Prediction of Heart Rate and Oxygen
Uptake During Incremental and Maximal
Exercise in Healthy Adults*
Mary Sue Fairbarn, M.P.E.; Stephen P. Blackie, M.D., F.C.C.P.f;
Noel G. McElvaney, M.B.; fBarry R. Wiggs, M.Sc.;
Peter D. Pare, M.D.; and Richard L. Pardy, M.B., F.C.C.P.
Measurement of heart rate and oxygen uptake dur-
ing incremental exercise and at maximal exercise is
useful in evaluating mechanisms responsible for
exercise limitation in patients with cardiopulmo-
nary disease. Presently used prediction equations
are based on relatively small groups of subjects in
whom there was an uneven distribution of subjects
with regard to age and sex or based on equations
that were from extrapolated data. Our prediction
equations are based on data from 231 men and
women equally divided within decades between 20
and 80 years. Patients exercised to a symptom-
limited maximum on a cycle ergometer while mea-
surements of heart rate and oxygen uptake were
recorded. The relationship between heart rate and
oxygen uptake throughout exercise (HR:VO!) was
determined using a statistical technique that in-
cluded each data point from each subject. The
HR:VO! throughout incremental exercise was best
described by separate equations for women younger
than 50 years and older than 50 years and for men
M easuring heart rate and oxygen uptake during
incremental exercise and at maximal exercise
is useful in evaluating mechanisms responsible for
exercise limitation in patients with cardiopulmonary
disease. 1-3 To evaluate whether there are abnormali-
ties in heart rate or oxygen uptake in individual
patients requires comparison with standards from a
healthy population. The prediction equations pres-
ently used for heart rate and oxygen uptake are
based on studies that involved relatively small groups
of subjects who were not evenly distributed by age
or by sex, or the data were analyzed with statistics
that have become outdated by more suitable analy-
sis. 4-B The purpose of the present study was to
develop more accurate prediction equations for
heart rate and oxygen uptake based on a large group
of normal subjects that included equal numbers of
men and women and equal numbers of subjects per
*From the Pulmonary Research Laboratory, University of Brit-
ish Columbia, St. Paul's Hospital, Vancouver, British Colum-
bia, Canada.
fRecipient of a fellowship from the British Columbia Lung
Association.
Manuscript received January 19, 1993; revision accepted Sep-
tember 29.
Reprint requests: Ms. Fairbarn, B.C. Lung Association, 2675 Oak
Street, Vancouver, BC, Canada V6H 21<2
younger than 70 years and older than 70 years.
Prediction equations for maximal heart rate (HRmax)
and maximal oxygen uptake (V<>2ffiax) were devel-
oped by linear regression and were selected from
all possible combinations of parameters. The HRmax
was most accurately predicted by age alone for both
sexes. Unlike the HR:VO! relationship, the slope of
the line relating heart rate to age was not different
for the older women compared with the younger
women so that a single equation was derived to
predict HRmax. A single equation for the men was
also sufficient since the slope of heart rate to age
was the same for all ages. To most accurately
predict V<>2max, a separate equation was required
for both the women and men that included age,
height, and weight. (Chest 1994; 105:1365-69)
Eq=equation; HRmax=maximal heart rate; H;R; VQz=
heart rate and oxygen uptake relationship; VQzmax=
maximal oxygen uptake
decade between the ages of 20 and 80 years. In
addition, we employed a recently published statisti-
cal technique9 that is more appropriate for analyzing
pooled data to develop such prediction equations.
Our goal was to describe three of the responses to
incremental cycle ergometer testing, namely: the
heart rate and oxygen uptake relationship through-
out testing (HR:V02), the maximal heart rate (HRmax),
