Factors affecting resting heart rate in free-living healthy humans

Resting heart rate (RHR) is a potential cardiac disease prevention target because it is strongly associated with cardiac morbidity and mortality, yet community-based monitoring of RHR remains in its infancy. Recently, smartwatches have become available enabling measurement with non-intrusive devices of relationships between RHR and other factors outside the laboratory. We carried out cross-sectional observational retrospective analysis of anonymised smartwatch data obtained by participants in their everyday lives between 2016 and 2021 in a single centre community-based study, using convenience sampling. Between participants, overall RHR means strongly or moderately inversely correlated with means of stand hour (SH), calculated VO 2 max, walking and running distance (WRD), steps and flights climbed (FC). Within participants, in quarterly averages, RHR inversely correlated moderately with frequency of standing (stand hours, SH). RHR also inversely correlated moderately with heart rate variability (HRV), consistent with the known impact of increasing parasympathetic dominance on RHR. These within participant correlations suggest that RHR might be modifiable by changes in SH and HRV within individuals. Indeed, analysing paired daily data, relationships between these three categories were dose dependent. 15 SH versus 5 SH associated with a reduction of 10 beats per minute in mean RHR and increase in mean HRV of 14 ms, respectively. We conclude that within individuals, RHR inversely correlates with frequency of standing and HRV, with paired daily measurements indicating effects are mediated that day. RHR also inversely correlates with fitness and activity measures between participants. Our findings provide initial community-based observational evidence supporting further prospective interventional investigation of frequency of standing or HRV modifiers, alongside more familiar interventions, for cardiac disease prevention.