Heart rate response to exercise stress testing in asymptomatic women: The St. James women take heart project

Martha Gulati, Leslee J. Shaw, Ronald A. Thisted, Henry R. Black, C. Noel Bairey Merz, Morton F. Arnsdorf

Research output: Contribution to journalArticlepeer-review

152 Scopus citations


Background-: The definition of a normal heart rate (HR) response to exercise stress testing in women is poorly understood, given that most studies describing a normative response were predominately based on male data. Measures of an attenuated HR response (chronotropic incompetence) and age-predicted HR have not been validated in asymptomatic women. We investigated the association between HR response to exercise testing and age with prognosis in 5437 asymptomatic women. Methods and results-: Participants underwent a symptom-limited maximal stress test in 1992. HR reserve (change in HR from rest to peak), chronotropic index, and age-predicted peak HR were calculated. Deaths were identified to December 31, 2008. Mean age at baseline was 52±11 years, with 549 deaths (10%) over 15.9±2.2 years. Mean peak HR was inversely associated with age; mean peak HR=206-0.88(age). After adjusting for exercise capacity and traditional cardiac risk factors, risk of death was reduced by 3% for every 1-beat-per-minute increase in peak HR, and by 2% for every 1-beat-per-minute increase in HR reserve (P<0.001). Inability to achieve 85% age-predicted HR was not an independent predictor of mortality, but being 1 SD below the mean predicted HR or a chronotropic index <0.80 based on the prediction model established by this cohort were independent predictors of mortality (P<0.001 and P=0.023, respectively). Conclusions-: Chronotropic incompetence is associated with an increased risk of death in asymptomatic women; however, the traditional male-based calculation overestimates the maximum HR for age in women. Sex-specific parameters of physiological HR response to exercise should be incorporated into clinical practice.

Original languageEnglish
Pages (from-to)130-137
Number of pages8
Issue number2
StatePublished - 13 Jul 2010
Externally publishedYes


  • Exercise
  • Exercise test
  • Heart rate
  • Mortality
  • Women


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