Energy expenditure estimation in beta-blocker-medicated cardiac patients by combining heart rate and body movement data

Jos J. Kraal, Francesco Sartor, Gabriele Papini, Wim Stut, Niels Peek, Hareld M C Kemps, Alberto G. Bonomi

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Background Accurate assessment of energy expenditure provides an opportunity to monitor physical activity during cardiac rehabilitation. However, the available assessment methods, based on the combination of heart rate (HR) and body movement data, are not applicable for patients using beta-blocker medication. Therefore, we developed an energy expenditure prediction model for beta-blocker-medicated cardiac rehabilitation patients. Methods Sixteen male cardiac rehabilitation patients (age: 55.8 ± 7.3 years, weight: 93.1 ± 11.8 kg) underwent a physical activity protocol with 11 low- to moderate-intensity common daily life activities. Energy expenditure was assessed using a portable indirect calorimeter. HR and body movement data were recorded during the protocol using unobtrusive wearable devices. In addition, patients underwent a symptom-limited exercise test and resting metabolic rate assessment. Energy expenditure estimation models were developed using multivariate regression analyses based on HR and body movement data and/or patient characteristics. In addition, a HR-flex model was developed. Results The model combining HR and body movement data and patient characteristics showed the highest correlation and lowest error (r2 = 0.84, root mean squared error = 0.834 kcal/minute) with total energy expenditure. The method based on individual calibration data (HR-flex) showed lower accuracy (i2 = 0.83, root mean squared error = 0.992 kcal/minute). Conclusions Our results show that combining HR and body movement data improves the accuracy of energy expenditure prediction models in cardiac patients, similar to methods that have been developed for healthy subjects. The proposed methodology does not require individual calibration and is based on the data that are available in clinical practice.

Original languageEnglish
Pages (from-to)1734-1742
Number of pages9
JournalEuropean Journal of Preventive Cardiology
Issue number16
Early online date13 Sept 2016
Publication statusPublished - 1 Nov 2016


  • Accelerometry
  • beta-blockers
  • cardiac rehabilitation
  • energy expenditure
  • heart rate monitoring
  • physical activity


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