Ann Rehabil Med.  2022 Jun;46(3):133-141. 10.5535/arm.21181.

Is Age-Predicted Maximal Heart Rate Applicable in Patients With Heart or Lung Disease?

• Han SH
• Choi MS
• Kim YM
• Kim DM
• Park HE
• Hong JW
• Kim SH
• Shin YB
• Lee BJ

• KMID: 2531284
• DOI: http://doi.org/10.5535/arm.21181

Abstract

Objective
To compare the predicted and actual maximal heart rate (HRmax) values in the cardiopulmonary exercise test (CPET).
Methods
We retrospectively investigated 1,060 patients who underwent a CPET between January 2016 and April 2020 at our institution’s cardiopulmonary rehabilitation center. The following patients were included: those aged >20 years, those tested with a treadmill, and those who underwent symptom-limited maximum exercise testing— reaching ≥85% of the predicted HRmax (62% if taking beta-blockers) and highest respiratory exchange ratio ≥1.1. Ultimately, 827 patients were included in this study. Data on diagnosis, history of taking beta-blockers, age, body mass index (BMI), and CPET parameters were collected. Subgroup analysis was performed according to age, betablockers, BMI (low <18.5 kg/m², normal, and high ≥25 kg/m²), and risk classification.
Results
There was a significant difference between the actual HRmax and the predicted value (p<0.001). Betablocker administration resulted in a significant difference in the actual HRmax (p<0.001). There were significant differences in the moderate-to-high-risk and low-risk groups and the normal BMI and high BMI groups (p<0.001). There was no significant difference between the elderly and younger groups. We suggest new formulae for HRmax of cardiopulmonary patients: estimated HRmax=183-0.76×age (the beta-blocker group) and etimated HRmax=210-0.91×age (the non-beta-blocker group).
Conclusion
Age-predicted HRmax was significantly different from the actual HRmax of patients with cardiopulmonary disease, especially in the beta-blocker group. For participants with high BMI and moderate-tosevere risk, the actual HRmax was significantly lower than the predicted HRmax.

Keyword

Cardiac rehabilitation; Exercise test; Exercise therapy; Heart rate; Predictive value of tests

Figure

• 

  Fig. 1. Comparison of actual maximal heart rate (HR) and age-predicted maximal HR. Boxplots of (A) beta-blocker group (n=431) and (B) non-beta-blocker group (n=431). Participants were divided into subgroups according to age, body mass index (BMI, kg/m2), and risk classification. *p<0.05 (Bonferroni correction for continuous variable), **p<0.05 (least significant difference correction for continuous variable).

• 

  Fig. 2. Scatterplot between age and actual maximal heart rate (n=827). Divided into two groups depending on whether they were taking beta-blockers or not. (A) Group with taking beta-blockers (n=396). (B) Group without betablockers (n=431). And divided into by disease group, (C) cardiac disease group (n=537) and (D) pulmonary disease group (n=290). All participants were classified into high risk, moderate risk, and low risk according to the risk classification and displayed in different diagrams.

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