Use of heart rate reserve and rating of perceived exertion to prescribe exercise intensity in diabetic autonomic neuropathy
Open accessAbstract
OBJECTIVE—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. RESEARCH DESIGN AND METHODS—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 Vo2 values recorded at each stage. RESULTS—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 Vo2 reserve (Vo2R) existed for both groups (r = 0.98). A similar slightly weaker relationship (r = 0.94) was found between RPE and %Vo2R. CONCLUSIONS—In conclusion, in diabetic individuals, %HRR provides an accurate prediction of %Vo2R 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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The presence of CAN doubles the risk of mortality and indicates more frequency of silent myocardial ischemia, orthostatic hypotension, or resting tachycardia.
“The presence of CAN doubles the risk of mortality ( 48 , 265 ) and indicates more frequency of silent myocardial ischemia ( 265 ), orthostatic hypotension, or resting tachycardia ( 76 , 177 ).”
From Exercise and Type 2 Diabetes (2010) · cites this paper as [48]
The paper’s introductory discussion (indexed under Abstract; page not provided) says diabetic autonomic neuropathy increases resting heart rate, supporting the resting-tachycardia portion of the claim. It does not report orthostatic hypotension, a doubling of mortality risk, or a higher frequency of silent myocardial ischemia. (LLM, conf=0.84)
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- Authors
- Colberg, S. R., Swain, D. P., & Vinik, A. I.
- Affiliations
- Old Dominion University (US)
- Eastern Virginia Medical School (US)
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2003-04-01
- Volume
- 26
- Issue
- 4
- Pages
- 986-990
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2137336521
- Cited by
- 109
- References
- 24
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 2 · 2023: 3 · 2022: 9 · 2021: 3 · 2020: 10 · 2019: 5 · 2018: 2 · 2017: 1 · 2016: 4 · 2015: 5 · 2014: 5 · 2013: 3 · 2012: 6
- FWCI
- 8.41
- Type
- journal article
- Language
- en
- Open access
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- ODU Digital Commons (Old Dominion University) (submittedVersion)
- Funders
- American Diabetes Association
- 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 › Heart Rate Variability and Autonomic Control
- Keywords
- diabetic autonomic neuropathy, heart rate reserve, rating of perceived exertion, exercise intensity prescription, type 2 diabetes, peak aerobic capacity, heart rate variability, respiratory exchange ratio, exercise monitoring
- MeSH terms
- Aged, Blood Glucose, Body Constitution, Diabetes Mellitus, Type 2, Diabetic Neuropathies, Physical Exertion, Female, Heart Rate, Humans, Male, Middle Aged, Oxygen Consumption, Regression Analysis, Exercise
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