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Determining Target Heart Rate for Exercising in a Cardiac Rehabilitation Program: A Retrospective Study

Sebastian, Lonnie A. MSN, RN-BC; Reeder, Sara PhD, RN; Williams, Mark BS

Journal of Cardiovascular Nursing: March/April 2015 - Volume 30 - Issue 2 - p 164–171
doi: 10.1097/JCN.0000000000000154

Background: One of the well-established methods used to determine endurance training intensity for patients in outpatient cardiac rehabilitation (CR) is to take a percentage (70%–85%) of the maximal or peak heart rate (HRmax) from a recent postevent symptom-limited graded exercise test (GXT). Because many patients are referred to CR without having had a maximal GXT, a current practice is to use 30% to 50% above resting heart rate (RHR) to estimate endurance training intensity.

Objective: The purpose of this study was to determine if a target heart rate (THR) of 30% to 50% above RHR approximated a THR of 70% to 85% of the HRmax achieved on GXT (HRmax GXT) and provided equivalent exercise intensity based on ratings of perceived exertion (RPE) and metabolic equivalency thresholds (METs).

Methods: A retrospective chart review of 53 patients enrolled in CR and had documentation of postevent GXT was conducted to determine the patient’s mean exercise heart rate (HR) achieved at each session to percentage above RHR and percentage HRmax GXT. Analysis was conducted to determine and compare patients’ HRs, RPE, and MET levels when patients were exercising within the THR ranges of 30% to 50% above RHR and 70% to 85% HRmax GXT.

Results: A THR range of 30% to 50% above RHR approximated 60% to 70% HRmax GXT. Mean exercise HRs progressed from 39% to 49% above RHR sessions 2 to 6 with mean (SD) RPE of 10.58 (0.55) to 11.44 (0.68) on the Borg scale and mean (SD) MET level of 2.91 (0.55) to 3.31 (0.6). Mean exercise HRs progressed to 54% to 65% above RHR sessions 7 to 18 and approximated 70% to 73% HRmax GXT. Mean (SD) RPE at this intensity ranged from 11.57 (0.58) to 12.21 (0.53) with a mean (SD) MET level of 3.47 (0.6) to 3.8 (0.77).

Conclusion: In the observed population, a THR of 30% to 50% above RHR underestimated the THR range of 70% to 85% HRmax GXT but provided adequate exercise intensity for patients at the beginning of a CR program based on percentage HRmax GXT, RPE and MET levels.

Lonnie A. Sebastian, MSN, RN-BC Staff Nurse, Outpatient Cardiac Rehabilitation Department, Bryn Mawr Hospital, Pennsylvania.

Sara Reeder, PhD, RN Nurse Research Consultant, Main Line Health, Bryn Mawr Hospital, and Associate Professor, College of Nursing, Villanova University, Pennsylvania.

Mark Williams, BS Vice President, Applied Clinical Intelligence, LLC, Bala Cynwyd, Pennsylvania.

The authors have no funding or conflicts of interest to disclose.

Correspondence Lonnie A. Sebastian, MSN, RN-BC, Outpatient Cardiac Rehabilitation Department, Bryn Mawr Hospital, Bryn Mawr, PA 19010 (

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