Clin Physiol Funct Imaging (2016) 36, pp155–158
doi: 10.1111/cpf.12201
SHORT COMMUNICATION
Predicted maximal heart rate for upper body exercise testing M. Hill1, C. Talbot1 and M. Price2 1
Sport, Exercise and Life Sciences, University of Northampton, Northampton, UK and 2Faculty of Health and Life Sciences, Department of Biomolecular and Sport Sciences, Coventry University, Coventry, UK
Summary Correspondence M. Hill, Sport, Exercise and Life Sciences, University of Northampton, Boughton Green Road, Northampton, NN2 7AL, UK E-mail: [email protected]
Accepted for publication Received 14 August 2014; accepted 24 September 2014
Key words aging; arm crank ergometry; autonomic; exercise testing; rehabilitation
Age-predicted maximal heart rate (HRMAX) equations are commonly used for the purpose of prescribing exercise regimens, as criteria for achieving maximal exertion and for diagnostic exercise testing. Despite the growing popularity of upper body exercise in both healthy and clinical settings, no recommendations are available for exercise modes using the smaller upper body muscle mass. The purpose of this study was to determine how well commonly used age-adjusted prediction equations for HRMAX estimate actual HRMAX for upper body exercise in healthy young and older adults. A total of 30 young (age: 20 2 years, height: 1719 328 cm, mass: 777 126 kg) and 20 elderly adults (age: 66 6 years, height: 162 81 cm, mass: 653 123 kg) undertook maximal incremental exercise tests on a conventional arm crank ergometer. Ageadjusted maximal heart rate was calculated using prediction equations based on leg exercise and compared with measured HRMAX data for the arms. Maximal HR for arm exercise was significantly overpredicted compared with age-adjusted prediction equations in both young and older adults. Subtracting 10–20 beats min 1 from conventional prediction equations provides a reasonable estimate of HRMAX for upper body exercise in healthy older and younger adults.
Introduction Maximal heart rate (HRMAX) is widely used to prescribe exercise intensity in training for disease prevention and rehabilitation (Tanaka et al., 2001). Furthermore, in clinical settings, exercise is often terminated when individuals achieve a predetermined percentage of the age-predicted HRMAX (e.g. 85% HRMAX) (Balady et al., 2004). Maximal heart rate is also widely used as a criterion for achieving peak exercise intensity at termination of a maximal exercise test in healthy adults (Tanaka et al., 2001). When maximal exercise testing is not feasible (e.g. due to contraindications), HRMAX is often estimated using the age-adjusted prediction equation of 220 age (Fox et al., 1971). The validity of this formula has often been questioned. An alternative formula for age-adjusted HRMAX (208 07 9 age) based on a combined meta-analysis with cross-validation provides a more precise estimate of HRMAX over a wide age spectrum (Tanaka et al., 2001). However, both of the above-mentioned studies used exercise protocols using large muscle masses of the legs; therefore, these
equations cannot be generalized to exercise engaging the upper body musculature. Heart rate values obtained during upper body exercise, such as arm crank ergometry (ACE), are equivalent to 88–93% of HRMAX values recorded during cycle ergometry (Kang et al., 1997). In previous studies of young healthy men (Franklin et al., 1983) and women (Vander et al., 1984), individual peak heart rates were 9–35 beats min 1 lower during ACE than during leg ergometry. Furthermore, in healthy older males, HRMAX is ~10 beats min 1 lower during arm ergometry than during leg ergometry (Pogliaghi et al., 2006). The lower peak values achieved during maximal ACE are due to the utilization of a relatively small muscle mass compared with leg ergometry (Sawka, 1986). Therefore, exercise prescription for arm exercise that is based on HRMAX predictions for treadmill or leg ergometry will overestimate the appropriate training heart rate for the arms (Franklin et al., 1983). At present, no recommendations for upper body exercise HRMAX are available for healthy young or older adults. This is especially important for the elderly as they are the most prevalent population
© 2014 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd 36, 2, 155–158
155
156 Predicted maximal heart rate, M. Hill et al.
undergoing diagnostic exercise testing, which represents a key target group for exercise prescription (Balady et al., 2004). The aim of this study was to investigate the accuracy of ageadjusted prediction equations of HRMAX based on lower body exercise modes to estimate actual HRMAX for upper body exercise. Furthermore, this study aimed to provide a new estimate of HRMAX based on exercise engaging the upper body in both healthy younger and older adults. It was hypothesized that age-predicted HRMAX equations would overestimate actual HRMAX achieved during upper body exercise testing.
