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Relationship between exercise heart rate and age in men vs women
Nóra Sydó1, Sahar S Abdelmoneim2, Sharon L Mulvagh2
1Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN; Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
Insights
Sex differences exist in exercise heart rate (HR) responses. A new formula for predicting peak HR in women is recommended due to distinct age-related decreases compared to men.
Area of Science:
- Cardiology
- Exercise Physiology
- Preventive Medicine
Background:
- Accurate prediction of peak heart rate (HR) is crucial for exercise prescription and risk stratification.
- Traditional formulas for peak HR, such as 220-age, are widely used but may not account for sex-specific variations.
- Understanding sex differences in HR response during exercise is essential for personalized cardiovascular assessments.
Purpose of the Study:
- To investigate sex-based differences in various exercise heart rate parameters within a large patient cohort.
- To determine if separate, sex-specific equations are necessary for predicting peak heart rate (HR).
Main Methods:
- Analysis of treadmill exercise test data from 37,010 patients aged 40-89 years.
- Exclusion of patients with cardiovascular disease or on HR-attenuating medications.
- Age-adjusted analysis of variance to compare HR responses between sexes, followed by regression analysis on a pure cohort.
Main Results:
- Men exhibited higher peak HR, HR reserve, and HR recovery compared to women.
- Factors like poor exercise capacity, smoking, diabetes, and obesity significantly lowered peak HR in both sexes.
- While men's peak HR closely followed the 220-age formula, women's peak HR showed a lower intercept and a slower decline with age, necessitating a distinct formula.
Conclusions:
- Exercise-induced heart rate responses demonstrate significant differences between men and women.
- The traditional peak HR prediction formula is less accurate for women.
- A separate, sex-specific equation for predicting peak HR in women is warranted to improve clinical accuracy.
Objective:
To analyze a large cohort of patients who underwent exercise testing and also report sex differences in other exercise heart rate (HR) parameters to determine whether separate sex-based equations to predict peak HR are indicated.
Patients And Methods:
Patients aged 40 to 89 years who performed treadmill exercise tests (Bruce protocol) from September 21, 1993, to December 20, 2010, were included. Patients with cardiovascular disease or taking HR-attenuating drugs were excluded. After analyses on preliminary cohort, peak HR-modifying factors were eliminated to obtain a pure data set. Analysis of variance was used to test difference in HR responses by sex with age adjustment.
Results:
A total of 37,010 patients (67.3% men) were included in the preliminary cohort. Men had higher peak HR (166±17 vs 163±16 beats/min [bpm]; P<.001), HR reserve (90±19 vs 84±17 bpm; P<.001), and HR recovery (19±8 vs 18±9 bpm; P<.03). Poor exercise capacity, current smoking, diabetes, and obesity had significant peak HR-lowering effects (all P<.001). In a pure cohort of 19,013 patients (51.3% of full cohort) without these factors, regression lines approximated more closely the traditional line of 220 - age. For men, the regression line in our final cohort was peak HR = 220 - 0.95 × age. For women, both slope (0.79 bpm/y) and intercept (210 bpm) were still substantially different from those obtained with the traditional formula.
Conclusion:
The HR responses to exercise are different in men and women. The HR response of men was close to that obtained with the traditional formula, but peak HR in women had a lower intercept and decreased more slowly with age. A separate formula for peak HR in women appears to be appropriate.
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