Cited by 3,775Cardiovascular and exercise physiologyPhysical Activity and HealthCardiovascular Effects of Exercise

Age-predicted maximal heart rate revisited

Open access
Tanaka, Hirofumi, Monahan, Kevin D, Seals, Douglas R·2001·Journal of the American College of Cardiology

Abstract

OBJECTIVES We sought to determine a generalized equation for predicting maximal heart rate (HRmax) in healthy adults. BACKGROUND The age-predicted HRmax equation (i.e., 220 - age) is commonly used as a basis for prescribing exercise programs, as a criterion for achieving maximal exertion and as a clinical guide during diagnostic exercise testing. Despite its importance and widespread use, the validity of the HRmax equation has never been established in a sample that included a sufficient number of older adults. METHODS First, a meta-analytic approach was used to collect group mean HRmax values from 351 studies involving 492 groups and 18,712 subjects. Subsequently, the new equation was cross-validated in a well-controlled, laboratory-based study in which HRmax was measured in 514 healthy subjects. RESULTS In the meta-analysis, HRmax was strongly related to age (r = -0.90), using the equation of 208 - 0.7 x age. The regression equation obtained in the laboratory-based study (209 - 0.7 x age) was virtually identical to that obtained from the meta-analysis. The regression line was not different between men and women, nor was it influenced by wide variations in habitual physical activity levels. CONCLUSIONS 1) A regression equation to predict HRmax is 208 - 0.7 x age in healthy adults. 2) HRmax is predicted, to a large extent, by age alone and is independent of gender and habitual physical activity status. Our findings suggest that the currently used equation underestimates HRmax…

Integrity signals

Registry

Crossref · 10.1016/s0735-1097(00)01054-8

Cites

18 of 18 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

1 of 31 cited sources checked · 0 supported · 0 flagged · accuracy not yet measured

  • Premisenone given

    Previous attempts to establish a more appropriate HRmax equation probably or definitely included subjects with cardiovascular disease who smoked and/or were taking cardiac medications.

    “However, similar to the original reports by Fox and Haskell (7,8), these studies probably or definitely included subjects with cardiovascular disease who smoked and/or were taking cardiac medications.”
    Quote in the paperSubstantial claim1 of 5 sources checked
    • cites [9] Londeree, 1984, Influence of age and other factors on maximal heart rate, J Cardiac Rehabil
    • cites [10] Whaley, 1992, Predictors of over- and underachievement of age-predicted maximal heart rate, Med Sci Sports Exerc source
    • cites [11] Sheffield, 1978, Maximal heart rate and treadmill performance of healthy women in relation to age, Circulation source

      Subjects and Methods (p. 1) reports that three volunteers took mild antihypertensive medications and that none had been told she had cardiovascular disease other than elevated blood pressure. This supports the medication concern in part, but the paper does not report that its volunteers smoked or had other known cardiovascular disease. Its introduction (p. 1) also says medication use was unreported in an earlier study, not that those subjects definitely took medication. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [7] Fox, 1970, The exercise stress test

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [8] Fox, 1971, Physical activity and the prevention of coronary heart disease, Ann Clin Res source
  • Findingown data

    The meta-analysis regression equation for HRmax when all subjects were combined is 208 − 0.7 × age.

    “using the equation of 208 Ϫ 0.7 ϫ age.”
    • Also stated in: § RESULTS · plain
      “The regression equation, when all the subjects were combined, was 208 Ϫ 0.7 ϫ age.”
    • Also stated in: § DISCUSSION · plain
      “First, a regression equation for estimating HR max is 208 Ϫ 0.7 ϫ age in healthy adult humans, which is significantly different from the traditional 220 Ϫ age equation.”
    Quote in the paperSubstantial claim
  • Findingown data

    The laboratory-based regression equation was virtually identical to the meta-analysis equation.

    “The regression equation obtained in the laboratory-based study (209 Ϫ 0.7 ϫ age) was virtually identical to that obtained from the meta-analysis.”
    Quote in the paperSubstantial claim
  • Findingown data

    The traditional 220 − age equation is significantly different from the new 208 − 0.7 × age equation.

    “First, a regression equation for estimating HR max is 208 Ϫ 0.7 ϫ age in healthy adult humans, which is significantly different from the traditional 220 Ϫ age equation.”
    Quote in the paperSubstantial claim
  • Findingown data

    The laboratory-based study regression equation for HRmax is 209 − 0.7 × age.