tal stage and immediately upon reaching volitional exhaustion. Oxygen uptake (V_ O2) and the respiratory exchange ratio (RER) were measured using a breath-by-breath online gas system (MetaMax, Cortex Biophsik, Borsdorf, Germany). Maximal heart rate was defined as the highest value recorded during the test (Tanaka et al., 2001). Respiratory exchange ratio of >115 and a local rating of perceived exertion (RPE) of at least 18 on the 6–20 points Borg scale were the accepted criterions for the achievement of maximal effort. Statistical analysis
Methods Participants A total of 30 young (age: 20 2 years, height: 1719 328 cm, mass: 777 126 kg) and 20 elderly adults (age: 66 6 years, height: 162 81 cm, mass: 653 123 kg) volunteered to take part in this study, which had received institutional ethical approval. All participants were deemed healthy without any contraindications, as determined by a health screening questionnaire. None of the participants were specifically trained in upper body exercise. Prior to any involvement, all individuals provided written informed consent to participate in the study.
Data were tested for normality (Shapiro–Wilk) and homogeneity of variance (Levene test). Age-adjusted maximal heart rate was predicted using the following equations: (i) 220 age (Fox et al., 1971), (ii) 208 07 9 age (Tanaka et al., 2001) and (iii) 220 age 10 (Franklin et al., 1983). A one-way ANOVA was used to determine differences between measured HRMAX and age-adjusted prediction equations. Younger and older age groups were analysed separately. The difference between measured HRMAX was subtracted from predicted HRMAX. Therefore, a negative value represents an overestimation of HRMAX for upper body exercise based on ageadjusted prediction equations. Data were analysed using IBM version 20.0 (SPSS Inc., Chicago, IL, USA). Statistical significance was set at P≤005.
Incremental exercise tests To determine each individual’s maximal heart rate, all participants performed an incremental exercise test on an arm crank ergometer to volitional exhaustion. The older cohort performed tests on an electronically braked ACE (older cohort; Lode Angio BV, Groningen, the Netherlands), which allowed lower initial power outputs and small incremental increases in power output to be performed. For the older adults, the ACE protocol started with an initial power output of 20 W, with increments of 5 W every 3 min for the first two stages, followed by increments of 5 W min 1 until volitional exhaustion. The young cohort completed ACE trials on a modified cycle ergometer which was clamped to a sturdy table (Monark, 824E, Ergomedic, Sweden). The protocol started with an initial power output of 50 W for 3 min with increments of 20 W every 2 min until volitional exhaustion. The lower initial power output and relatively smaller increments in W for the older compared with younger adults were chosen to avoid premature fatigue among the older cohort. The aforementioned protocols have previously been successfully used to elicit peak responses in healthy young (Price et al., 2011) and older adults (Pogliaghi et al., 2006). The crank rate was set at 70 rev min 1 in young adults (Smith et al., 2001) and adjusted to 60 rev min 1 for older adults to allow for direct comparisons of HRMAX with the only known study in healthy older adults (Pogliaghi et al., 2006). Heart rate (HR) was continually monitored (Polar Electro, Oy, Finland) and recorded in the final 10 s of each incremen-
Results All participants attained an RER ≥ 115 or a local RPE of 18 at volitional exhaustion which was not different between younger and older cohorts (Table 1), suggesting similar maximal efforts for all participants. Mean values for measured and predicted HRMAX are presented in Table 1. There was a statistically significant difference in measured and predicted HRMAX for both young (F2,87 = 77769, P≤001) and older (F2,57 = 24502, P≤001) adults. Post hoc analyses revealed that the mean Tanaka-HRMAX prediction equation significantly overestimated measured HRMAX for arm crank ergometry in both younger (P≤001, 14 10 beats min 1) and older cohorts (P≤001, 18 11 beats min 1). The mean FoxHRMAX prediction equation also significantly overestimated measured HRMAX for arm crank ergometry in both younger (P≤001, 20 10 beats min 1) and older cohorts (P≤001, 10 11 beats min 1). The mean Franklin-HRMAX prediction significantly overestimated HRMAX in young adults (P≤005, 10 10 beats min 1) but not in older adults (P≥005, 0 11 beats min 1).
