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Understanding Heart Rate and Exercise Intensity with Parkinson’s

For people with Parkinson’s, exercise plays a crucial role in maintaining movement, strength, and overall health. Research suggests that exercising at 60–85% of your maximum heart rate (HR max) can be particularly beneficial, and upon completion, the Sparx3 trial will provide information about which heart rate target is most beneficial.

Because heart rate is often used to measure efficacy in exercise, to make the most of the most up-to-date understanding of best exercise practices, it is important to know how to determine your theoretical maximum heart rate. You also should know the unique factors should you consider when living with Parkinson’s, including that your heart rate capacity may be impacted by Parkinson’s. Because of this, traditional maximum heart rate formulas might not be entirely reliable, so be sure to talk with a member of your care team before you make a conclusion about what your maximum heart rate is.

To help you understand how to measure your heart rate, this post will discuss: 

  • How to calculate HR max using different formulas 
  • Why heart rate response may be lower in Parkinson’s 
  • How the Rate of Perceived Exertion (RPE) scale can help measure intensity 
  • The most reliable heart rate monitoring devices 
  • Why consulting a doctor before high-intensity exercise is important.

How to Calculate Maximum Heart Rate (HR Max)

Knowing your maximum heart rate helps you stay within the workout intensity range recommended by your care team. While no single formula is perfect–and there are many calculation methods besides those we discuss in this post–here are two widely used methods: 

220 – Age Formula 

  • The simplest and most common equation. 
  • Example: A 60-year-old would have an estimated maximum heart rate of 160 bpm (220 – 60). 

Tanaka Formula (208 – 0.7 × Age) 

  • A research-backed alternative that may be more accurate. 
  • Example: A 60-year-old’s HR max would be 166 bpm (208 – 42). 

These formulas provide estimates, but they may not work well for people with Parkinson’s, as their heart rate response can be lower than expected. 

How Parkinson’s Affects Heart Rate Response

People with Parkinson’s may experience a blunted heart rate response, meaning their heart rate does not increase as much during exercise. This is due to changes in the autonomic nervous system that affect cardiovascular regulation. This possible variability is one important reason to talk with your care team before you begin targeting specific heart rate ranges. Talking beforehand can help you know the appropriate target for your circumstances and set reasonable goals for yourself.

What This Means for Exercise
  • Maximum heart rate (HR max) may be lower than predicted by standard formulas
  • Perceived effort may not match heart rate
  • Medications can further impact heart rate regulation. 

Because of this, heart rate measurements alone may not be the best measure of exercise intensity for people with Parkinson’s. The Rate of Perceived Exertion (RPE) scale can offer a more reliable way to track effort, but it does require some attention throughout your exercise practice.

Using the RPE Scale to Measure Effort

The Rate of Perceived Exertion (RPE) scale  helps track workout intensity without relying solely on measurements of heart rate. It is based on how hard exercise feels rather than specific heart rate measurements. Note that there are two scales that are sometimes used for the RPE, one that goes from 0-10 and one that goes from 0-20. For ease of use, we’ll discuss the 0-10 scale.

Generally, on the 10-point RPE scale, you can multiple your rating by 10 and this will give you an estimate of what percentage of your maximum heart rate you are at in that moment. For example, an RPE of 8 means you are likely to be at approximately 80% of your maximum heart rate.

How the RPE Scale Works

0–10 Scale: 

  • 0 = Rest
  • 1 = Very light effort, like walking casually
  • 2-3 = Light effort
  • 4-5 = Moderate effort, an intensity at which you can still talk easily and maintain conversation
  • 6-7 = Vigorous effort, an intensity at which breathing becomes heavier and talking becomes challenging
  • 8-9 = Very hard, an intensity at which breathing becomes more difficult, talking is not manageable, and you are pushing your limit
  • 10 = Maximum effort 

For people with Parkinson’s, the RPE scale may be more reliable than maximum hear rate formulas, but using it requires attention during your workout. It’s also essential to know that these ratings are subjective, so this scale does not give certainty of your actual heart rate. For this reason, the utility of the RPE in estimating your exercise intensity can be increased if you work with a physical therapist or other trained exercise specialist. 

Limitations of These Methods

Both the HR max formulas and the RPE scale have their drawbacks: 

  • Generalized Estimates: The formulas are based on averages and may not account for individual differences in fitness, genetics, or health conditions. 
  • Subjectivity in RPE: How you feel can be influenced by many factors—such as sleep, stress, and environmental conditions—which means your perceived effort might not always correlate perfectly with your heart rate. 
  • Variable Conditions: Certain conditions, including Parkinson’s, can further complicate the picture, affecting heart rate response and overall exercise tolerance. 

Best Heart Rate Monitors: Are They Accurate?

Heart rate tracking can be helpful, but not all devices provide accurate data.

Types of Heart Rate Monitors

Best: Chest Strap Monitors 

  • Uses electrical signals for the most precise heart rate readings. 
  • Recommended for high-intensity exercise. 

Moderate Accuracy: Wrist-Based Monitors 

  • Uses optical sensors (light-based tracking). 
  • Can be inaccurate during movement-heavy activities. 
  • Factors like sweat, movement, and fit can affect readings.

Why Talk to a Doctor Before High-Intensity Workouts?

Exercising at 80–85% of your maximum heart rate is considered high intensity, which may not be suitable for everyone. Even 60% of maximum heart rate can be too much for some people, so before increasing workout intensity, consult a healthcare professional. In addition to the safety considerations, it is possible that because of 

Key Takeaways
  • HR max formulas provide estimates but may not be right for people with Parkinson’s. 
  • The RPE scale is often a more reliable way to measure effort. 
  • Chest strap monitors are the most accurate heart rate tracking devices. 
  • Medical guidance is essential before starting any exercise program. 

By using a combination of HR tracking, RPE, and medical guidance, you can exercise more effectively and safely while living with Parkinson’s and maximize the benefits of movement and strength training. 

Additional Resources

Accuracy of Commonly Used Age-Predicted Maximal Heart Rate Equations  
Heart Rate Calculator 
Blunted Cardiovascular Responses to Exercise in Parkinson’s 
The Heart of The Matter: Cardiovascular Effects of Parkinson’s 
The Rate of Perceived Exertion (RPE) Scale Explained 
Accuracy of Wrist-Worn Heart Rate Monitors  
How Sweat Affects Fitness Watch Accuracy Comparison of Wrist-Based Monitors and Chest Straps 

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