Original Article
Exercise Blood Pressure and Heart Rate Reference Values

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Background

Besides their prognostic impact blood pressure and peak heart rate are widely used endpoint parameters for incremental exercise tests. Reference equations and ranges on both are sparse.

Objective

This study aims to describe prediction equations and reference ranges for systolic and diastolic blood pressure as well as for peak heart rate assessed during a symptom limited incremental exercise test based on a population based study – the Study of Health in Pomerania.

Design

For this purpose, 1708 individuals aged 25–85 years underwent cardiopulmonary exercise testing.

Results

After exclusion of subjects with cardiopulmonary diseases and antihypertensive medications regression analyses revealed age, sex and body mass index as statistically significant interfering factors. In accordance, prediction equations and reference ranges for blood pressure and peak heart rate with respect to sex, age and BMI have been established.

Conclusion

This study provides a reliable set of prediction equations for blood pressure and heart rate values at peak exercise, assessed in a general population over a wide age range.

Introduction

Several levels of evidence underline the importance of resting systolic (SBP) and diastolic blood pressure (DBP) as predictors for increased cardiovascular diseases mortality [1], [2], [3]. Furthermore, exaggerated blood pressure responses to exercise may indicate an increased risk for cardiovascular morbidity [4] and mortality [5] and may potentially provide superior risk estimates for the development of arterial hypertension and cardiovascular events than resting measures [6]. In patients with pulmonary arterial hypertension the magnitude of SBP change from rest to exercise has shown to provide reliable prognostic information's on survival [7]. Correspondingly, heart rate at peak exercise (HRpeak) as well as heart rate response gives easily available prognostic information in patients with cardiovascular diseases [8].

In general, the interpretation of results requires the knowledge of normal responses [9]. Even if frequently applied in clinical settings, reference values on both, blood pressure and HRpeak are sparse. The majority of available reference equations are based on small and preselected samples of healthy volunteers, and therefore are very likely not representative for the general population [9], [10], [11]. For example, reference values on blood pressure at peak exercise published in the most widely used text book of exercise physiology base on two studies in only 99 volunteers [9], [12], [13]. Furthermore, HRpeak as a potential surrogate of maximal exhaustion during incremental exercise tests is usually calculated by the equation “HRpeak = 220  age”. As shown by Robergs and Landwehr, this equation does not have sufficient scientific merit since it was based on observations resulting from data of 11 references consisting of published research and unpublished observations [10].

Against this background our study aims to compile reference values based on a large-scale population based study representing a general adult population in the north-east of Germany – the Study of Health in Pomerania (SHIP).

Section snippets

Study Population

Study volunteers were participants of the first follow-up survey of SHIP. The study details are given elsewhere [14]. In brief, from the entire study population of 212,157 inhabitants living in the area, a sample was selected from the population registration offices, where all German inhabitants are registered. A representative sample was drawn, comprised of 7008 adults, ages 20–79 years with 292 persons of each gender in each of the 12 five-year age strata. The net sample (without migrated or

General Characteristics

Men were more often current or former smokers (63.8% vs. 50.1%, p < 0.01) and were more often >2 h per week physically active (26.9% vs. 19.2%, p < 0.01) than women. Moreover men had a higher BMI (26.1 kg/m2 vs. 24.5 kg/m2, p < 0.01) than women. Regarding SBPpeak and DBPpeak an increase with age was seen, even if in the oldest age-groups the blood pressure slightly decreased in our study population (Table 1). The HRpeak decreased with age in both men and women (Table 1).

Univariate Reference Ranges

Table 2 presents, separately for

Discussion

This study provides population-based prediction equations and reference ranges for blood pressure and heart rate at maximal exhaustion during an incremental exercise test. To the best of our knowledge these data are unique in the quality of assessment, pre-exercise diagnostics to minimise the potential influence of so far undetected cardiovascular or pulmonary diseases, number of volunteers and the statistical considerations of potential interfering factors.

In our study, 26 volunteers had to be

Conclusion

This study provides prediction equations on peak exercise blood pressure and heart rate. Both parameters are influenced by age, sex and body mass index. In addition, upper and lower limits of normality have been given. We assume that these results may help to interpret results focusing on these easily assessable exercise variables in the future since the base to calculate results in relation to normality is given.

Conflict of interest

The authors declare no conflict of interest.

Funding

SHIP is part of the Community Medicine Net of the University of Greifswald, which is funded by grants from the German Federal Ministry of Education and Research for SHIP (BMBF, grant 01ZZ96030, 01ZZ0701) and German Asthma and COPD Network (COSYCONET; BMBF grant 01GI0883); the Ministry for Education, Research, and Cultural Affairs; and the Ministry for Social Affairs of the Federal State of Mecklenburg – West Pomerania. This work was further supported by the research project Greifswald Approach

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  • 1

    Those authors contributed equally.

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