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Maximal heart rate (HRmax) is one of the most commonly related to the physiologic stress imposed by strenuous
used values in clinical medicine and physiology. For exam- exercise. Thus, ironically, the 220 ⫺ age HRmax prediction
ple, a straight percentage of HRmax or a fixed percentage of equation is used in this population more than in any other.
heart rate reserve (HRmax ⫺ heart rate at rest) is used as a Accordingly, the aim of the present study was to deter-
basis for prescribing exercise intensity in both rehabilitation mine an equation for predicting HRmax in healthy, non-
and disease prevention programs (1,2). Moreover, in some medicated humans ranging widely in age. To address this
clinical settings, exercise testing is terminated when subjects aim, we first used a meta-analytic approach in which group
reach an arbitrary percentage of their age-predicted maximal mean HRmax values were obtained from the published data.
heart rate (e.g., 85% of HRmax) (3). Maximal heart rate also Subsequently, we cross-validated the newly derived equa-
is widely used as a criterion for achieving peak exertion in tion in a well-controlled, laboratory-based study. With each
the determination of maximal aerobic capacity (1,4,5). approach, we attempted to establish the generalizability of
Because maximal exercise testing is not feasible in many the equation by determining whether gender or habitual
settings, HRmax is often estimated using the age-predicted physical activity status exerted a significant modulatory
equation of 220 ⫺ age. However, the validity of the influence on the HRmax-age relation.
age-predicted HRmax equation has not been established,
particularly in a study sample that included an adequate
METHODS
number of older adults (e.g., ⬎60 years of age). The latter
limitation is crucial in that older adults demonstrate the Meta-analytic study. Meta-analysis is a set of quantitative
highest prevalence of cardiovascular and other chronic procedures for systematically integrating and analyzing the
diseases. As such, this is the most prevalent population findings of previous research. Meta-analysis in the present
undergoing diagnostic exercise testing, representing a key study was conducted as described previously in detail by our
clinical target for exercise prescription. Importantly, older laboratory (6). As an initial step, an extensive search of the
adults are a population in which there is often a reluctance published data was conducted to identify as many studies as
or an inability to measure HRmax directly, owing to concerns possible in which HRmax was measured. Initially, this was
done by using computer searches. In addition, extensive
From the Human Cardiovascular Research Laboratory, Department of Kinesiology hand searching and cross-referencing were performed using
and Applied Physiology, University of Colorado at Boulder, Boulder, Colorado; and
Divisions of Cardiology and Geriatric Medicine, Department of Medicine, University bibliographies of already retrieved studies. The following
of Colorado Health Sciences Center, Denver, Colorado. This work was supported by criteria for inclusion were used: 1) English language studies
National Institutes of Health (Bethesda, Maryland) awards AG-00847, AG-06537 published in peer-reviewed journals; 2) data on men and
and AG-13038.
Manuscript received April 18, 2000; revised manuscript received July 24, 2000, women reported separately; 3) at least five subjects per
accepted September 13, 2000. group; 4) only the most recently published results of a
Figure 2. Relation between maximal heart rate (HRmax) and age obtained
from the prospective, laboratory-based study.
provides a more accurate estimation of HRmax on average, as the adult age range in healthy humans. Specifically, the
with previous equations, it may not precisely predict true traditional equation underestimates HRmax past age 40
HRmax in some individuals, because of the standard devia- years, markedly so in older adults. On the basis of the
tion. As such, despite the convenience and ease of use of cross-confirmatory findings of our meta-analysis and com-
age-predicted HRmax, direct measurements of HRmax plementary prospective study, we present a new equation for
should be used as an indicator of physical stress whenever future use that should provide more precise results. These
possible. Alternatively, individuals may choose to use more findings have important clinical implications related to
subjective end points of exercise, such as breathlessness exercise testing and prescription.
and/or a fatigue level considered to be “somewhat hard” to
“hard” on the Borg perceived exertion scale (2). Reprint requests and correspondence: Dr. Hirofumi Tanaka,
Clinical implications. These differences in HRmax could Department of Kinesiology and Applied Physiology, Campus Box
have a number of important clinical implications for older 354, University of Colorado at Boulder, Boulder, Colorado 80309-
adults. First, because exercise testing is terminated when 0354. E-mail: tanakah@colorado.edu.
subjects reach a certain percentage of predicted HRmax (e.g.,
85% HRmax) in some clinical settings (3), use of the REFERENCES
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