CVR Physiotherapy › Technique cards › Scales and investigations
Scales: Borg, mMRC, NYHA, CCS and quality-of-life questionnaires
Scales are quick 3-mark questions: Borg CR10 (S16, S18), modified Borg (S26), NYHA (S21) and quality-of-life questionnaires for COPD, heart failure and PAD (W24). Write the whole scale with its anchors, and say what it is used for.
- Syllabus
- Ch 10 Introduction to functional scales: generic and disease-specific; patient's perception compared with therapist's evaluation
- Priority
- Moderate. In 5 of 20 papers (2016–2026), all 3-mark questions.
- Asked as
- 3m S16S18S21W24S26
- Usual split
- 3-mark: write the scale, or name the questionnaires
- Checked against
- Borg scales (Borg 1998); ATS six-minute walk statement (2002) for the modified Borg anchors; GOLD (mMRC); Canadian Cardiovascular Society angina grading. Full list under Sources.
- Content checked
- 19 October 2026. Next review due October 2027.
- My revision
-
1Borg rating of perceived exertion (6–20)
Rates the overall effort of exercise. The numbers roughly match heart rate ÷ 10 in healthy young adults (13 ≈ 130 beats per minute).
| Rating | Words |
|---|---|
| 6 | No exertion at all |
| 7 | Extremely light |
| 9 | Very light |
| 11 | Light |
| 13 | Somewhat hard |
| 15 | Hard (heavy) |
| 17 | Very hard |
| 19 | Extremely hard |
| 20 | Maximal exertion |
The even numbers in between have no words. Use: Phase I cardiac rehab below 13; Phase II training 11–16 (start 11–13); moderate intensity 12–13.
2Modified Borg and CR10 breathlessness scales (3 marks in S16, S18, S26)
A category–ratio scale from 0 to 10 for breathlessness (or fatigue, pain) during activity. The modified Borg dyspnoea scale below is the version used in the six-minute walk test.
| Rating | Breathlessness |
|---|---|
| 0 | Nothing at all |
| 0.5 | Very, very slight (just noticeable) |
| 1 | Very slight |
| 2 | Slight |
| 3 | Moderate |
| 4 | Somewhat severe |
| 5 | Severe |
| 6 | – |
| 7 | Very severe |
| 8 | – |
| 9 | Very, very severe (almost maximal) |
| 10 | Maximal |
- Borg's own CR10 uses the same 0–10 frame with slightly different words ("extremely weak" at 0.5, "weak" at 2, "strong" at 5, "very strong" at 7, "extremely strong" at 10), and allows ratings above 10 for an absolute maximum. Either version scores the S16 and S18 question.
- Why "category–ratio": the numbers have word anchors (categories) and are spaced so that a 4 feels about twice a 2 (ratio), so it can be used to compare intensities.
- Uses: breathlessness before and after the 6MWT; pulmonary rehab training at 3–5 (moderate to severe); stop criteria (for example above 7); pacing advice.
3mMRC dyspnoea scale
| Grade | Description |
|---|---|
| 0 | Breathless only with strenuous exercise |
| 1 | Short of breath when hurrying on the level or walking up a slight hill |
| 2 | Walks slower than people of the same age on the level because of breathlessness, or has to stop for breath when walking at own pace on the level |
| 3 | Stops for breath after walking about 100 metres or after a few minutes on the level |
| 4 | Too breathless to leave the house, or breathless when dressing or undressing |
Use: grades breathlessness in daily life (not during a test); GOLD uses mMRC 2 or more as "more symptoms". MUHS cases quote it (S21 bronchiectasis mMRC 3; S21 ILD mMRC 2).
