Resting Heart Rate-An Independent Prognostic Marker for Cancer Mortality and a Modifiable Target of Physical Activity: A Prospective Cohort Study of 615,730 Asian Participants.

OBJECTIVE

To examine the independent and joint associations of resting heart rate (RHR) and physical activity (PA) with cancer mortality and whether reducing elevated RHR through PA enhances its protective effects.

PARTICIPANTS AND

METHODS

This prospective cohort study included 615,730 cancer-free Taiwanese individuals aged 20 years or older who attended a medical screening program between January 1, 1994, and December 31, 2017. Participants were followed up through December 31, 2020 (maximum, 26 years; median, 17 years). Resting heart rate was measured by resting electrocardiography. Self-reported PA was categorized as inactive, low active, or active. Cox models estimated hazard ratios for cancer mortality, adjusting for demographic characteristics, lifestyle, and clinical factors.

RESULTS

Each 10-beats/min increase in RHR was associated with 10% higher cancer mortality and a 3- to 4-year shorter life expectancy. Inactivity was associated with 14% to 30% higher cancer mortality vs being active (P<.001). Inactive adults with RHR of 90 to 99 beats/min had a 56% higher cancer mortality risk than active adults with RHR of 60 to 69 beats/min (P<.001). Among individuals with initial RHR of 90 to 99 beats/min, PA was associated with 47% to 84% lower cancer mortality (P<.001), depending on the initial RHR level. Higher PA volume and lower RHR had consistent dose-response associations across several cancer sites.

CONCLUSION

Elevated RHR independently predicts higher cancer mortality. Regular PA is associated with lower risk, particularly when accompanied by lower RHR. Resting heart rate may serve as a practical marker to guide and motivate effective PA for cancer prevention.