How to Lower Resting Heart Rate: What the Evidence Actually Shows

Key Takeaways

• Higher resting heart rate is associated with higher all-cause mortality, but this does not prove that lowering the number itself is protective.[1]
• In controlled exercise trials, endurance training and yoga were the only forms of exercise that significantly lowered resting heart rate in both women and men.[2]
• In a large observational study, alcohol intake was associated with a dose-dependent increase in heart rate during sleep, already at the lowest intake level.[3]
• Repeated short sleep raised heart rate in small laboratory studies, and a few recovery nights did not fully reverse it.[4][5]
• Large weight loss was associated with a lower heart rate, and heart rate was lower on single days of smoking abstinence in a small study.[6][7]
• “Normal” varies widely between individuals but is fairly consistent within the same person, so one’s own usual level may provide useful context alongside population reference ranges.[8]
• In highly trained athletes, a resting heart rate of 30 bpm or more without symptoms is considered normal; a very low rate with symptoms needs medical evaluation.[9]
• In my clinical experience, context matters more than a single reading: whether the rate is usual for the person, whether it is regular, and whether there are symptoms such as shortness of breath or chest discomfort.
• In my practice, a persistently elevated resting heart rate, particularly a recent rise, may prompt a check of thyroid function depending on symptoms and other findings, and an irregular pulse can warrant assessment for atrial fibrillation even in young people.
• In my clinical experience, stress and panic symptoms commonly raise heart rate; for panic disorder itself, NICE recommends cognitive behavioural therapy or an SSRI antidepressant.[10]

Introduction: Why People Want to Know How to Lower Resting Heart Rate

Wearable devices have turned resting heart rate into a number that many people check every morning. It is easy to understand why: large population studies link a higher resting heart rate with higher mortality.[1] The practical question is how to lower resting heart rate, and which of the commonly suggested methods are actually supported by research.

From a sports medicine perspective, the answer has two sides. A slow resting heart rate is a common training-related finding in athletes, but a markedly raised resting heart rate can have causes such as fever, infection, anemia or hyperthyroidism.[9] This article reviews what peer-reviewed studies show about exercise, sleep, alcohol, body weight, smoking and breathing techniques, and where the limits of the evidence lie.

What Counts as a Normal Resting Heart Rate?

Population “normal ranges” hide large individual differences. In a retrospective study of 92,457 US adults who wore a wrist-worn heart rate tracker for a median of 320 days, the mean daily resting heart rate was 65.5 bpm, and individual average resting heart rates ranged from 39.7 to 108.6 bpm.[8] Sex, age, body mass index and sleep duration together accounted for no more than 10% of the variability between people. Within individuals, resting heart rate was much more consistent over time, with a small seasonal trend (maximum in January, minimum in July), and 20% of participants had at least one week in which their resting heart rate fluctuated by 10 bpm or more.[8]

Definitions of a “slow” heart rate also differ between documents. The 2018 ACC/AHA/HRS bradycardia guideline defines sinus bradycardia as a sinus rate below 50 bpm, as one potential component of sinus node dysfunction,[11] whereas the international criteria for ECG interpretation in athletes define it as a heart rate below 60 bpm.[9] In highly trained athletes, much lower rates can still be normal (see below).

In my practice, resting heart rate comes up regularly, and I consider it part of a patient’s overall clinical assessment. Many patients ask what a normal heart rate is, and the answer varies a lot between people. Today the question is often prompted by smart rings and other wearables, which record heart rate through the night, when it is typically lower. In my clinical experience, the heart rate I most often see during routine blood pressure measurements is in the 60s, sometimes around 70 if the patient is nervous at the appointment. Physically active people may have considerably lower values, around 50 or even in the 40s, particularly at night. Some patients have seen night-time readings in the 30s on their device and have understandably been alarmed. In my clinical experience, in otherwise healthy, highly trained patients this is often fairly ordinary. Even so, readings in the 30s should be interpreted in the context of symptoms, training history and measurement reliability, and a very low heart rate may warrant investigation at least once (see below).