and the maximal oxygen uptake (Vo2max) of 40
people per decade.
METHODS
Subjects
We recruited subjects by written advertisement and also by
lectures at community centers throughout Vancouver, British
Columbia, Canada over a five-year period. Prior to their partici-
pation, all volunteers gave informed consent and had a screening
history and physical examination. Their lung function was as-
sessed by spirometry and each subject older than 55 years had a
resting electrocardiogram (ECG). Athletes (individuals who
regularly participated in lh hour or greater of vigorous exercise
daily) were not included. Subjects were also excluded if they
were unable to perform cycle ergometry for any reason, if they
were taking medications that would interfere with exercise
performance and/or heart rate response (eg, digoxin, ,8-adrener-
gic blocking drugs, sympathomimetics), or if the resting ECG or
baseline spirometry findings were abnormal. The body mass
index for these subjects were 23 ± 3 for the women and 24 ± 3 for
CHEST /105/5/ MAY, 1994 1385
 Table l-HR:Vo2 Equations Throughout Exercise ±95 response for the women older than 50 years. Equa-
Percent CI* tion 3 was derived from the women as one group.
Equation No. N The slope of the line for the women older than 50
years is steeper than for the women younger than 50
Women years (p<0.05). The data for the men were analyzed
(1) 20-49 yr 60 HR (beats/min)=73.76+45.53 V02± 15
(2) 50-80 yr 60 HR (beats/min)=65.35+55.82 V02± 15 in the same way as the women's data and again we
(3) 20-80 yr 120 HR (beats/min)=69.93+50.20 V02 ± 14 found two groups based on a difference between
Men decades. The men older than 70 years were differ-
(4) 20-69 yr 100 HR (beats/min)=65.57+34.69 V02 ± 14 ent from each of the other decades so we include
(5) 70-80 yr 11 HR (beats/min)=64.78+43.62 V02± 16 separate equations for the men younger and older
(6) 20-80 yr 111 HR (beats/min)=65.64+35.46 V02± 15
than 70 years. In Table 1, Eq 4 best describes the
*V02=oxygen uptake in Liters/min- 1. Hr: Vo2 for men younger than 70 years and Eq 5 for
the men. The ideal body mass index associated with the lowest
the men older than 70 years. The slope of the line
risk of illness is between 20 and 25. We have previously for the HR:Vo2 relationship for men older than 70
described this study population in an earlier article. 10 years is steeper than for men younger than 70 years
Exercise Protocol (p<0.05). The slopes of the lines for the HR:Vo2 for
both groups of men are lower than the slopes for
Each subject performed an incremental exercise test on an
electronically braked cycle ergometer (Quinton Instruments, both groups of women.
models 844 or Corival 400, Seattle) that was factory calibrated. The equation to describe Vo2:Work relationship
Resting measurements were taken with the subject seated on the with 95 percent confidence intervals for women is
ergometer. The first power output was either 16 or 32 Wand the Vo2 (L/min- 1)=0.2579+0.0021 Work (kpm) ±0.46.
power was increased by 16 W each minute until the subject This relationship for men is Vo2 (L/min- 1)=
reached a symptom-limited maximal power output. The equip-
ment for measuring ventilation and gas analysis has been de- 0.3055+0.0021 Work (kpm) ± 0.31 .
scribed previously. 10 The gas analyzers were calibrated for both Maximal Exercise
accuracy and linearity prior to each test. In addition, ten
subjects repeated the exercise test a minimum of three times The mean data for HRmax and Vo2max for each
during the period of data collection to provide biologic calibra-
22S r
a
tion to ensure reproducibility.
200 ~
Statistical Analysis
....e 17 s I,-
Data were analyzed separately for men and women. The mean
data are presented ± SD. For the HR :V<>2 relationship through-
..."'
GIS I so I·
II)
out the incremental exercise test, the statistical technique used .....,
.0