4NYHA classes (3 marks in S21) and CCS angina grades
| Class | Description |
|---|---|
| I | No limitation; ordinary activity causes no undue breathlessness, fatigue or palpitations |
| II | Slight limitation; comfortable at rest, ordinary activity causes symptoms |
| III | Marked limitation; comfortable at rest, less than ordinary activity causes symptoms |
| IV | Unable to do any activity without discomfort; symptoms may be present at rest |
| Grade | Description |
|---|---|
| I | Ordinary activity (walking, climbing stairs) does not cause angina; angina only with strenuous, rapid or prolonged exertion |
| II | Slight limitation: angina walking or climbing stairs rapidly, uphill, after meals, in cold or wind, under stress; or walking more than two blocks on the level or more than one flight of stairs at a normal pace |
| III | Marked limitation: angina walking one or two blocks on the level or one flight of stairs at a normal pace |
| IV | Unable to do any physical activity without discomfort; angina may occur at rest |
5Quality-of-life questionnaires (3 marks in W24)
| Condition | Questionnaire | Key facts |
|---|---|---|
| COPD | St George's Respiratory Questionnaire (SGRQ) | Symptoms, activity and impacts; 0–100, higher = worse; a change of 4 points matters |
| COPD | Chronic Respiratory Questionnaire (CRQ) | Dyspnoea, fatigue, emotion, mastery; a change of 0.5 per item matters |
| COPD | COPD Assessment Test (CAT) | 8 items scored 0–5 (total 0–40); 10 or more = high symptom impact (used by GOLD) |
| Heart failure | Minnesota Living with Heart Failure Questionnaire (MLHFQ) | 21 items, 0–105; higher = worse |
| Heart failure | Kansas City Cardiomyopathy Questionnaire (KCCQ) | 23 items, 0–100; higher = better |
| Peripheral arterial disease | Walking Impairment Questionnaire (WIQ) | Walking distance, speed and stair climbing; 0–100, higher = better |
| Peripheral arterial disease | Vascular Quality of Life Questionnaire (VascuQoL) | 25 items covering pain, symptoms, activities, social and emotional life |
| Any condition (generic) | SF-36, EQ-5D, WHOQOL-BREF | Compare across diseases and with healthy people |
Generic or disease-specific (syllabus 10a): generic tools compare different conditions but are less sensitive to change in one disease; disease-specific tools detect small changes after rehab. Use one of each when possible, and compare the patient's own rating with your assessment (syllabus 10b).
6Exam corner
Past questions (MUHS, 2016–2026)
- 3-mark questionsBorg's CR10 scale (S16, S18). Grades of the NYHA scale (S21). One quality-of-life questionnaire each for COPD, heart failure and peripheral arterial disease (W24). Write the modified Borg scale (S26).
3 moderate, 5 severe, 7 very severe, 10 maximal
Test yourself
3 mWrite the NYHA classes.
I: no limitation. II: slight limitation, ordinary activity causes symptoms. III: marked limitation, less than ordinary activity causes symptoms. IV: symptoms with any activity or at rest.
MCQA patient stops for breath after walking about 100 m on the level. mMRC grade:A. 1B. 2C. 3D. 4
C. Grade 3.
MCQWhich questionnaire is specific to heart failure?A. SGRQB. MLHFQC. WIQD. CAT
B. Minnesota Living with Heart Failure Questionnaire (KCCQ is the other).
Sources
- MUHS BPTh syllabus (2012) and MUHS IV BPTh question papers 2016–2026 (muhsonline.com, unofficial archive; Dhole Patil College of Physiotherapy past-paper page).
- Borg G. Borg's Perceived Exertion and Pain Scales. Human Kinetics, 1998.
- ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002 (modified Borg dyspnoea scale wording).
- Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2026 report (mMRC, CAT).
- Campeau L. Grading of angina pectoris (Canadian Cardiovascular Society). Circulation 1976;54:522–3.
- The Criteria Committee of the New York Heart Association. Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels, 9th ed., 1994.
- Structure and classical content: Hillegass (2022); Main & Denehy (2016).
Educational notes for exam preparation. Not medical advice.
Version 1. Content checked 19 October 2026. Next review October 2027.