The Safe Heart Rate

Before considering the target heart rate from a physiological training perspective, the safe exercise HR has to be regarded as the prime governor to the upper limit of exercise (Coplan, et al., 1986).This specifically refers to the heart rate at which medically significant myocardial events can occur (e.g. ischaemia, arrhythmia and failure to increase cardiac output). Such a level can only be determined from a standard ETT. Based on evidence for individuals with silent myocardial ischaemia (Hoberg, et al., 1990) the ACSM (2000) recommend that

Table 3.1. Recommended aerobic exercise intensities relative to the percentage of maximal oxygen uptake (%VO2max), maximal heart rate reserve (%HRRmax) and maximal heart rate (%HRmax)

Guideline

ACSM (1994, 2000)

BACR (1995), SIGN (2002)

%VO2max*

40%-85%

40%-60%**

%HRRmax

40%-85%

40%-60%**

%HRmax

55%-90%

60%-75%**

*The term VO2max is used in this case for reasons of simplicity but it must be noted that guidelines vary in the use of VO2peak or maximal VO2reserve.

**In Britain the upper intensity limit is lower than that for the USA because British programmes do not typically use sophisticated ECG heart rate monitoring during the actual exercise sessions, except in cases of higher risk patients.

*The term VO2max is used in this case for reasons of simplicity but it must be noted that guidelines vary in the use of VO2peak or maximal VO2reserve.

**In Britain the upper intensity limit is lower than that for the USA because British programmes do not typically use sophisticated ECG heart rate monitoring during the actual exercise sessions, except in cases of higher risk patients.

the upper HR limit should be set at least 10 beats-min-1 below the level associated with myocardial dysfunction. In patients who do get typical symptoms that relate to ischaemia or cardiac output dysfunction (angina and breath-lessness, respectively), it is possible that these symptoms could arise at a point higher than the actual onset of the clinically measured significant change. Hence, it would be unwise to use these symptoms as a reference point for determining the upper HR training limit. It is therefore important first to acknowledge the safe heart rate limit, relative to the effective physiological training HR limits, as outlined in Table 3.1.

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