    “The regression equation for HR max (209 Ϫ 0.7 ϫ age) was virtually identical to that obtained from the meta-analysis.”
    Quote in the paperSubstantial claim
  • May combine two claims. 11
  • Classified as probably not a substantial claim. 6
  • May combine two claims.

    Findingown data

    In the meta-analysis, the rate of decline and y intercepts of the HRmax-age relation did not differ between men and women.

    “The rate of decline and the y intercepts were not different between men and women”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    Data from treadmill and cycle ergometers were evaluated together and separately, and there were no differences in the results between the two analyses.

    “Data from treadmill and cycle ergometers were evaluated together and separately.There were no differences in the results between the two analyses.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Study design and conductown data

    Maximal respiratory exchange ratio and maximal rating of perceived exertion were not different across ages, suggesting consistently similar voluntary maximal efforts.

    “The maximal respiratory exchange ratio (1.17 Ϯ 0.06) and maximal rating of perceived exertion (19.1 Ϯ 0.8) were not different across ages, suggesting consistently similar voluntary maximal efforts.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Interpretationown data

    HRmax is predicted, to a large extent, by age alone and is independent of gender and habitual physical activity status.

    “HR max is predicted, to a large extent, by age alone and is independent of gender and habitual physical activity status.”
    • Also stated in: § DISCUSSION · plain
      “Second, HR max is predicted, to a large extent, by age alone and is independent of gender and physical activity status.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Premisecitation

    Gender and habitual physical activity do not appear to influence intrinsic heart rate in humans.

    “consistent with the present findings, gender (14) and habitual physical activity (16) do not appear to influence intrinsic heart rate in humans.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [14] Jose, 1970, The normal range and determinants of the intrinsic heart rate in man, Cardiovasc Res source
    • cites [16] Shi, 1995, Autonomic nervous system control of the heart, Med Sci Sports Exerc source
  • May combine two claims.

    Interpretationown data

    The traditional equation underestimates HRmax past age 40 years, markedly so in older adults.

    “Specifically, the traditional equation underestimates HR max past age 40 years, markedly so in older adults.”
    • Also stated in: § Abstract · hedged
      “Our findings suggest that the currently used equation underestimates HR max in older adults.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    The age-predicted HRmax equation (220 − age) is commonly used as a basis for prescribing exercise programs, as a criterion for achieving maximal exertion, and as a clinical guide during diagnostic exercise testing.

    “The age-predicted HR max equation (i.e., 220 Ϫ age) is commonly used as a basis for prescribing exercise programs, as a criterion for achieving maximal exertion and as a clinical guide during diagnostic exercise testing.”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [1] 2000

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [2] Fletcher, 1997, How to implement physical activity in primary and secondary prevention, Circulation source
    • cites [3] Gibbons, 1997, ACC/AHA guidelines for exercise testing, J Am Coll Cardiol source
    • cites [4] Tanaka, 1997, Greater rate of decline in maximal aerobic capacity with age in physically active vs. sedentary healthy women, J Appl Physiol source
    • cites [5] Howley, 1995, Criteria for maximal oxygen uptake, Med Sci Sports Exerc source
  • May combine two claims.

    Interpretationcitation

    Use of the prevailing prediction equation would result in premature termination of exercise testing and possibly failure to attain required exertion levels for diagnostic validity.

    “use of the prevailing prediction equation would result in premature termination of the test and possibly failure to attain required exertion levels for diagnostic validity.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3] Gibbons, 1997, ACC/AHA guidelines for exercise testing, J Am Coll Cardiol source
  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Each subject achieved maximal exertion as verified by at least three of four conventional criteria.

    “To ensure that each subject achieved maximal exertion, at least three of the following four criteria were met by each subject: 1) a plateau in VO 2 with increasing exercise intensity (Ͻ100 ml); 2) a respiratory exchange ratio of at least 1.15; 3) a maximal respiratory rate of at least 35 breaths/min; and 4) a rating of perceived exertion of at least 18 units on the Borg scale (5).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [5] Howley, 1995, Criteria for maximal oxygen uptake, Med Sci Sports Exerc source
  • May combine two claims.

    Premisecitation

    Cardiovascular disease, smoking, and cardiac medications each influence HRmax independent of age.