was a random effects regression for pooled data.9 All data points
for each subject are included in this analysis (Fig 1, top) and a
regression line is calculated for each subject (Fig 1, bottom). By
weighting both the intersubject and intrasubject variability, the .....
GIS
line of best fit was calculated for the subjects grouped by decade II)

using the random effects program. We tested the differences ::c 2s i

between the age groups with a x 2 analysis. 11 At maximal exercise, 0
i ~--· -

the relationship between variables was analyzed using Pearson 0 4 6

correlation coefficients and multiple linear regression.
1
Oxygen Uptake (J iters.min " )
RESULTS r
"
225

Throughout Incremental Exercise ....c 200

The equations that describe the heart rate as a ....e 115

function of the oxygen uptake (HR:Vo2) throughout ..."'

GIS ISO
exercise are shown in Table 1. There were no
II)
.....,
.0
125
differences in the HR: Vo2 relationship for the women
in the 20 to 29, 30 to 39, and 40 to 49 year age
...
II)

GIS
100
1¥
.
1S
groups so their data were pooled. There were also ... so
no differences in the relationship for the women in GIS
II)
the three decades over 50 years so these subjects ::c 2S
were also treated as a group. Since the women 0
younger than 50 years were different as a group 0 2 3 4 5 6

from the women older than 50 years, there are Oxygen Uptake (1iters.min " ) 1

separate equations for each group (Table 1). Equa-

FIGURE l. An example of the data used for random effects
tion 1 (Eq 1) describes the response for the women regression analysis. Top (a), All data points for each woman
younger than 50 years and Eq 2 describes the (n=l20). Bottom (b), A regression line for each woman.

1388 Predk:tion of Heart Rate and ~ Uptake During Exercise (Fairbam et al)
 Table 2-Maximal Heart Rate and Maximal Oxygen Uptake (Mean ± SD)
Maximal Oxygen Uptake
Maximal Heart Rate ,
Age, yr Beats/ min L/ min- 1 ml/kg/min Maximal Work Rate, Watts

Women
20-29 186±10 2.67±0.50 43.9±9.6 188±30
30-39 180± 10 2.58±0.38 43.9±5.4 177±27
40-49 173±8 2.20±0.42 35.9±7.3 151 ± 28
50-59 163±14 1.77 ±0.40 27.9±5.1 132±26
60-69 156± 10 1.58±0.32 24.3±4.6 109±21
70-80 142± 16 1.35±0.25 22.7±4.1 85±17
Men
20-29 185± 14 3.58±0.77 51.7 ± ll.4 255±50
30-39 181 ± 10 3.42±0.71 47.4± 10.4 241 ± 41
40-49 176± 14 3.33±0.80 42.3±9.2 232±46
50-59 170± 10 3.03±0.50 40.3±6.5 208±33
60-69 152± 17 2.44±0.43 32.9±6.4 175±29
70-80 153± 15 1.88±0.40 26.3±5.6 141 ±25