Why Resting Heart Rate Matters: The Mortality Link and Its Limits

A large meta-analysis of prospective cohort studies included 46 studies from the general population, of which 40 contributed to the all-cause mortality analysis, with 1,246,203 participants and 78,349 deaths.[1] After adjustment for other risk factors, every 10 bpm higher resting heart rate was associated with a relative risk of 1.09 for all-cause mortality and 1.08 for cardiovascular mortality. Compared with the lowest heart rate category, people with a resting heart rate above 80 bpm had a relative risk of 1.45 for all-cause mortality. The authors also reported substantial heterogeneity and publication bias; after correction for publication bias with the trim-and-fill method, the relative risk per 10 bpm was 1.04 for all-cause mortality and 1.03 for cardiovascular mortality.[1]

These are observational associations. The authors of a large exercise meta-analysis on resting heart rate point out that resting heart rate does not meet all criteria for an independent risk factor, because evidence that treating an elevated resting heart rate reduces mortality is still lacking, so a non-causal relationship cannot be excluded.[2] For this reason, a lower resting heart rate may be better viewed as a marker than as a goal in itself.

How to Lower Resting Heart Rate With Exercise

Much of the evidence on how to lower resting heart rate with exercise comes from a systematic review and meta-analysis of controlled trials in healthy people (including participants with overweight, obesity, hypertension or dyslipidemia), which identified 191 eligible studies and, after excluding duplicate publications, combined 215 samples from 181 articles with 12,952 participants.[2] Across all comparisons, resting heart rate fell by 3.3 bpm (4.7%) more in the exercising groups than in the control groups.

The type of exercise mattered:

• Endurance training lowered resting heart rate significantly, by 2.7 to 5.8 bpm (4.5% to 9.0%) depending on participants’ sex.[2]
• Yoga lowered resting heart rate significantly in both women and men, by 5.2 to 5.5 bpm (4.1% to 5.5%).[2]
• Strength training did not produce a significant overall effect, although when analyzed by sex it significantly lowered resting heart rate in women (by 2.2 bpm, or 5.0%), but not in men.[2]

Two other findings are useful for setting expectations. People who started with a higher resting heart rate had larger reductions, and older study populations had smaller average reductions, while age was not significantly associated with the total number of training sessions.[2] The authors noted that the effect appeared after only a few months, on average about three months of training three times per week, while the total number of sessions did not significantly predict the size of the change.[2]

Why does endurance training slow the resting heart? Training-induced bradycardia has been widely attributed to increased vagal (parasympathetic) tone, although the rodent study described below challenged this view.[12] International consensus criteria for athlete ECG interpretation attribute the slow resting heart rate of endurance athletes to increased vagal tone and possible structural remodeling of the atria.[9] Animal research points to another mechanism: in trained rodents, the slower heart rate persisted after pharmacological blockade of the autonomic nervous system in mice and in isolated, denervated sinus node tissue, and it was linked to downregulation of the HCN4 “funny channel” in the heart’s own pacemaker.[12] Because these were rodent experiments, they show a plausible mechanism rather than proof of the same process in humans.

Sleep, Alcohol and Recovery: The Overnight Signal

Alcohol. A Finnish real-world study analyzed beat-to-beat heart rate recordings from 4,098 employees, comparing each person’s nights with and without alcohol.[3] During the first three hours of sleep, average heart rate was 1.4 bpm higher after low intake (≤0.25 g/kg), 4.0 bpm higher after moderate intake (>0.25–0.75 g/kg) and 8.7 bpm higher after high intake (>0.75 g/kg). In the low-intake group, roughly 90% of measurement days involved a single drink. Being physically active did not protect against the effect, and the heart rate increase was larger in younger than in older participants.[3] Alcohol intake was self-reported and the study was observational, but each person served as their own comparison. Two of the authors were employed by the company that made the recording device.

Sleep restriction. In 15 healthy young men whose time in bed was limited to 4 hours per night for five nights after two baseline nights of 8 hours, heart rate rose from 60 bpm at baseline to 63 bpm after the restriction period and to 65 bpm after three recovery nights of 8 hours in bed, while none of the measured parameters changed in an 8-person control group.[4] In a randomized crossover study that enrolled 20 healthy men, of whom 18 were included in the analysis (mean age 40.6 years), one night of restricted sleep (5 instead of 8 hours) was associated with a significantly higher heart rate during light (N1) sleep, whereas sleep fragmentation did not significantly change heart rate compared with baseline.[5] These are small studies in men, but in both, short sleep was associated with a higher heart rate, and in the first study heart rate was still higher after three recovery nights than at baseline. More on this in our article on sleep.

Body Weight, Smoking and Other Modifiable Factors

Weight loss. A systematic review and meta-analysis of nine studies (110 patients with obesity but no clinical heart failure; six dietary and three bariatric surgery studies) found that a median weight loss of 43 kg over a median of 9.7 months was associated with a 9 bpm lower heart rate (95% CI −12 to −6).[6] These were large weight losses, so the result may not apply directly to modest weight change.

