Highlights the limitations of using predicted maximal heart rate for exercise prescription in heart failure patients and recommends alternative methods like perceived exertion or the talk test when CPET is unavailable.
Exercise prescription for heart failure (HF) is a cornerstone for a clinically effective and safe cardiac rehabilitation (CR) programme.1,2 Likewise, the prescription of the intensity according to the ventilatory thresholds, identified by cardiopulmonary exercise testing (CPET), is considered an optimal method.2–4 Although with lower accuracy, when CPET is not available, a percentage of the measured maximal heart rate (MHR) during an exercise stress test (EST) is considered the minimum standard in recent CR guidelines worldwide.2,3 However, professionals must be prepared to safely assess and monitor patients when this assessment is unavailable5 since the evidence shows that most centres are still not performing this evaluation prior to beginning CR.6 Thus, in the absence of maximal tests (CPET or EST) or a submaximal volitional test (field and submaximal tests), the rating of perceived exertion and the talk test are two commonly recommended techniques to estimate the intensity for appropriate exercise prescription since the determination according to a percentage of the predicted MHR can be highly divergent in HF patients, mainly due to negative chronotropic influence of the beta-blockers, and disease-related dysfunctions.2
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Milani et al. (2022) studied this question.
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