decade are presented in Table 2. The equations to age, height, and weight (Eq 16). Age accounted for
predict the maximal heart rate are presented in 35 percent of the variability for the men. Including
Table 3. The subject's age was the parameter that weight in this equation increased the r2 value only
provided the most accurate prediction of HRmax slightly (from 0.421 to 0.428). When the men were
after all possible combinations of anthropometric divided into two age groups, the r 2 value was lower
and physiologic parameters were investigated. The for the men younger than 70 years (Eq 17) and
accuracy of predicting the HRmax for women was higher for the men older than 70 years (Eq 18).
highest with a single equation for the women as one Seventy-two percent of the men older than 70 years
group (Eq 9) rather than when they were divided were below the regression line when age was con-
into two groups older and younger than 50 years sidered separately.
(Eqs 7 and 8). For the men, the equation for the The coefficients of variation for the ten subjects
entire group (Eq 12) had a higher r2 value (0.475) who were tested for biologic calibration were as
than when the men were divided into the two follows: HRmax, 3.0 ± 1.0 percent; Vo2max, 7.0 ± 6.0
groups younger and older than 70 years (Eqs 10 and percent; and maximal minute ventilation, 6.0 ± 5.0
11). percent.
The equation that best described the Vo2max for
DISCUSSION
the women included the data from the entire group
and the combination of parameters that included In this article, we have described the relationship
age, height, and weight (Table 4, Eq 13). The between heart rate and oxygen uptake during incre-
parameter of age alone accounted for 64 percent of mental exercise in a cohort of 231 healthy people
the variability. When the women were divided into with equal representation of men and women. To
two groups by age, the r2 value was lower for both our knowledge, this is the first study in which the
the women younger than 50 years and older than 50 relationship between heart rate and oxygen uptake
years (Eqs 14 and 15). For the men as one group, has been reported throughout incremental exercise
the best predictor of Vo2max was a combination of in a large group of subjects with equal numbers of
men and women and equal representation through-
out adult ages. In addition, we have developed
Table 3-Equations for Predicting Maximal Heart Rate prediction equations for HRmax and Vo2max.
Normal values for the HR:Voz relationship com-
Equation 95%
No. r2
monly used to assess the heart rate response in
N CI*
clinical exercise testing are derived from a study of
Women 100 subjects described by Jones et al. 6 The lines
(7) 20-49 yr 60 HRmax=201-0.63 age ± 19 0.205
(8) 50-80 yr
describing the HR:Voz relationship based on the
60 HRmax=233-1.23 age ±27 0.316
(9) 20-80 yr 120 HRmax=209-0.86 age ±23 0.613 work of Jones et al were derived by joining the
Men resting values to the predicted maximal heart rate
(10) 20-69 yr 100 HRmax=208-0.80 age ±26 0.438 (Eq 22) and the predicted maximal oxygen uptake
(ll) 70-80 yr ll HRmax=474-4.45 age ±36 0.225 (Eq 25). To demonstrate how our results differ from
(12) 20-80 yr Ill HRmax=207-0.78 age ±26 0.475
those reported by Jones et al, we have drawn a
*95% CI=confidence interval at the mean age within each group. comparison in Figure 2. Our predicted lines were

CHEST /105/5/ MAY, 1994 1387

 Table 4-Eqootiom for Predicting Maximal Oxygen Uptake

Equation No. N Constant Age, yrs Height, em Weight, kg 95% CI* r2

1
Women V02max (L/min- )=
(13) 20-80 yr 120 0.207 -0.027 0.0158 . 0.00899 ±0.7 0.696
(14) 20-49 yr 60 -0.379 -0.022 0.0184 0.00895 ±2.51 0.299
(15) 50-80 yr 60 0.259 -0.022 0.013 0.00995 ±2.12 0.389
Men
(16) 20-80 yr Ill -0.332 -0.031 0.023 0.0117 ±1.24 0.428
(17) 20-69 yr 100 -0.8739 -0.0241 0.029 ± 1.25 0.299
(18) 70-80 yr 11 1.3529 -0.0965 0.0431 ±0.62 0.587

*95% CI=confidence interval at the mean age, height, and weight within each group.

drawn from Eqs 1 and 2 for women (Fig 2, top) and the equation. There are several possible reasons for
Eqs 4 and 5 for men (Fig 2, bottom) . For both of the the differences between our results, namely, the
women's age groups, our equations predicted a group of subjects we studied was larger and evenly
lower heart rate for any oxygen uptake. Our results distributed throughout the age groups; the equa-
for the men older than 70 years are very close to tions were constructed by different statistical analy-
those of Jones et al, but for men younger than 70 ses; and perhaps our subjects were more fit. Since
years, our equations also predict lower heart rates we did not measure the cardiac output during this
for any oxygen uptake. Jones et al6 also provide an study, we can only speculate that the difference
equation for the heart rate and oxygen uptake between the slope of the lines for our older and
related to size, but we were unable to make com- younger subjects may be due to a smaller stroke
parisons since they do not provide an intercept for volume for the older groups.
200 (a) In addition to analyzing the results throughout
exercise, we constructed equations to predict HRmax
....
=
Jones ---:" Ours
and Vo2max. Prediction equations for these param-
et al ~
....E
170
I eters have been described in previous studies and
..."' I
/

the most frequently used are presented in Table 5

•
4)
.Jl
140 I
I
/
/
/

for comparison. Our results for HRmax are similar

"'0 I/
to those reported in earlier work. 3 •6•12•13 For example,
... 1/

~
• 110 + Women < 50 with our Eqs 7, 8, and 12 and previous Eqs 19, 20,
...... A Women > 50 and 21, the range of predicted HRmax for a 45-year-
•4)
80 old woman is from 170 to 175 beats/min; for a 55-
::c year-old woman, it is from 163 to 165 beats/min; and
so for a 45-year-old man, it is from 172 to 175 beats/
(b) + min, respectively. However, Eq 22 predicts maximal
200
heart rates about 10 beats/min higher than any of
...... Jones
·~= et al
~
Ours
the other equations .
....E
170
Although there was concordance between the
..."' equations used to predict HRmax, we found sub-
•
4)
140 stantial differences between equations used to pre-
.._,
.Jl
dict Vo2max. The equation that best predicts the
...
0

~
• II 0
+ Men < 70
Vozmax for women between 20 and 80 years in our
...... • Men .. 70
study contained the parameters of age, height, and
weight (Eq 13). Equation 23 (Table 5), which was
•0
80
based on the parameters of age and weight, predicts
::c
a VOmax 22 percent lower than we observed. Simi-
so
0 2 4 larly, Eq 25, which includes the parameters of sex,
height, and age, predicts a Vozmax 23 percent lower
vo2 (J.min: 1 )
than we observed. Equation 26 has, in addition, the
FIGURE 2. Comparison of predictions for HR:V<>2 from Jones et
al6 and the present data. The lines from Jones et al are derived by
parameter of weight as well as a subjective score for
joining the resting HR and V<>2 to the predicted maximum leisure activities. The leisure score corresponds to
values (Eqs 22 and 25). The data for our lines were obtained by the number of hours per week a subject participates
random effects regression incorporating data points throughout in regular physical activity. A leisure score of 1
exercise. Top (a), Predictions for women Eqs 1 and 2; bottom
(b), for men Eqs 4 and 5. The error bars denote the confidence indicates <1 h/wk of regular physical activity; a
intervals around our data. score of 2=1 to 3 h/wk; a score of 3=3 to 6 h/wk;

