Pediatric Cardiology

, Volume 34, Issue 6, pp 1431–1437

Recovery Heart Rate: An Indicator of Cardiovascular Risk Among Middle School Children

  • Daniel Simhaee
  • Nicole Corriveau
  • Roopa Gurm
  • Zachary Geiger
  • Eva Kline-Rogers
  • Caren Goldberg
  • Kim A. Eagle
  • Elizabeth A. Jackson
Original Article


Recovery heart rate (RHR) has been used in adults to evaluate cardiovascular (CV) fitness, but less is known about RHR in children. Data from 1,276 participants in Project Healthy Schools, a school-based intervention in southeast Michigan, were collected. In addition, to demographic characteristics, physiologic factors examined included body mass index (BMI), lipid and glucose levels, blood pressure, and HR. Information on diet, physical activity, and sedentary behavior was collected through self-report. RHR was determined by measurement of HR after a 3-minute step test. Using quartiles of RHR as a marker of fitness, associations with demographic, physiologic, and behavioral factors were explored using χ2 and Student t tests. Compared with children in the lowest quartile of RHR (i.e., most fit), those in the upper quartile of RHR (i.e., least fit) had greater mean LDL cholesterol (93.0 vs. 86.7 mg/dL; P = 0.02) and lower mean HDL cholesterol (50.9 vs. 55.9 mg/dL; P < 0.001). Children in the upper 95 % of BMI had greater mean RHR compared with those in the normal BMI range (116.6 vs. 100.3 kg/m2). Children in the upper quartile of RHR reported fewer days of vigorous to moderate exercise per week compared with children in the lowest quartile of RHR [4.8 vs. 4.1 (P < 0.001) for moderate exercise and 3.6 vs. 3.0 (P = 0.001) for vigorous exercise]. Among middle school children, RHR appears to be associated with physiologic parameters and health behaviors. RHR may be useful for identifying children at increased risk for developing CV risk factors.


Childhood obesity Diet Physical activity Cardiovascular risk factors Community health 


  1. 1.
    Andersen RE et al (1998) Relationship of physical activity and television watching with body weight and level of fatness among children: results from the Third National Health and Nutrition Examination Survey. JAMA 279(12):938–942PubMedCrossRefGoogle Scholar
  2. 2.
    Carnethon MR et al (2005) A longitudinal study of physical activity and heart rate recovery: CARDIA, 1987–1993. Med Sci Sports Exerc 37(4):606–612PubMedCrossRefGoogle Scholar
  3. 3.
    Cheng YJ et al (2003) Heart rate recovery following maximal exercise testing as a predictor of cardiovascular disease and all-cause mortality in men with diabetes. Diabetes Care 26(7):2052–2057PubMedCrossRefGoogle Scholar
  4. 4.
    Cotts TB et al (2008) A school-based health education program can improve cholesterol values for middle school students. Pediatr Cardiol 29(5):940–945PubMedCrossRefGoogle Scholar
  5. 5.
    Epstein LH, Wing RR, Koeske R, Ossip D, Beck S (1982) A comparison of lifestyle change and programmed aerobic exercise on weight and fitness changes in obese children. Behav Ther 13:651–665CrossRefGoogle Scholar
  6. 6.
    Flegal KM, Wei R, Ogden C (2002) Weight-for-stature compared with body mass index-for-age growth charts for the United States from the Centers for Disease Control and Prevention. Am J Clin Nutr 75(4):761–766PubMedGoogle Scholar
  7. 7.
    Francis K, Feinstein R (1991) A simple height-specific and rate-specific step test for children. South Med J 84(2):169–174PubMedCrossRefGoogle Scholar
  8. 8.
    Hasselstrom H et al (2002) Physical fitness and physical activity during adolescence as predictors of cardiovascular disease risk in young adulthood. Danish Youth and Sports Study. An eight-year follow-up study. Int J Sports Med 23(Suppl 1):S27–S31PubMedCrossRefGoogle Scholar
  9. 9.
    Hausenloy DJ, Yellon DM (2008) Targeting residual cardiovascular risk: raising high-density lipoprotein cholesterol levels. Heart 94(6):706–714PubMedCrossRefGoogle Scholar
  10. 10.
    Himes JH, Dietz WH (1994) Guidelines for overweight in adolescent preventive services: recommendations from an expert committee. The Expert Committee on Clinical Guidelines for Overweight in Adolescent Preventive Services. Am J Clin Nutr 59(2):307–316PubMedGoogle Scholar
  11. 11.
    Hoelscher DM et al (2003) Reproducibility and validity of the secondary level school-based nutrition monitoring student questionnaire. J Am Diet Assoc 103(2):186–194PubMedCrossRefGoogle Scholar
  12. 12.
    Hofman A, Walter HJ (1989) The association between physical fitness and cardiovascular disease risk factors in children in a five-year follow-up study. Int J Epidemiol 18(4):830–835PubMedCrossRefGoogle Scholar
  13. 13.
    Jackson EA et al (2009) Childhood obesity: a comparison of health habits of middle-school students from two communities. Clin Epidemiol 1:133–139PubMedGoogle Scholar
  14. 14.
    Kizilbash MA et al (2006) The temporal relationship between heart rate recovery immediately after exercise and the metabolic syndrome: the CARDIA study. Eur Heart J 27(13):1592–1596PubMedCrossRefGoogle Scholar
  15. 15.
    Kuczmarski RJ, Ogden CL, Guo SS et al (2002) 2000 CDC growth charts for the United States: Methods and development. In: Control CfD (ed) Vital and health statistics. Library of Congress, Atlanta, pp 1–190Google Scholar
  16. 16.
    Kvaavik E, Tell GS, Klepp KI (2003) Predictors and tracking of body mass index from adolescence into adulthood: follow-up of 18 to 20 years in the Oslo Youth Study. Arch Pediatr Adolesc Med 157(12):1212–1218PubMedCrossRefGoogle Scholar
  17. 17.
    Kvaavik E et al (2009) Physical fitness and physical activity at age 13 years as predictors of cardiovascular disease risk factors at ages 15, 25, 33, and 40 years: extended follow-up of the Oslo Youth Study. Pediatrics 123(1):e80–e86PubMedCrossRefGoogle Scholar
  18. 18.
    Lin LY et al (2008) Inverse correlation between heart rate recovery and metabolic risks in healthy children and adolescents: insight from the National Health and Nutrition Examination Survey 1999–2002. Diabetes Care 31(5):1015–1020PubMedCrossRefGoogle Scholar
  19. 19.
    Mark AE, Janssen I (2008) Relationship between screen time and metabolic syndrome in adolescents. J Public Health (Oxf) 30(2):153–160CrossRefGoogle Scholar
  20. 20.
    Master AM (1935) The two-step test of myocardial function. Am Heart J 10:495–510CrossRefGoogle Scholar
  21. 21.
    Matthews CE et al (2008) Amount of time spent in sedentary behaviors in the United States, 2003–2004. Am J Epidemiol 167(7):875–881PubMedCrossRefGoogle Scholar
  22. 22.
    Mora S et al (2003) Ability of exercise testing to predict cardiovascular and all-cause death in asymptomatic women: a 20-year follow-up of the lipid research clinics prevalence study. JAMA 290(12):1600–1607PubMedCrossRefGoogle Scholar
  23. 23.
    Morshedi-Meibodi A et al (2002) Heart rate recovery after treadmill exercise testing and risk of cardiovascular disease events (The Framingham Heart Study). Am J Cardiol 90(8):848–852PubMedCrossRefGoogle Scholar
  24. 24.
    Nilsson G et al (2007) Heart rate recovery is more strongly associated with the metabolic syndrome, waist circumference, and insulin sensitivity in women than in men among the elderly in the general population. Am Heart J 154(3):460e1–460e7CrossRefGoogle Scholar
  25. 25.
    Ogden CL et al (2006) Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 295(13):1549–1555PubMedCrossRefGoogle Scholar
  26. 26.
    Reisinger JA (1938) The determination of exercise tolerance by the two-step test. Am Heart J 15:341–353CrossRefGoogle Scholar
  27. 27.
    Sacher PM et al (2010) Randomized controlled trial of the MEND program: a family-based community intervention for childhood obesity. Obesity (Silver Spring) 18(Suppl 1):S62–S68CrossRefGoogle Scholar
  28. 28.
    Shishehbor MH et al (2006) Association of socioeconomic status with functional capacity, heart rate recovery, and all-cause mortality. JAMA 295(7):784–792PubMedCrossRefGoogle Scholar
  29. 29.
    Singh TP, Curran TJ, Rhodes J (2007) Cardiac rehabilitation improves heart rate recovery following peak exercise in children with repaired congenital heart disease. Pediatr Cardiol 28(4):276–279PubMedCrossRefGoogle Scholar
  30. 30.
    Singh TP, Rhodes J, Gauvreau K (2008) Determinants of heart rate recovery following exercise in children. Med Sci Sports Exerc 40(4):601–605PubMedCrossRefGoogle Scholar
  31. 31.
    Tiukinhoy S, Beohar N, Hsie M (2003) Improvement in heart rate recovery after cardiac rehabilitation. J Cardiopulm Rehabil 23(2):84–87PubMedCrossRefGoogle Scholar
  32. 32.
    Tucker LA (1986) The relationship of television viewing to physical fitness and obesity. Adolescence 21(84):797–806PubMedGoogle Scholar
  33. 33.
    Vivekananthan DP et al (2003) Heart rate recovery after exercise is a predictor of mortality, independent of the angiographic severity of coronary disease. J Am Coll Cardiol 42(5):831–838PubMedCrossRefGoogle Scholar
  34. 34.
    Washington RL, van Gundy JC, Cohen C, Sondheimer HM, Wolfe RR (1985) Normal aerobic and anaerobic exercise data for North American school-age children. J Pediatr 112(2):223–233Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Daniel Simhaee
    • 1
  • Nicole Corriveau
    • 1
  • Roopa Gurm
    • 1
  • Zachary Geiger
    • 1
  • Eva Kline-Rogers
    • 1
    • 2
  • Caren Goldberg
    • 1
    • 3
  • Kim A. Eagle
    • 1
    • 2
  • Elizabeth A. Jackson
    • 1
    • 2
  1. 1.Michigan Cardiovascular Outcomes Research and Reporting ProgramUniversity of Michigan Health SystemAnn ArborUSA
  2. 2.Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of Michigan Health SystemAnn ArborUSA
  3. 3.Department of PediatricsUniversity of Michigan C.S. Mott Children’s Hospital, University of Michigan Health SystemAnn ArborUSA

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