Heart rate recovery (HRR) after exercise correlates with decreased vagal tone and mortality. Patients with COPD may have altered autonomic tone. We sought to determine the association of HRR with spirometry measures of pulmonary function. An abnormal HRR was seen in 229 patients (36%). The mean FEV1 values broken into quartiles 1 to 4 were 54 ± 11% predicted, 74 ± 3% predicted, 87 ± 4% predicted, and 106 ± 10% predicted. In smokers and nonsmokers, a worsening FEV1 percent predicted was associated with an abnormal HRR. In a multivariable model accounting for confounding factors including medications and functional capacity, the predictors of an abnormal HRR included FEV1 percent predicted (adjusted odds ratio for 1 SD decrease, 1.32; 95% confidence interval, 1.07 to 1.65; p = 0.0004), impaired functional capacity, male gender, and age. Abnormalities found on spirometry are associated with abnormal HRR, which may reflect an altered autonomic tone associated with pulmonary dysfunction, either obstructive or restrictive in nature. [ABSTRACT FROM AUTHOR]