Discussion The primary finding of this study was that measured HRMAX for upper body exercise, which met predetermined criteria for attaining maximal efforts, was overpredicted by age-adjusted prediction equations of HRMAX using Fox et al.’s (1971),
© 2014 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd 36, 2, 155–158
Predicted maximal heart rate, M. Hill et al.157
Table 1 Physiological responses to maximal upper body exercise in healthy young and older adults Young _ 2PEAK (l min 1) VO _ 2PEAK (ml min 1 kg) VO HRMAX (beats min 1) Predicted HRMAX (208 07 * age) (beats min 1) HR difference Predicted HRMAX (220 age) (beats min 1) HR difference Predicted HRMAX (220 age 10) (beats min 1) HR difference Respiratory exchange ratio Local RPE
242 316 179 194
Older
040* 58* 11* 2*
113 172 144 162
039 50 12 4
14 10 200 2*
18 11 154 5
20 10 190 2
10 11 144 5
10 10* 131 011 19 1
0 11 115 005 20 1
*P≤005 between age groups.
Tanaka et al.’s (2001) and Franklin et al.’s (1983) formulas. These formulas would result in overestimating the true level of physiological stress elicited during arm exercise, as well as the intensity of exercise regimens based on arbitrary percentages of HRMAX. Franklin et al. (1983) provide the most reasonable estimation for HRMAX in older adults, but overpredict HRMAX by 10 beats min 1 in young adults. The present findings suggest that HRMAX prediction equations based on lower body exercise modes cannot be used interchangeably with upper body exercise testing. Early reports proposing the 220 age HRMAX equation appear to derive from reviews by Fox et al. (1971) in the 1970s. However, this equation is not generalizable to older adults as the majority of adults were 115 or RPE > 18), HRMAX is significantly overpredicted when exercising with the arms. Target heart rates are typically designated 10 beats min 1 lower for arm training than for leg training in young adults (Franklin et al., 1983). While subtracting 10 beats min 1 from the HRMAX achieved with the lower body appears a reasonable estimate, this method is
subjective and lacks empirical evidence. Indeed, the present data suggest that this may still overestimate arm exercise when compared with the more accurate Tanaka et al.’s (2001) equation. These discrepancies in HRMAX for the arms provide significant relevance for older and clinical populations. For example, in some clinical settings where upper body exercise training is popular, such as those undergoing hip replacement rehabilitation (Maire et al. 2006), exercise is terminated when individuals achieve a percentage of HRMAX (e.g. 85% HRMAX), which would result in a more severe exercise intensity when performed with the arms. This is particularly important considering the growing popularity of arm exercise training in clinical populations (Tew et al., 2009) owing to concerns related to the level of physiological stress imposed by strenuous arm exercise. Furthermore, individuals may reach volitional exhaustion prior to achieving 85% HRMAX when exercising with the arms. Exercise prescription for the arms based on conventional formulas would result in a target heart rate well above the intended intensity, which may result in premature fatigue and subsequent negligible training adaptations.
Conclusion The results of this study provide novel evidence in that traditional prediction equations for HRMAX significantly overestimate true HRMAX when performing exercise with the upper body musculature. Practitioners should be aware that these methods may prescribe heavy or even severe intensity exercise with the arms. As Tanaka et al.’s (2001) equation is most widely used among older adults, it is recommended that 20 beats min 1 are subtracted from this equation for exercise using the arms. Alternatively, subtracting 10 beats min 1 from the less accurate 220 age provides a reasonable estimate for older adults. For young adults, it is recommended that 10, 15 and 20 beats min 1 are subtracted from the Franklin-HRMAX, Tanaka-HRMAX and Fox-HRMAX prediction equations. Practitioners should be aware that individual’s age will determine the extent to which prediction equations should be adjusted. These findings provide important implications related to diagnostic exercise testing and exercise prescription for rehabilitation and disease prevention using the upper body musculature. Future research should focus on developing a formula specifically aimed at upper body exercise testing, based on a combined meta-analysis with cross-validation in a large cohort.
References Balady GJ, Larson MG, Vasan RS, Leip EP, O’Donnell CJ, Levy D. Usefulness of exercise testing in the prediction of coronary
disease risk among asymptomatic persons as a function of the Framingham risk score. Circulation (2004); 110: 1920–1925.