    “Each of these conditions influences HR max independent of age (10,12,13).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [10] Whaley, 1992, Predictors of over- and underachievement of age-predicted maximal heart rate, Med Sci Sports Exerc source
    • cites [12] Wilmore, 1985, Acute response to submaximal and maximal exercise consequent to beta-adrenergic blockade, Am J Cardiol source
    • cites [13] Graettinger, 1995, Relationship of left ventricular structure to maximal heart rate during exercise, Chest source
  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The laboratory study excluded subjects with severe obesity by including only subjects with a body mass index less than 35 kg/m2.

    “To eliminate the potentially confounding influence of severe obesity, only subjects with a body mass index Ͻ35 kg/m 2 were included.”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Subjects older than 50 years were further evaluated by physical examination and by rest and maximal exercise electrocardiography.

    “Subjects Ͼ50 years of age were further evaluated by physical examination and by rest and maximal exercise electrocardiography ECG (3).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] Gibbons, 1997, ACC/AHA guidelines for exercise testing, J Am Coll Cardiol source
  • May combine two claims.

    Premisecitation

    The 220 − age equation was determined arbitrarily from a total of 10 studies, with the highest age included being less than 65 years and the majority of subjects being 55 years old or younger.

    “The age-predicted equation was determined “arbitrarily” from a total of 10 studies.The highest age included was Ͻ65 years, with the majority of subjects being Յ55 years old.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [7] Fox, 1970, The exercise stress test

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [8] Fox, 1971, Physical activity and the prevention of coronary heart disease, Ann Clin Res source
  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    Because weighted results by sample size were previously shown not to be significantly different from unweighted results, no weighting scheme was used in the present meta-analysis.

    “Because we have previously shown that weighted results by sample size were not significantly different from unweighted results (6), no weighting scheme was used in the present meta-analysis.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [6] Fitzgerald, 1997, Age-related decline in maximal aerobic capacity in regularly exercising vs. sedentary females, J Appl Physiol source
  • Classified as probably not a substantial claim.

    Premisecitation

    It has been postulated that the primary mechanism underlying the age-related reduction in HRmax is related to an age-related decline in intrinsic heart rate.

    “It has been postulated that the primary mechanism is related to an age-related decline in intrinsic heart rate (i.e., independent of autonomic influences) (14,15).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [14] Jose, 1970, The normal range and determinants of the intrinsic heart rate in man, Cardiovasc Res source
    • cites [15] de Marneffe, 1986, Variations of normal sinus node function in relation to age, Eur Heart J source
15 of 15
  • The paper relies on this without support.

    Older adults demonstrate the highest prevalence of cardiovascular and other chronic diseases.

    “The latter limitation is crucial in that older adults demonstrate the highest prevalence of cardiovascular and other chronic diseases.”
  • The paper relies on this without support.

    Older adults are often reluctant or unable to measure HRmax directly because of concerns about the physiologic stress imposed by strenuous exercise.

    “Importantly, older adults are a population in which there is often a reluctance or an inability to measure HR max directly, owing to concerns related to the physiologic stress imposed by strenuous exercise.”
  • The paper relies on this without support.

    The 220 − age HRmax prediction equation is used in older adults more than in any other population.

    “Thus, ironically, the 220 Ϫ age HR max prediction equation is used in this population more than in any other.”
3 of 3

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Authors
Tanaka, H., Monahan, K. D., & Seals, D. R.
Affiliations
University of Colorado Boulder (US)
Corresponding author
Tanaka, Hirofumi
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
2001-01
Volume
37
Issue
1
Pages
153-156
ISSN
0735-1097 (ISSN-L)
OpenAlex
W2090296913
Cited by
3,775
References
20
Citations by year
2026: 249 · 2025: 277 · 2024: 304 · 2023: 240 · 2022: 295 · 2021: 262 · 2020: 273 · 2019: 259 · 2018: 246 · 2017: 189 · 2016: 182 · 2015: 174 · 2014: 178 · 2013: 149 · 2012: 107
FWCI
38.36
Type
journal article
Language
en
Open access
Locations
  • Journal of the American College of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute on Aging (AG-13038, AG 00847, AG-06537, R01AG006537)
Topics
  • Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
Keywords
maximal heart rate, heart rate prediction equations, older adults, exercise prescription, exercise testing, physical stress, physical activity behavior, sex differences
MeSH terms
Adult, Aged, Aged, 80 and over, Aging, Female, Heart Rate, Humans, Male, Middle Aged, Reference Values

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