Monitoring exercise intensity in diabetes: applicability of “heart rate-index” to estimate oxygen consumption during aerobic and resistance training

  • A. L. Colosio
  • G. Spigolon
  • E. Bacchi
  • P. Moghetti
  • S. PogliaghiEmail author
Original Article



Accurate quantification and monitoring of exercise “dose”, described by oxygen consumption (VO2), is necessary for exercise prescription and individualization. However, due to the complexity and elevated cost of direct, gold-standard methods, this is rarely done outside research laboratories. Heart rate-index (HRindex) is a new simple method to estimate VO2 in healthy and clinical populations. We tested the performance of HRindex to estimate VO2 in diabetic patients during aerobic (AT) and isotonic training (IT).


Data from 12 males (age: 64 ± 5 years; BMI: 26 ± 12) with type 2 diabetes were analysed. VO2 and heart rate were measured during one AT and one IT session. Furthermore, VO2 was indirectly estimated based on HRindex. Then, the correspondence between measured and estimated VO2 was evaluated by two-way RM-ANOVA, correlation and Bland–Altman analysis.


Estimated average VO2 values during AT (1292 ± 366 ml/min) were not different from (p = 0.243) and highly correlated with (r = 0.87, p < 0.001) the measured values (1369 ± 417 ml/min), with a small bias and imprecision. Conversely during IT, HRindex overestimated VO2 compared to the actual measures (1048 ± 404 vs 667 ± 230 ml/min, p ≤ 0.001) and only a moderate correlation was found between values (r = 0.43, p ≤ 0.001), with a large bias and imprecision.


VO2 of aerobic exercises can be accurately estimated in diabetes patients using HRindex. During isotonic exercise, this method is not recommended for monitoring metabolic intensity due to large overestimation and imprecision. In aerobic exercise, HRindex offers a simple and valid alternative to the direct VO2 determination and may favour the applicability of time-resolved measures of exercise “dose”.


Exercise prescription Oxidative metabolism Field methods Physical activity 



Analysis of variance


Aerobic training


Body mass index


Estimated oxygen consumption


Glycated haemoglobin


Heart rate


Heart rate-index


Isotonic training


Metabolic equivalent


Measured oxygen consumption


Type 2 diabetes mellitus


Exercise onset


Oxygen consumption


Maximal oxygen consumption


Author contributions

ACL and SP conceived and designed the study, GS and EB acquired the data. ACL and SP wrote the first draft of the manuscript. All authors interpreted the data, contributed to writing and revising the manuscript and approved the final version.



Compliance with ethical standards

Conflict of interest

All the authors declare that they have no conflict of interest.

Ethical approval

This study was conducted in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments.

Informed consent

Written informed consent was obtained from all patients included in this study


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Copyright information

© Italian Society of Endocrinology (SIE) 2019

Authors and Affiliations

  1. 1.Department of Neurosciences, Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
  2. 2.Department of Medicine, Section of Endocrinology, Diabetes and MetabolismUniversity and AOUI of VeronaVeronaItaly

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