Fox SM, Naughton JP, Haskell WL. Physical activity and the prevention of coronary heart disease. Ann Clin Res (1971); 3: 404–432.
© 2014 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd 36, 2, 155–158
158 Predicted maximal heart rate, M. Hill et al.
Franklin BA, Vander L, Wrisley D, Rubenfire M. Arm exercise testing and training. Physician Sports Med (1983); 11: 81–90. Kang J, Robertson RJ, Goss FL, Dasilva SG, Suminski RR, Utter AC, Zoeller RF, Metz KF. Metabolic efficiency during arm and leg exercise at the same relative intensities. Med Sci Sports Exerc (1997); 29: 377–382. Maire J, Dugué B, Faillenet-Maire A, Smolander J, Tordi N, Parratte B, Rouillon J, et al. Influence of a 6-week arm exercise program on walking ability and health status after hip arthroplasty: a 1-year follow-up pilot study. J of Rehab Res Dev (2006); 43: 445–450.
Pogliaghi S, Terziotti P, Cevese A, Balestreri F, Schena F. Adaptations to endurance training in the healthy elderly: arm cranking versus leg cycling. Eur J Appl Physiol (2006); 97: 723–731. Price MJ, Bottoms L, Smith PM, Nicholettos A. The effects of an increasing versus constant crank rate on peak physiological responses during incremental arm crank ergometry. J Sports Sci (2011); 29: 263–269. Sawka MN. Physiology of upper body exercise. Exerc Sport Sci Rev (1986); 14: 175–211. Smith PM, Price MJ, Doherty M. The influence of crank rate on peak oxygen
consumption during arm crank ergometry. Journal of Sport Sci (2001); 19: 955–960. Tanaka H, Monahan KD, Seals DR. Age-predicted maximal heart rate revisited. J Am Coll Cardiol (2001); 37: 153–156. Tew G, Nawaz S, Zwierska I, Saxton JM. Limb-specific and cross-transfer effects of arm-crank exercise training in patients with symptomatic peripheral arterial disease. Clin Sci (2009); 117: 405–413. Vander LB, Franklin BA, Wrisley D, Rubenfire M. Cardiorespiratory responses to arm and leg ergometry in women. Physician Sports Med (1984); 12: 101–106.
© 2014 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd 36, 2, 155–158
doi: 10.1111/cpf.12201
SHORT COMMUNICATION
Predicted maximal heart rate for upper body exercise testing M. Hill1, C. Talbot1 and M. Price2 1
Sport, Exercise and Life Sciences, University of Northampton, Northampton, UK and 2Faculty of Health and Life Sciences, Department of Biomolecular and Sport Sciences, Coventry University, Coventry, UK
Summary Correspondence M. Hill, Sport, Exercise and Life Sciences, University of Northampton, Boughton Green Road, Northampton, NN2 7AL, UK E-mail: [email protected]
Accepted for publication Received 14 August 2014; accepted 24 September 2014
Key words aging; arm crank ergometry; autonomic; exercise testing; rehabilitation
Age-predicted maximal heart rate (HRMAX) equations are commonly used for the purpose of prescribing exercise regimens, as criteria for achieving maximal exertion and for diagnostic exercise testing. Despite the growing popularity of upper body exercise in both healthy and clinical settings, no recommendations are available for exercise modes using the smaller upper body muscle mass. The purpose of this study was to determine how well commonly used age-adjusted prediction equations for HRMAX estimate actual HRMAX for upper body exercise in healthy young and older adults. A total of 30 young (age: 20 2 years, height: 1719 328 cm, mass: 777 126 kg) and 20 elderly adults (age: 66 6 years, height: 162 81 cm, mass: 653 123 kg) undertook maximal incremental exercise tests on a conventional arm crank ergometer. Ageadjusted maximal heart rate was calculated using prediction equations based on leg exercise and compared with measured HRMAX data for the arms. Maximal HR for arm exercise was significantly overpredicted compared with age-adjusted prediction equations in both young and older adults. Subtracting 10–20 beats min 1 from conventional prediction equations provides a reasonable estimate of HRMAX for upper body exercise in healthy older and younger adults.
