise were selected for analyses.Significant interindividual variability in RPE was observed at both relative exercise intensities (6 to 20 RPE range at 60% MHRR; 8 to 20 RPE range at 80% MHRR) for both populations. Thirty-nine percent of healthy subjects and 32% of cardiac patients reported an RPE outside an 11 to 14 range at 60% of MHRR, whereas 32% of healthy subjects and 52% of cardiac patients reported an RPE outside of a 14 to 17 range at 80% of MHRR. Peak RPE was higher for the apparently healthy subjects compared with the cardiac patients (18.8 ± 1.2 versus 16.5 ± 1.8; P < 0.01).These results challenge the applicability of the generalized RPE recommendations described in recent exercise guidelines under typical clinical exercise testing conditions. The basis for the generalized RPE recommendations warrant further investigation. Those who desire to use RPE as a marker of relative exercise intensity during SSLMGXT should take into consideration the large interindividual variability in these measures.