Use of heart rate reserve and rating of perceived exertion to prescribe exercise intensity in diabetic autonomic neueropathy

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.