Milani, Juliana Goulart Prata OliveiraJuliana Goulart Prata OliveiraMilaniMilani, MauricioMauricioMilaniMachado, Felipe Vilaça CavallariFelipe Vilaça CavallariMachadoWilhelm, MatthiasMatthiasWilhelm0000-0003-4541-3995Marcin, ThimoThimoMarcin0000-0001-7229-5985D'Ascenzi, FlavioFlavioD'AscenziCavigli, LunaLunaCavigliKeytsman, CharlyCharlyKeytsmanFalter, MaartenMaartenFalterBonnechere, BrunoBrunoBonnechereMeesen, RafRafMeesenBraga, FabrícioFabrícioBragaCipriano, Graziella França BernardelliGraziella França BernardelliCiprianoCornelissen, VeroniqueVeroniqueCornelissenVerboven, KennethKennethVerbovenJunior, Gerson CiprianoGerson CiprianoJuniorHansen, DominiqueDominiqueHansen2024-10-262024-10-262024-11-18https://boris-portal.unibe.ch/handle/20.500.12422/176857AIMS To develop and validate equations predicting heart rate (HR) at the first and second ventilatory thresholds (VTs) and an optimized range-adjusted prescription for patients with cardiometabolic disease (CMD). To compare their performance against guideline-based exercise intensity domains. METHODS Cross-sectional study involving 2,868 CMD patients from nine countries. HR predictive equations for first and second VTs (VT1, VT2) were developed using multivariate linear regression with 975 cycle-ergometer cardiopulmonary exercise tests (CPET). 'Adjusted' percentages of peak HR (%HRpeak) and HR reserve (%HRR) were derived from this group. External validation with 1,893 CPET (cycle-ergometer or treadmill) assessed accuracy, agreement, and reliability against guideline-based %HRpeak and %HRR prescriptions using mean absolute percentage error (MAPE), Bland-Altman analyses, intraclass correlation coefficients (ICC). RESULTS HR predictive equations (R²: 0.77 VT1, 0.88 VT2) and adjusted %HRR (VT1: 42%, VT2: 77%) were developed. External validation demonstrated superiority over widely used guideline-directed intensity domains for %HRpeak and %HRR. The new methods showed consistent performance across both VTs with lower MAPE (VT1: 7.1%, VT2: 5.0%), 'good' ICC for VT1 (0.81, 0.82) and 'excellent' for VT2 (0.93). Guideline-based exercise intensity domains had higher MAPE (VT1: 6.8%-21.3%, VT2: 5.1%-16.7%), 'poor' to 'good' ICC for VT1, and 'poor' to 'excellent' for VT2, indicating inconsistencies related to specific VTs across guidelines. CONCLUSION Developed and validated HR predictive equations and the optimized %HRR for CMD patients for determining VT1 and VT2 outperformed the guideline-based exercise intensity domains and showed ergometer interchangeability. They offer a superior alternative for prescribing moderate intensity exercise when CPET is unavailable.enCardiac Rehabilitation Cardiovascular Diseases Exercise Exercise Test Exercise Therapy Health Planning Guidelines Metabolic Diseases Validation Study600 - Technology::610 - Medicine & healtharticle10.48350/1960923863609310.1093/eurjpc/zwae149