Cardiopulmonary Rehabilitation Exercise Prescriptions: Quality Comparison of Exercise Tolerance Testing vs Estimated Target Heart Rates

Elizabeth Weiner, MD (VA Greater Los Angeles (UCLA) Health System, Los Angeles, California); Dixie Aragaki, MD; Jerry Luo, MD; Grace Zhang, MD; Sara Flores, MD; Babak K. Darvish, MD; Mike Trung-Hung Tran, MD

Meeting: AAPM&R Annual Assembly 2021

Categories: Practice Management, Leadership, and Quality Improvement (2021)

Session Information

Session Title: AA 2021 Virtual Posters - Practice Management, Leadership, and Quality Improvement

Session Time: None. Available on demand.

Disclosures: Elizabeth Weiner, MD: No financial relationships or conflicts of interest

Objective: We aim to compare cardiopulmonary rehabilitation exercise prescriptions based on exercise tolerance tests (ETT) versus estimated target heart rates (THR) without an ETT. If THR calculated without an ETT yields similar results, non-ETT estimates may be considered for situations where in-person testing can be avoided. Ongoing goals include risk stratification to identify patients who would benefit from an ETT.

Design: We performed a preliminary chart review of 42 veterans who underwent ETT in 2019. ANOVA was used to retrospectively compare THR ranges using the following methods: ETT, Karvonen formula based on age-predicted maximum HR, and resting heart rate (RHR) +20 – 30 beats per minute (BPM). Overlap between groups was determined using a quantitative statistic.Setting : Veterans Affairs (VA) cardiopulmonary rehabilitation clinicParticipants : Veterans who completed ETT in 2019-2020

Interventions: None

Main Outcome Measures: Difference in THR ranges between ETT, Karvonen formula using age-predicted maximum HR, and RHR +20 – 30 (BPM). Future measures include incidence of 6-month re-hospitalization and repeat acute coronary syndrome events.

Results: Preliminary comparison of data revealed a significant difference (p < 0.05) between patient THRs as calculated by ETT vs age-predicted vs RHR +20 - 30 BPM. There was more agreement between the ETT and the range calculated by RHR + 20 - 30 BPM (52%) than that of age-predicted maximum HR (26%).Conclusions: Using an age-determined predicted maximum heart rate rather than an ETT as the basis for cardiopulmonary rehabilitation exercise prescription may be ill-advised. For patients with multiple factors influencing their achievable heart rates, predetermined formulae cannot replace an ETT. Further investigation is necessary to increase the power of our analysis and examine patient demographics for purposes of risk stratification.

Level of Evidence: Level V

To cite this abstract in AMA style:

Weiner E, Aragaki D, Luo J, Zhang G, Flores S, Darvish BK, Tran MT. Cardiopulmonary Rehabilitation Exercise Prescriptions: Quality Comparison of Exercise Tolerance Testing vs Estimated Target Heart Rates [abstract]. PM R. 2021; 13(S1)(suppl 1). https://pmrjabstracts.org/abstract/cardiopulmonary-rehabilitation-exercise-prescriptions-quality-comparison-of-exercise-tolerance-testing-vs-estimated-target-heart-rates/. Accessed May 12, 2025.

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