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Heart Rate Index-An Alternative Exercise-Based Equation for Estimating Peak VO 2
John R Wicks1, Neil B Oldridge, Barry A Franklin
1Author Affiliations: Department of Rehabilitation, Gold Coast University Hospital, Southport, Queensland, Australia (Dr Wicks); School of Rehabilitation Sciences & Technology, College of Health Professions & Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Oldridge); and Preventive Cardiology and Cardiac Rehabilitation, Corewell Health, William Beaumont University Hospital, Royal Oak, Michigan (Dr Franklin).
Journal of Cardiopulmonary Rehabilitation and Prevention
|February 20, 2025
Summary
Heart rate index (HRI) closely estimates measured peak oxygen uptake (VO 2peak ). Estimated VO 2peak significantly overpredicts actual values, suggesting HRI equations improve fitness assessments.
Area of Science:
- Cardiovascular Physiology
- Exercise Science
- Prognostic Biomarkers
Background:
- Heart rate (HR)-derived variables and peak oxygen uptake (VO 2peak ) are key prognostic indicators for mortality.
- The utility of heart rate index (HRI) as a surrogate for VO 2peak has not been fully established.
- Accurate VO 2peak estimation is crucial for cardiovascular risk assessment.
Purpose of the Study:
- To establish heart rate index (HRI) as a reliable surrogate for measured (Meas) and estimated (Est) peak oxygen uptake (VO 2peak ) during cycle ergometry (CE) and treadmill testing (TT).
- To compare HRI-derived VO 2peak (HRI-VO 2peak ) with both Meas and Est VO 2peak values.
- To evaluate the accuracy of HRI in predicting VO 2peak compared to traditional estimation methods.
Main Methods:
- A systematic literature search identified 150 studies reporting HR-derived variables and VO 2peak.
- HRI-VO 2peak was calculated using the equation METs = 6 × HRI - 5, where HRI = peak HR/resting HR.
- HRI-VO 2peak was compared against group mean data for Meas CE/TT-VO 2peak (n=21,773) and Est CE/TT-VO 2peak (n=331,435).
Main Results:
- HRI-VO 2peak demonstrated a close agreement with Meas CE/TT-VO 2peak (1% difference; 7.08 ± 3.02 METs vs. 7.15 ± 3.25 METs).
- Est CE/TT-VO 2peak significantly overpredicted HRI-VO 2peak by 25.6% (7.12 ± 2.27 METs vs. 8.94 ± 2.36 METs).
- Treadmill testing (TT) showed higher overprediction (26.6%) compared to cycle ergometry (CE) (11.9%) when using HRI estimation.
Conclusions:
- Measured VO 2peak and HRI-VO 2peak show strong concordance, validating HRI as an accurate surrogate.
- Current exercise-based equations for estimated VO 2peak significantly overestimate actual values.
- Utilizing HRI and/or Fitness Registry and the Importance of Exercise National Database (FRIEND) registry equations is recommended for more precise VO 2peak estimation.
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