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Improvements in Heart Rate Recovery Among Women After Cardiac Rehabilitation Completion

Beckie, Theresa M. PhD, FAHA; Beckstead, Jason W. PhD; Kip, Kevin E. PhD, FAHA; Fletcher, Gerald MD, FAHA

The Journal of Cardiovascular Nursing: January/February 2014 - Volume 29 - Issue 1 - p 38–47
doi: 10.1097/JCN.0b013e31827324e2

Background: Heart rate recovery (HRR) after exercise cessation is thought to reflect the rate of reestablishment of parasympathetic tone. Relatively little research has focused on improved HRR in women after completing cardiac rehabilitation (CR) exercise training.

Objective: We examined the influence of exercise training on HRR in women completing a traditional CR program and in women completing a CR program tailored for women.

Methods: A 2-group randomized clinical trial compared HRR between 99 women completing a traditional 12-week CR program and 137 women completing a tailored CR program. Immediately upon completion of a symptom-limited graded exercise test, HRR was measured at 1 through 6 minutes.

Results: Compared with baseline, improvement in 1-minute HRR (HRR1) was similar (P = 0.777) between the tailored (mean [SD], 17.5 [11] to 19.1 [12]) and the traditional CR program (15.7 [9.0] to 16.9 [9.5]). The amount of change in the 2-minute HRR (HRR2) for the tailored (30 [13] to 32.8 [14.6]) and traditional programs (28.3 [12.8] to 31.2 [13.7]) also was not different (P = 0.391). Similar results were observed for HRR at 3 through 6 minutes. Given these comparable improvements of the 2 programs, in the full cohort, the factors independently predictive of post-CR HRR1, in rank order, were baseline HRR1 (part correlation, 0.35; P < 0.001); peak exercise capacity, estimated as metabolic equivalents (METs; 0.24, P < 0.001); anxiety (−0.17, P = 0.001); and age (−0.13, P = 0.016). The factors independently associated with post-CR HRR2 were baseline HRR2 (0.44, P < 0.001), peak METs (0.21, P < 0.001), and insulin use (−0.10, P = 0.041).

Conclusions: One to 6 minutes after exercise cessation, HRR was significantly improved among the women completing both CR programs. The modifiable factors positively associated with HRR1 included peak METs and lower anxiety, whereas HRR2 was associated with insulin administration and peak METs. Additional research on HRR after exercise training in women is warranted.

Theresa M. Beckie, PhD, FAHA Professor, College of Nursing, University of South Florida, Tampa.

Jason W. Beckstead, PhD Associate Professor, College of Nursing, University of South Florida, Tampa.

Kevin E. Kip, PhD, FAHA Professor, College of Nursing, University of South Florida, Tampa.

Gerald Fletcher, MD, FAHA Professor of Medicine, Cardiovascular Diseases, Mayo Clinic College of Medicine, Jacksonville, Florida.

Funding for this study was provided by the National Institute of Nursing Research (5R01 NR07678).

The authors have no conflicts of interest to disclose.

Correspondence Theresa M. Beckie, PhD, FAHA, College of Nursing, MDC 22, University of South Florida, 12901 Bruce B. Downs Blvd, Tampa, FL 33612 (

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins