PURPOSE: Heart rate recovery (HRR) following exercise testing consistently demonstrates diagnostic/prognostic value in both healthy and cardiac populations. Furthermore, aerobic exercise training significantly reduces HRR in patients with cardiovascular disease. While initial evidence indicates that HRR is prognostic in patients with pulmonary disease, the impact of exercise training on HRR has not been investigated. The present investigation examines the impact of exercise training on HRR in elderly patients with COPD.
METHODS: Seventy-two patients ≥80 years of age (47 female/25 male, mean: 83.6 ± 2.9 years) with pulmonary disease (78% diagnosed with COPD) were included. Subjects underwent treadmill exercise testing prior to and immediately following participation in 24 sessions of pulmonary physical therapy. The program consisted of breathing retraining, aerobic exercise and resistance training as well as patient education, nutritional counseling, smoking cessation and stress reduction where indicated. Heart rate recovery was calculated as the difference between heart rate at peak exercise and at three minutes into the recovery phase.
RESULTS: Paired t-testing revealed peak metabolic equivalent (MET) level (2.4 ± 0.91 vs. 4.3 ± 1.5 METs, p<0.001) and HRR (23.1 ± 9.3 vs. 27.4 ± 10.1 beats per minute, p<0.001) were significantly higher following pulmonary rehabilitation. Pearson product moment correlation revealed the relationship between change in peak MET level and change in HRR following pulmonary physical therapy was not significant (r=0.12, p=0.33).
CONCLUSION: The results of the present study indicate that HRR is favorably altered following exercise training in patients with pulmonary disease. This same finding has been previously demonstrated in cohorts with cardiac disease. This adaptation appears to be independent of the improvement in exercise tolerance. In addition, the advanced age of the subjects make these findings particularly novel, regardless of diagnosis.
CLINICAL IMPLICATIONS: COPD is a leading cause of mortality and morbidity, causing a heavy global health and economic burden. Further research is recommended to more clearly establish the prognostic value of HRR in patients with pulmonary disease and to determine if clinical assessment of this variable is warranted.
DISCLOSURE: Noah Greenspan, No Financial Disclosure Information; No Product/Research Disclosure Information