Introduction Maximal heart rate (HRMAX) is widely used to prescribe exercise intensity in training for disease prevention and rehabilitation (Tanaka et al., 2001). Furthermore, in clinical settings, exercise is often terminated when individuals achieve a predetermined percentage of the age-predicted HRMAX (e.g. 85% HRMAX) (Balady et al., 2004). Maximal heart rate is also widely used as a criterion for achieving peak exercise intensity at termination of a maximal exercise test in healthy adults (Tanaka et al., 2001). When maximal exercise testing is not feasible (e.g. due to contraindications), HRMAX is often estimated using the age-adjusted prediction equation of 220 age (Fox et al., 1971). The validity of this formula has often been questioned. An alternative formula for age-adjusted HRMAX (208 07 9 age) based on a combined meta-analysis with cross-validation provides a more precise estimate of HRMAX over a wide age spectrum (Tanaka et al., 2001). However, both of the above-mentioned studies used exercise protocols using large muscle masses of the legs; therefore, these
equations cannot be generalized to exercise engaging the upper body musculature. Heart rate values obtained during upper body exercise, such as arm crank ergometry (ACE), are equivalent to 88–93% of HRMAX values recorded during cycle ergometry (Kang et al., 1997). In previous studies of young healthy men (Franklin et al., 1983) and women (Vander et al., 1984), individual peak heart rates were 9–35 beats min 1 lower during ACE than during leg ergometry. Furthermore, in healthy older males, HRMAX is ~10 beats min 1 lower during arm ergometry than during leg ergometry (Pogliaghi et al., 2006). The lower peak values achieved during maximal ACE are due to the utilization of a relatively small muscle mass compared with leg ergometry (Sawka, 1986). Therefore, exercise prescription for arm exercise that is based on HRMAX predictions for treadmill or leg ergometry will overestimate the appropriate training heart rate for the arms (Franklin et al., 1983). At present, no recommendations for upper body exercise HRMAX are available for healthy young or older adults. This is especially important for the elderly as they are the most prevalent population
© 2014 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd 36, 2, 155–158
155
156 Predicted maximal heart rate, M. Hill et al.
undergoing diagnostic exercise testing, which represents a key target group for exercise prescription (Balady et al., 2004). The aim of this study was to investigate the accuracy of ageadjusted prediction equations of HRMAX based on lower body exercise modes to estimate actual HRMAX for upper body exercise. Furthermore, this study aimed to provide a new estimate of HRMAX based on exercise engaging the upper body in both healthy younger and older adults. It was hypothesized that age-predicted HRMAX equations would overestimate actual HRMAX achieved during upper body exercise testing.
tal stage and immediately upon reaching volitional exhaustion. Oxygen uptake (V_ O2) and the respiratory exchange ratio (RER) were measured using a breath-by-breath online gas system (MetaMax, Cortex Biophsik, Borsdorf, Germany). Maximal heart rate was defined as the highest value recorded during the test (Tanaka et al., 2001). Respiratory exchange ratio of >115 and a local rating of perceived exertion (RPE) of at least 18 on the 6–20 points Borg scale were the accepted criterions for the achievement of maximal effort. Statistical analysis
Methods Participants A total of 30 young (age: 20 2 years, height: 1719 328 cm, mass: 777 126 kg) and 20 elderly adults (age: 66 6 years, height: 162 81 cm, mass: 653 123 kg) volunteered to take part in this study, which had received institutional ethical approval. All participants were deemed healthy without any contraindications, as determined by a health screening questionnaire. None of the participants were specifically trained in upper body exercise. Prior to any involvement, all individuals provided written informed consent to participate in the study.
Data were tested for normality (Shapiro–Wilk) and homogeneity of variance (Levene test). Age-adjusted maximal heart rate was predicted using the following equations: (i) 220 age (Fox et al., 1971), (ii) 208 07 9 age (Tanaka et al., 2001) and (iii) 220 age 10 (Franklin et al., 1983). A one-way ANOVA was used to determine differences between measured HRMAX and age-adjusted prediction equations. Younger and older age groups were analysed separately. The difference between measured HRMAX was subtracted from predicted HRMAX. Therefore, a negative value represents an overestimation of HRMAX for upper body exercise based on ageadjusted prediction equations. Data were analysed using IBM version 20.0 (SPSS Inc., Chicago, IL, USA). Statistical significance was set at P≤005.
