Use of Heart Rate Reserve and Rating of Perceived Exertion to Prescribe Exercise Intensity in Diabetic Autonomic Neuropathy

Old Dominion University, Norfolk, Virginia 23529, USA.
Diabetes Care (Impact Factor: 8.42). 04/2003; 26(4):986-90. DOI: 10.2337/diacare.26.4.986
Source: PubMed


Individuals with diabetic autonomic neuropathy (DAN) exhibit an increased resting heart rate but depressed maximal heart rate. Thus, the purpose of this study was to examine the validity of using either percent of heart rate reserve (HRR) or a rating of perceived exertion (RPE) scale to prescribe exercise intensity in diabetic individuals both with and without DAN.
The subjects consisted of 23 individuals with type 2 diabetes, ages 45-75 years, with (DAN; n = 13) or without (No DAN; n = 10) clinical signs of DAN, as assessed by heart rate variability using the expiration-to-inspiration ratio of the R-R interval. Peak aerobic capacity was determined using a graded protocol on a cycle ergometer, with RPE, heart rate, and VO(2) values recorded at each stage.
The subjects were similar with the exception of depressed autonomic function in DAN subjects. Peak respiratory exchange ratio values were significantly higher (P < 0.05) in the DAN group (1.08 +/- 0.02 vs. 1.02 +/- 0.01 in No DAN subjects), although DAN subjects exhibited a significantly lower (P < 0.05) peak exercise heart rate. A similarly highly linear relationship between %HRR and percent VO(2) reserve (VO(2)R) existed for both groups (r = 0.98). A similar slightly weaker relationship (r = 0.94) was found between RPE and %VO(2)R.
In conclusion, in diabetic individuals, %HRR provides an accurate prediction of %VO(2)R and can be used to prescribe and monitor exercise intensity, regardless of the presence of DAN. The RPE scale is also a valid, albeit slightly less accurate, method to monitor exercise intensity in diabetic individuals.

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    • "Again, the time course of the _ VO 2 response was not reported, but the mean ± SD resting _ VO 2 of 3.0 ± 0.40 mL kg -1 min -1 was very similar to the present study. Other studies have assessed resting _ VO 2 using only 3 min for acclimation and 10 min for assessment, making the achievement of a _ VO 2 steady state unlikely and the accuracy of the resting _ VO 2 values questionable (Colberg et al. 2003; Davenport et al. 2008; Mezzani et al. 2007; Rotstein and Meckel 2000; Swain and Leutholtz 1997; Swain et al. 1998 "
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