Key result
The ≥85% maxHR threshold misclassifies ~33% of exercise tests compared to the RER reference.
Why the study?
Although widely used to judge exercise test adequacy, the ≥85% age-predicted maximum heart rate threshold originated as a safety limit rather than a marker of maximal exertion.
Does the ≥85% maxHR threshold reliably indicate maximal physiological effort compared to RER >1.05 during cardiopulmonary exercise testing?
Population
211 individuals undergoing CPET, including competitive athletes and individuals with cardiovascular disease
Comparison
Conventional criterion of ≥85% maxHR vs metabolic reference RER >1.05
Design
Consecutive cohort study
Authors
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85% maxHR threshold lacks specificity for maximal effort in CPET; leaves open whether RER criteria warrant prospective validation.
Cohort (n=211)
Does the ≥85% maxHR threshold reliably indicate maximal physiological effort compared to RER >1.05 during cardiopulmonary exercise testing?
The conventional threshold of ≥85% age-predicted maximum heart rate is an inaccurate marker of maximal exertion during exercise testing, especially in patients on beta-blockers, and should not replace metabolic criteria like RER.
Graziano et al. (2026) conducted a cohort in Cardiovascular disease and healthy athletes (n=211). ≥85% maxHR threshold vs. RER >1.05 was evaluated on Maximal effort defined by RER >1.05. The ≥85% maxHR threshold for defining maximal exercise effort showed 91% sensitivity but only 13% specificity compared to the metabolic reference of RER >1.05, misclassifying 33% of tests.
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