Incremental exercise tests To determine each individual’s maximal heart rate, all participants performed an incremental exercise test on an arm crank ergometer to volitional exhaustion. The older cohort performed tests on an electronically braked ACE (older cohort; Lode Angio BV, Groningen, the Netherlands), which allowed lower initial power outputs and small incremental increases in power output to be performed. For the older adults, the ACE protocol started with an initial power output of 20 W, with increments of 5 W every 3 min for the first two stages, followed by increments of 5 W min 1 until volitional exhaustion. The young cohort completed ACE trials on a modified cycle ergometer which was clamped to a sturdy table (Monark, 824E, Ergomedic, Sweden). The protocol started with an initial power output of 50 W for 3 min with increments of 20 W every 2 min until volitional exhaustion. The lower initial power output and relatively smaller increments in W for the older compared with younger adults were chosen to avoid premature fatigue among the older cohort. The aforementioned protocols have previously been successfully used to elicit peak responses in healthy young (Price et al., 2011) and older adults (Pogliaghi et al., 2006). The crank rate was set at 70 rev min 1 in young adults (Smith et al., 2001) and adjusted to 60 rev min 1 for older adults to allow for direct comparisons of HRMAX with the only known study in healthy older adults (Pogliaghi et al., 2006). Heart rate (HR) was continually monitored (Polar Electro, Oy, Finland) and recorded in the final 10 s of each incremen-
Results All participants attained an RER ≥ 115 or a local RPE of 18 at volitional exhaustion which was not different between younger and older cohorts (Table 1), suggesting similar maximal efforts for all participants. Mean values for measured and predicted HRMAX are presented in Table 1. There was a statistically significant difference in measured and predicted HRMAX for both young (F2,87 = 77769, P≤001) and older (F2,57 = 24502, P≤001) adults. Post hoc analyses revealed that the mean Tanaka-HRMAX prediction equation significantly overestimated measured HRMAX for arm crank ergometry in both younger (P≤001, 14 10 beats min 1) and older cohorts (P≤001, 18 11 beats min 1). The mean FoxHRMAX prediction equation also significantly overestimated measured HRMAX for arm crank ergometry in both younger (P≤001, 20 10 beats min 1) and older cohorts (P≤001, 10 11 beats min 1). The mean Franklin-HRMAX prediction significantly overestimated HRMAX in young adults (P≤005, 10 10 beats min 1) but not in older adults (P≥005, 0 11 beats min 1).
Discussion The primary finding of this study was that measured HRMAX for upper body exercise, which met predetermined criteria for attaining maximal efforts, was overpredicted by age-adjusted prediction equations of HRMAX using Fox et al.’s (1971),
© 2014 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd 36, 2, 155–158
Predicted maximal heart rate, M. Hill et al.157
Table 1 Physiological responses to maximal upper body exercise in healthy young and older adults Young _ 2PEAK (l min 1) VO _ 2PEAK (ml min 1 kg) VO HRMAX (beats min 1) Predicted HRMAX (208 07 * age) (beats min 1) HR difference Predicted HRMAX (220 age) (beats min 1) HR difference Predicted HRMAX (220 age 10) (beats min 1) HR difference Respiratory exchange ratio Local RPE
242 316 179 194
Older
040* 58* 11* 2*
113 172 144 162
039 50 12 4
14 10 200 2*
18 11 154 5
20 10 190 2
10 11 144 5
10 10* 131 011 19 1
0 11 115 005 20 1
*P≤005 between age groups.
Tanaka et al.’s (2001) and Franklin et al.’s (1983) formulas. These formulas would result in overestimating the true level of physiological stress elicited during arm exercise, as well as the intensity of exercise regimens based on arbitrary percentages of HRMAX. Franklin et al. (1983) provide the most reasonable estimation for HRMAX in older adults, but overpredict HRMAX by 10 beats min 1 in young adults. The present findings suggest that HRMAX prediction equations based on lower body exercise modes cannot be used interchangeably with upper body exercise testing. Early reports proposing the 220 age HRMAX equation appear to derive from reviews by Fox et al. (1971) in the 1970s. However, this equation is not generalizable to older adults as the majority of adults were 115 or RPE > 18), HRMAX is significantly overpredicted when exercising with the arms. Target heart rates are typically designated 10 beats min 1 lower for arm training than for leg training in young adults (Franklin et al., 1983). While subtracting 10 beats min 1 from the HRMAX achieved with the lower body appears a reasonable estimate, this method is
subjective and lacks empirical evidence. Indeed, the present data suggest that this may still overestimate arm exercise when compared with the more accurate Tanaka et al.’s (2001) equation. These discrepancies in HRMAX for the arms provide significant relevance for older and clinical populations. For example, in some clinical settings where upper body exercise training is popular, such as those undergoing hip replacement rehabilitation (Maire et al. 2006), exercise is terminated when individuals achieve a percentage of HRMAX (e.g. 85% HRMAX), which would result in a more severe exercise intensity when performed with the arms. This is particularly important considering the growing popularity of arm exercise training in clinical populations (Tew et al., 2009) owing to concerns related to the level of physiological stress imposed by strenuous arm exercise. Furthermore, individuals may reach volitional exhaustion prior to achieving 85% HRMAX when exercising with the arms. Exercise prescription for the arms based on conventional formulas would result in a target heart rate well above the intended intensity, which may result in premature fatigue and subsequent negligible training adaptations.