1388 Prediction of Heart Rate and Ch Uptake During Exercise (Fairbam et sf)
 Table 5-Previously Published Equations for Comparison
Equation No. Reference
Maximal heart rate
(19) Jones et al 6 Women:
(20) Jones et al 6 Men:
(21) Bailey 12 Both:
(22) Jones3 Both:
Maximal oxygen uptake:
(23) Wasserman et aP 4 Women:
(24) Wasserman et aP 4 Men:
(25) Jones et al6 Both:
(26) Jones et al6 Both:
and a score of 4 means >6 h/wk. Although we found
it difficult to quantify the leisure score of our older
subjects, for comparison we arbitrarily assigned all
subjects a score of 2, and the predicted values with
Eq 26 were 33 percent lower than we observed.
With a leisure score of 3 (3 to 6 h/wk), the differ-
ence between equations decreased to 20 percent.
For example, we found the mean Vo2max for women
in the 50 to 59 year decade was 1. 77 ± 0.40 L but
the predicted Vo2max according to Eqs 23, 25, and
26 would be 1.53, 1.56, 1.59 (leisure score=2) or
1.44 L/ min (leisure score= 1), respectively. Some
of the reasons for the differences observed may be
related to the mode of exercise and to subject
selection. In the study from which Eq 23 was
developed, the data from a number of studies were
combined and the mode of exercise was a treadmill;
Eqs 25 and 26 were derived from data that com-
bined the results of men and women.
For the men, the equation that best described
Vo2max included the anthropometric parameters of
age, height, and weight (Eq 16). A comparison of
our prediction equations to those previously pub-
lished offers results similar to those discussed above
for women. Our observed Vo2max was 24 percent
higher than predicted by Eq 24, 10 percent higher
than Eq 25, and 14 percent higher than Eq 26 when
an arbitrary leisure score of 2 was assigned to all
men. Increasing the leisure score from 2 to 3 in Eq
26 would decrease the difference between observed
and predicted Vo2max to 7 percent lower than
observed.
In summary, these data describe for the first time
the relationship between heart rate and oxygen
uptake throughout incremental exercise. In addi-
tion, we have developed prediction equations for
HRmax and Vo2max. The HR: Vo2 throughout incre-
mental exercise is best described by separate equa-
tions for women older and younger than 50 years
(Eqs 1 and 2) and also an age distinction for men
younger and older than 70 years (Eqs 4 and 5) is
appropriate. The HRmax should be predicted with-
out an age separation for both women (Eq 9)
198-0.63 Age
206-0.80 Age
220-Age
210-0.66 Age
(42.8+Weight)X(22.78-0.17 Age)
WeightX(50.72-0.372 Age)
0.046 Height-0.021 Age-0.624 Sex-4.31
0.025 Height-0.023 Age-0.542 Sex+0.019 Weight+0.15 Leisure-2.32
and the men (Eq 12). The Vo2max can best be
predicted for both women (Eq 13) and men (Eq 16)
with a combination of anthropometric variables,
including age, height, and weight and Eq 18 for men
older than 70 years.
ACKNOWLEGMENT: The authors wish to thank Dr. Pearce
Wilcox, Dr. Nancy Morrison, and Lorraine Verburgt for their
assistance with this project.
REFERENCES
1 Sue DY, Wasserman K. Impact of integrative cardiopulmo-
nary exercise testing on clinical decision making. Chest
1991; 99:981-92
2 Blackie SP, Pardy RL. Exercise testing in the assessment of
pulmonary disease. Clin Rev Allergy 1990; 8:215-27
3 Jones NL. Clinical exercise testing. Philadelphia: WB Saunders
Co, 1988; 158-85
4 Blackie SP, Fairbam MS, McElvaney NG, Morrison NJ,
Wilcox PG, Pardy RL. Prediction of maximal oxygen uptake
and power during cycle ergometry in subjects older than 55
years of age. Am Rev Respir Dis 1989; 139:1424-29
5 McElvaney NG, Blackie SP, Morrison NJ, Wilcox PG, Fairbam
MS, Pardy RL. Cardiac output at rest and in exercise in
elderly subjects. Med Sci Sports Exerc 1989; 21:293-98
6 Jones NL, Makrides L, Hitchcock C, Chypchar T, McCartney
N. Normal standards for an incremental progressive cycle
ergometer test. Am Rev Respir Dis 1985; 131:700-08
7 Hansen JE, Sue DY, Wasserman K. Predicted values of
clinical exercise testing. Am Rev Respir Dis 1984; 129:549-
55
8 Spiro SG, Juniper E, Bowman P, Edwards RHT. An increas-
ing work rate test for assessing the physiological strain of
submaximal exercise. Clin Sci Mol Med 1974; 46:191-206
9 Feldman HA. Families of lines: random effects in linear
regression analysis. J Appl Physiol1988; 64:1721-32
10 Blackie SP, Fairbam MS, McElvaney NG, Wilcox PG,
Morrison NG, Pardy RL. Normal values and ranges for
ventilation and breathing pattern at maximal exercise. Chest
1991; 100:136-42
11 Zar JH. Biostatistical analysis. Englewood Cliffs, NJ: Prentice-
Hall Inc, 1984; 40-60
12 Bailey C. The new fit or fat. Boston: Houghton MifBen Co,
1991; 42
13 Ploughman SA, Drinkwater BL, Horvath SM. Age and
aerobic power in women: a longitudinal study. J Gerontal
1979; 34:512-20
14 Wasserman K, Hansen JE, Sue DY, Whipp BJ. Principles of
exercise testing and interpretation. Philadelphia: Lea &
Febiger, 1987; 72-86
CHEST /105/5/ MAY,1994 1389