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Vol. 21. Issue 4.
Pages 251-258 (01 July 2017)
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Vol. 21. Issue 4.
Pages 251-258 (01 July 2017)
Original research
DOI: 10.1016/j.bjpt.2017.05.002
Are heart rate dynamics in the transition from rest to submaximal exercise related to maximal cardiorespiratory responses in COPD?
Adriana Mazzucoa, Wladimir Musetti Medeirosb, Aline Soares de Souzab, Maria Clara Noman Alencarb, José Alberto Nederb,c, Audrey Borghi-Silvaa,
Corresponding author

Corresponding author at: Laboratório de Fisioterapia Cardiopulmonar (LACAP), Universidade Federal de São Carlos, Rodovia Washington Luís km 235 – Bairro Monjolinho, CEP 13565-905 São Carlos, SP, Brazil.
a Laboratório de Fisioterapia Cardiopulmonar (LACAP), Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
b Setor de Função Pulmonar e Fisiologia Clínica do Exercício (SEFICE), Disciplina de Pneumologia, Departamento de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
c Laboratory of Clinical Exercise Physiology (LACEP), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, Kingston, Canada

  • Exercise intolerance is a hallmark in COPD patients.

  • Changes in HRV dynamics are early and sensitive indices of impaired health.

  • 6MWD provides relevant information about functional (in)capacity in COPD patients.

  • A system with loss of complexity interferes with exercise performance.

  • HRV modulation to submaximal exercise may reflect ventilatory and hemodynamic abnormalities.

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Figures (2)
Tables (3)
Table 1. Baseline patient characteristics.
Table 2. Functional variables at rest and at submaximal and maximal peak exercises.
Table 3. Correlation coefficients between HRV indices (at rest, during exercise, and in the transition from rest to submaximal exercise) and 6MWT variables.
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Poor exercise capacity is an important negative prognostic marker in patients with chronic obstructive pulmonary disease (COPD). Heart rate variability (HRV) responses can indicate alterations in cardiac autonomic control. Nevertheless, it remains unclear whether these abnormalities are related to cardiorespiratory responses to exercise in these patients.


To evaluate whether HRV at rest and submaximal exercise are related to impaired cardiopulmonary responses to exercise in COPD patients.


Fifteen men (66.2±8.7 years) with COPD (FEV1: 55.1±19.2%) were assessed. The R-R interval (RRi) data collection was performed at rest (stand position) and during the six-minute walk test (6MWT). All patients performed a symptom-limited cardiopulmonary exercise test on a cycle ergometer. The HRV changes from rest to submaximal exercise (Δ rest-6MWT) were calculated.


We found significant correlations between low frequency (LF) and high frequency (HF) Δ rest-6MWT with Δ oxyhemoglobin saturation by pulse oximetry (r=−0.64 and r=0.65, respectively; p<0.05), minute ventilation/carbon dioxide output relationship from beginning to peak exercise (r=−0.52 and r=0.53, p<0.05), and exercise ventilatory power (r=0.52 and r=−0.53, p<0.05). Interestingly, there was a strong positive correlation (r=0.82, p<0.05) between six-minute walk distance (6MWD) and Δ LF/HF from rest to exercise.


HRV analysis in the transition from rest to submaximal exercise is associated with exercise ventilatory and hemodynamic abnormalities in COPD patients. Rehabilitative strategies to improve HRV responses may provide an important tool to clinical practice in these patients.

Six minute walk test
Cardiopulmonary exercise testing
Cardiac autonomic nervous system


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