Conclusion The results of this study provide novel evidence in that traditional prediction equations for HRMAX significantly overestimate true HRMAX when performing exercise with the upper body musculature. Practitioners should be aware that these methods may prescribe heavy or even severe intensity exercise with the arms. As Tanaka et al.’s (2001) equation is most widely used among older adults, it is recommended that 20 beats min 1 are subtracted from this equation for exercise using the arms. Alternatively, subtracting 10 beats min 1 from the less accurate 220 age provides a reasonable estimate for older adults. For young adults, it is recommended that 10, 15 and 20 beats min 1 are subtracted from the Franklin-HRMAX, Tanaka-HRMAX and Fox-HRMAX prediction equations. Practitioners should be aware that individual’s age will determine the extent to which prediction equations should be adjusted. These findings provide important implications related to diagnostic exercise testing and exercise prescription for rehabilitation and disease prevention using the upper body musculature. Future research should focus on developing a formula specifically aimed at upper body exercise testing, based on a combined meta-analysis with cross-validation in a large cohort.
References Balady GJ, Larson MG, Vasan RS, Leip EP, O’Donnell CJ, Levy D. Usefulness of exercise testing in the prediction of coronary
disease risk among asymptomatic persons as a function of the Framingham risk score. Circulation (2004); 110: 1920–1925.
Fox SM, Naughton JP, Haskell WL. Physical activity and the prevention of coronary heart disease. Ann Clin Res (1971); 3: 404–432.
© 2014 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd 36, 2, 155–158
158 Predicted maximal heart rate, M. Hill et al.
Franklin BA, Vander L, Wrisley D, Rubenfire M. Arm exercise testing and training. Physician Sports Med (1983); 11: 81–90. Kang J, Robertson RJ, Goss FL, Dasilva SG, Suminski RR, Utter AC, Zoeller RF, Metz KF. Metabolic efficiency during arm and leg exercise at the same relative intensities. Med Sci Sports Exerc (1997); 29: 377–382. Maire J, Dugué B, Faillenet-Maire A, Smolander J, Tordi N, Parratte B, Rouillon J, et al. Influence of a 6-week arm exercise program on walking ability and health status after hip arthroplasty: a 1-year follow-up pilot study. J of Rehab Res Dev (2006); 43: 445–450.
Pogliaghi S, Terziotti P, Cevese A, Balestreri F, Schena F. Adaptations to endurance training in the healthy elderly: arm cranking versus leg cycling. Eur J Appl Physiol (2006); 97: 723–731. Price MJ, Bottoms L, Smith PM, Nicholettos A. The effects of an increasing versus constant crank rate on peak physiological responses during incremental arm crank ergometry. J Sports Sci (2011); 29: 263–269. Sawka MN. Physiology of upper body exercise. Exerc Sport Sci Rev (1986); 14: 175–211. Smith PM, Price MJ, Doherty M. The influence of crank rate on peak oxygen
consumption during arm crank ergometry. Journal of Sport Sci (2001); 19: 955–960. Tanaka H, Monahan KD, Seals DR. Age-predicted maximal heart rate revisited. J Am Coll Cardiol (2001); 37: 153–156. Tew G, Nawaz S, Zwierska I, Saxton JM. Limb-specific and cross-transfer effects of arm-crank exercise training in patients with symptomatic peripheral arterial disease. Clin Sci (2009); 117: 405–413. Vander LB, Franklin BA, Wrisley D, Rubenfire M. Cardiorespiratory responses to arm and leg ergometry in women. Physician Sports Med (1984); 12: 101–106.
© 2014 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd 36, 2, 155–158
