Arena Ross, Myers Jonathan, Kaminsky Leonard A
Department of Physical Therapy and Integrative Physiology Laboratory, College of Applied Science, University of Illinois, Chicago, IL.
VA Palo Alto Health Care System and Stanford University, Ball State University, Muncie, IN.
Am Heart J. 2016 Mar;173:49-56. doi: 10.1016/j.ahj.2015.12.006. Epub 2015 Dec 17.
Despite high error ranges, age-predicted maximal heart rate (APMHR) is frequently used to gauge the achievement of adequate effort during an exercise test. The current analysis revisits this issue using the Fitness Registry and the Importance of Exercise: National Database (FRIEND Registry).
A total of 4,796 (63% male) apparently healthy subjects underwent a maximal cardiopulmonary exercise test on a treadmill. The mean age, maximal heart rate (HR), and maximal aerobic capacity of the cohort were 43 ± 12 years, 178 ± 15 beats per minute, and 36.1 ± 10.6 mlO2 · kg(-1) · min(-1), respectively. All subjects reached or surpassed a peak respiratory exchange ratio of 1.10. A linear regression equation using age to predict maximal HR was validated in 3,796 subjects and cross-validated in the remaining 1,000 (randomly assigned).
The APMHR equation in the validation cohort was as follows: 209.3 - 0.72(age). The r value and standard error of estimate for this regression was 0.61 (P < .001) and 11.35 beats/min, respectively. A 1-sample t test revealed that the mean difference between actual maximal HR and APMHR was not significantly different from 0 (mean difference = 0.32, P = .43). However, Bland-Altman revealed high limits of agreement (upper 25.31 and lower -24.67) and a significant proportional bias.
The APMHR equation derived from this analysis included a large cohort of apparently healthy individuals with maximal exercise effort validated by the criterion standard (ie, peak respiratory exchange ratio). Using APMHR in this capacity should be discouraged, and new approaches to gauging an individual's exercise effort should be explored.
尽管误差范围较大，但年龄预测的最大心率（APMHR）仍经常用于评估运动测试期间是否达到了足够的运动强度。本分析使用健身注册与运动重要性：国家数据库（FRIEND注册库）重新审视了这个问题。
共有4796名（63%为男性）表面健康的受试者在跑步机上进行了最大心肺运动测试。该队列的平均年龄、最大心率（HR）和最大有氧能力分别为43±12岁、每分钟178±15次心跳和36.1±10.6 mlO2·kg⁻¹·min⁻¹。所有受试者均达到或超过了1.10的峰值呼吸交换率。使用年龄预测最大心率的线性回归方程在3796名受试者中进行了验证，并在其余1000名（随机分配）受试者中进行了交叉验证。
验证队列中的APMHR方程如下：209.3 - 0.72（年龄）。该回归的r值和估计标准误差分别为0.61（P <.001）和11.35次/分钟。单样本t检验显示，实际最大心率与APMHR之间的平均差异与0无显著差异（平均差异 = 0.32，P =.43）。然而，Bland-Altman分析显示一致性界限较高（上限为25.31，下限为-24.67）且存在显著的比例偏差。
本分析得出的APMHR方程纳入了大量表面健康的个体，且通过标准标准（即峰值呼吸交换率）验证了最大运动强度。不应鼓励以这种方式使用APMHR，应探索评估个体运动强度的新方法。
