title: Determination of exercise training heart rate in patients on beta-blockers after myocardial infarction.
abstract: BACKGROUND
  In patients with coronary artery disease, the target intensity-level of exercise training is usually based on a training heart rate that aims to be close to the upper level of metabolic aerobic exercise.
  
  
  OBJECTIVE
  We intended to evaluate whether a training heart rate calculated with the Karvonen formula after a conventional exercise test is comparable with the heart rate at the anaerobic threshold in patients after myocardial infarction treated with beta-blockers and if not to propose a new formula.
  
  
  RESULTS
  In this multicenter prospective study, 115 consecutive beta-blocked patients recovering from myocardial infarction performed a cardiopulmonary exercise test to determine the anaerobic threshold. The training heart rate determined by the Karvonen formula was compared with the heart rate at the anaerobic threshold in a derivation sample (n=58) and a validation sample (n=57) of patients. The Karvonen training heart rate was significantly lower than the heart rate at the anaerobic threshold (91+/-5 versus 102+/-17 bpm, P<0.0001) in the first sample of patients and this difference was clinically relevant in 40% of patients. Thus, a 'modified Karvonen training heart rate', equal to 0.8xx(maximum heart rate-resting heart rate)+resting heart rate, was calculated by linear regression in the derivation sample and prospectively assessed in the validation sample. The modified Karvonen training heart rate was closer to the heart rate at the anaerobic threshold than the Karvonen training heart rate, and the difference between the modified Karvonen training heart rate and the heart rate at the anaerobic threshold was clinically relevant in only 5% of patients.
  
  
  CONCLUSIONS
  The Karvonen formula underestimates the heart rate at the anaerobic threshold in beta-blocked patients, which may lead to undertraining of patients with coronary artery disease; we propose another formula more adapted to these patients.
authors.affiliation: Les Grands Près, Villeneuve-Saint-Denis, France. jtabet@free.fr
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Tabet
authors.forename: Philippe
authors.initials: P
authors.lastname: Meurin
authors.forename: Ahmed
authors.initials: A
authors.lastname: Ben Driss
authors.forename: Gabriel
authors.initials: G
authors.lastname: Thabut
authors.forename: Helene
authors.initials: H
authors.lastname: Weber
authors.forename: Nathalie
authors.initials: N
authors.lastname: Renaud
authors.forename: Ngaralbaye
authors.initials: N
authors.lastname: Odjinkem
authors.forename: Alain Cohen
authors.initials: AC
authors.lastname: Solal
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D015308:Anaerobic Threshold / Q000502:physiology; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000503:physiopathology / Q000534:rehabilitation*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists