{"doi":"10.2147/copd.s311572","title":"Identifying a Heart Rate Recovery Criterion After a 6-Minute Walk Test in COPD","abstract":"Background: Slow heart rate recovery (HRR) after exercise is associated with autonomic dysfunction and increased mortality. What HRR criterion at 1-minute after a 6-minute walk test (6MWT) best defines pulmonary impairment?. Study Design and Methods: A total of 5008 phase 2 COPDGene (NCT00608764) participants with smoking history were included. A total of 2127 had COPD and, of these, 385 were followed-up 5-years later. Lung surgery, transplant, bronchiectasis, atrial fibrillation, heart failure and pacemakers were exclusionary. HR was measured from pulse oximetry at end-walk and after 1-min seated recovery. A receiver operator characteristic (ROC) identified optimal HRR cut-off. Generalized linear regression determined HRR association with spirometry, chest CT, symptoms and exacerbations. Results: HRR after 6MWT (bt/min) was categorized in quintiles: ≤ 5 (23.0% of participants), 6– 10 (20.7%), 11– 15 (18.9%), 16– 22 (18.5%) and ≥ 23 (18.9%). Compared to HRR≤ 5, HRR≥ 11 was associated with (p< 0.001): lower pre-walk HR and 1-min post HR; greater end-walk HR; greater 6MWD; greater FEV 1 %pred; lower airway wall area and wall thickness. HRR was positively associated with FEV 1 %pred and negatively associated with airway wall thickness. An optimal HRR ≤ 10 bt/min yielded an area under the ROC curve of 0.62 (95% CI 0.58– 0.66) for identifying FEV 1 < 30%pred. HRR≥ 11 bt/min was the lowest HRR associated with consistently less impairment in 6MWT, spirometry and CT variables. In COPD, HRR≤ 10 bt/min was associated with (p< 0.001): ≥ 2 exacerbations in the previous year (OR=1.76[1.33– 2.34]); CAT≥ 10 (OR=1.42[1.18– 1.71]); mMRC≥ 2 (OR=1.42[1.19– 1.69]); GOLD 4 (OR=1.98[1.44– 2.73]) and GOLD D (OR=1.51[1.18– 1.95]). HRR≤ 10 bt/min was predicted COPD exacerbations at 5-year follow-up (RR=1.83[1.07– 3.12], P=0.027). Conclusion: HRR≤ 10 bt/min after 6MWT in COPD is associated with more severe expiratory flow limitation, airway wall thickening, worse dyspnoea and quality of life, and future exacerbations, suggesting that an abnormal HRR≤ 10 bt/min after a 6MWT may be used in a comprehensive assessment in COPD for risk of severity, symptoms and future exacerbations. Keywords: autonomic dysfunction, chest computed tomography, COPD exacerbation, exercise, spirometry","journal":"International Journal of COPD","year":2021,"id":160851,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":32,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9224,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":674324,"name":"Asghar Abbasi","orcid":"0000-0003-3034-0068","position":1,"is_corresponding":false},{"id":3295,"name":"Richard Casaburi","orcid":"0000-0002-8851-8589","position":2,"is_corresponding":false},{"id":390313,"name":"Alessandra Adami","orcid":"0000-0002-1917-9296","position":3,"is_corresponding":false},{"id":674325,"name":"Nicholas B. Tiller","orcid":"0000-0001-8429-658X","position":4,"is_corresponding":false},{"id":674326,"name":"Wei Yuan","orcid":"0000-0003-3550-712X","position":5,"is_corresponding":false},{"id":674327,"name":"Christopher Yee","orcid":"0009-0006-9269-7416","position":6,"is_corresponding":false},{"id":674328,"name":"Nicholas Jendzjowsky","orcid":"0000-0002-4342-1839","position":7,"is_corresponding":false},{"id":674329,"name":"David M. MacDonald","orcid":"0000-0003-4489-1872","position":8,"is_corresponding":false},{"id":382671,"name":"Ken M. Kunisaki","orcid":"0000-0001-8644-2827","position":9,"is_corresponding":false},{"id":674330,"name":"William W. Stringer","orcid":"0000-0003-2756-6728","position":10,"is_corresponding":false},{"id":485354,"name":"János Pórszász","orcid":"0000-0002-5823-0031","position":11,"is_corresponding":false},{"id":24990,"name":"Barry J. Make","orcid":"0000-0003-4349-8745","position":12,"is_corresponding":false},{"id":24947,"name":"Russell P. Bowler","orcid":"0000-0003-4651-363X","position":13,"is_corresponding":false},{"id":227020,"name":"Harry B. Rossiter","orcid":"0000-0002-7884-0726","position":14,"is_corresponding":false},{"id":674323,"name":"Dongxing Zhao","orcid":"0000-0002-4080-4754","position":0,"is_corresponding":true}],"reference_count":43,"raw_metadata":null,"created_at":"2026-07-18T23:44:48.240577Z","pmid":"34511898","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}