Is Your Heart Bullet-Proof?

by Paul Rogers on October 13, 2009

I credit Rad over at Eons for alerting me to the specifics of this heart rate recovery test, although I was aware that heart rate recovery research in relation to cardiovascular health had been around for some time, using various medical and fitness treadmill stress tests like the Bruce or Balke protocols. According to the researchers working in this field, heart rate recovery predicts all-cause mortality in a group without previous serious heart disease who were followed for 12 years — and was a stronger indicator of risk than other established risk factors.

Essentially the test requires you to build up to maximum heart rate and record the recovery time 60 seconds after slowing to a walk.  Although the original research was done on a treadmill using Bruce maximum exercise protocol, you can probably emulate this within reasonable limits down at the local park or on a rowing machine, treadmill or stationary bike.

It is important to understand that if you have been inactive for some time, or have signs of heart disease or a related condition like diabetes, or even if you are not used to exercising at maximum heart rate, then this is not for you. You should do this test or one similar under the supervision of a doctor or cardiologist or other appropriately trained medical professional; and at least get a doctor’s approval to do it if you’re unsure.

 Here is what to do. I’ll use a running track in this example.

  1. Warm up for 5-10 minutes at a slow to moderate pace (for you).
  2. Choose a distance over which you will run flat out for up to 30 seconds. I use 200 metres or near enough. You could use 400 metres or even 800 metres, but you want to try to hit top pace or maximum effort and hold it for at least 20 seconds.
  3. Don’t do this cold. Try to build your heart rate to 60 % of estimated maximum (200 minus your age) in the warm up.
  4. If for some reason you don’t think you hit a maximum heart rate, do another lap flat out after a short rest.
  5. Stop and walk, note the maximum heart rate reached  in beats per minute, then take it again after one minute has elapsed. This is best done with a heart rate monitor because by the time you get your watch up to measure the heart rate, it will have slowed slightly, or a lot, depending on your fitness.
  6. Subtract your heart rate after one minute from the maximum heart rate achieved. This is your recovery number.
  7. As with all statistics of this kind, poor values are only an indicator and not a sentence, yet worth following up.

 Below is the key. Patients with the lowest recovery (less than 12 beats per minute) had 4 times the risk of those in the highest category (over 40), even allowing for other factors like smoking, age, gender and hypertension.

The key (recovery in beats per minute – BPM):

POOR —> less than 12 — requires medical follow up
FAIR —> 12-20 — try to improve, follow up
GOOD —> 20-30
EXCELLENT —> 30-40
OUTSTANDING —> Over 40 — very low risk

 Other tests of physical fitness are related to cardiovascular health and overall mortality. Exercise capacity is another predictor. Heart rate recovery also seems to be a reliable indicator in sub-maximal testing as well. All up, being really fit has obvious benefits beyond the walk around the block each day.

– Cole et al. Heart-rate recovery immediately after exercise as a predictor of mortality. New England Journal of Medicine 1999;341:1351-1357
— Cole CR, Foody JM, Blackstone EH, Lauer MS. Heart rate recovery after submaximal exercise testing as a predictor of mortality in a cardiovascularly healthy cohort. Ann Intern Med. 2000 Apr 4;132(7):552-5.
— Vivekananthan DP, Blackstone EH, Pothier CE, Lauer MS. Heart rate recovery after exercise is a predictor of mortality, independent of the angiographic severity of coronary disease. J Am Coll Cardiol. 2003 Sep 3;42(5):831-8.
— Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med. 2002 Mar 14;346(11):793-801.

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