Smoking. In an exploratory study of 18 adult daily smokers who measured their own resting heart rate with smartphone apps, heart rate was 13.4 bpm lower on non-smoking days without nicotine replacement and 10.4 bpm lower on non-smoking days with nicotine replacement, compared with usual smoking days.[7] The difference between the two non-smoking conditions was not statistically significant. The study measured single days of abstinence, so it does not show how large or lasting the effect is after long-term smoking cessation.

For the related question of blood pressure, see how to lower blood pressure.

Breathing, Stress Reduction and Medication

In the exercise meta-analysis, yoga was the only mind-body practice that significantly lowered resting heart rate in both sexes; the numbers of tai chi and qigong studies were small.[2] For slow-paced breathing, a meta-analysis including 223 studies reported increases in vagally mediated heart rate variability (HRV) during slow breathing, immediately after a single session and after multi-session interventions.[13] An increase in HRV should not be assumed to mean a lasting change in resting heart rate. For more on how HRV fits with other recovery markers, see HRV and blood work.

In my clinical experience, stress is a common reason for a raised heart rate, and in chronically stressed patients the heart rate may stay elevated much of the time. Some patients become alarmed when they notice this, and some develop panic attacks, often worrying that they might be having a heart attack. In these situations the heart rate and the sympathetic nervous system can escalate together, and patients may also have shortness of breath, numbness in the fingers and tingling of the lips. From a clinical perspective, one simple way to calm the heart rate is to reduce sympathetic tone and increase parasympathetic activity. Rest, sleep, meditation, deep breathing, sitting with the eyes closed and breathing exercises are typical ways of doing this, for example in patients with panic disorder. We often refer patients to psychologists, who use imagery and breathing exercises and techniques aimed at vagal activation, which can calm the heart rate and often ease symptoms. In my experience, cognitive therapy can also often help reduce stress levels.

Medication is another option when a high heart rate itself is the problem. In my practice, beta blockers, especially propranolol, are fairly often prescribed for a high heart rate and the physical symptoms of sympathetic overactivity, including in some patients with panic symptoms, and in these patients propranolol often eases these symptoms quite well. In conditions where a high heart rate is part of the disease, such as hyperthyroidism or atrial fibrillation, beta blockers such as propranolol or bisoprolol are often used to slow the heart rate. The choice of medication depends on the underlying cause and the individual patient. For panic disorder itself, NICE guidance recommends cognitive behavioural therapy or, as first-line medication, a selective serotonin reuptake inhibitor (SSRI) antidepressant,[10] so in this context beta blockers address the physical symptoms rather than the panic disorder itself.

How to Lower Resting Heart Rate Safely: When the Number Signals Something Else

Before focusing on how to lower resting heart rate, it is worth asking why it is elevated. The authors of the exercise meta-analysis suggested endurance training and yoga as options for an unfavorably high resting heart rate after treatable conditions such as anemia, cardiac disorders and endocrine disorders (for example hyperthyroidism) have been excluded.[2] In the athlete ECG consensus, a resting sinus rate above 120 bpm is a reason to consider a repeat ECG after rest and to look for causes such as fever, infection, dehydration, stimulant use, anemia or hyperthyroidism.[9] Related reading: fever and training and hemoglobin.

At the other end of the range, some patients have a resting heart rate in the 70s or even the 80s. In my clinical experience, these patients often have something that increases sympathetic tone, such as stress. The key questions are clinical: is this rate usual for the patient, is it regular, and are there any symptoms? Symptoms such as shortness of breath or chest discomfort may point to something other than a normal heart rate and warrant attention. In my experience, a resting heart rate in the 80s is fairly unusual, and for me personally the threshold of concern lies at around 80 bpm; this is a personal clinical threshold rather than a research-based cut-off. In my experience, there is often something in the background raising the heart rate in that situation, and a somatic cause may also explain it, so, depending on the symptoms and other clinical findings, I would often check thyroid tests at least once. I have seen patients who reported a resting heart rate persistently above 80 for a long time, possibly with high rates already in their youth but with a recent rise, in whom hyperthyroidism turned out to be the cause.

In the emergency department, a patient with malaise, chest pain or shortness of breath and an elevated heart rate may, depending on their profile, bring pulmonary embolism to mind first for me. Such patients usually have other symptoms too, but in my experience pulmonary embolism can sometimes be fairly asymptomatic, which can complicate diagnosis. