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BACKGROUND: Beyond their resting values, exercise responses in blood pressure (BP) and heart rate (HR) may add prognostic information for cardiovascular disease (CVD). In cross-sectional studies, exercise BP and HR responses correlate with CVD risk factors; however, it is unclear which factors influence longitudinal changes in exercise responses over time, which is important for our understanding of the development of CVD.

METHODS AND RESULTS: We assessed BP and HR responses to low-level exercise tests (6-minute Bruce protocol) in 1231 Framingham Offspring participants (55% women) who underwent a routine treadmill test in 1979-1983 (baseline; mean age 39±8 years) that was repeated in 1998-2001 (follow-up; mean age 58±8 years). Adjusting for baseline exercise responses, we related the follow-up exercise responses to baseline CVD risk factors and to their changes between examinations. Compared with men, women had greater rise in exercise systolic (S)BP and HR at 20-year follow-up (both P0.005). Baseline blood lipid levels, resting SBP and HR, and smoking status were associated with greater exercise SBP at follow-up (all P0.05). Weight gain across examinations was associated with higher exercise SBP and HR at follow-up (both P0.0001). Smoking cessation was associated with a 53% reduced risk of attaining the highest quartile of exercise SBP (≥180 mm Hg) at follow-up (P0.05).

CONCLUSION: An adverse CVD risk factor profile in young adults and its worsening over time were associated with higher SBP and HR responses to low-level exercise in midlife. Maintaining or adopting a healthy risk factor profile may favorably impact the exercise responses over time.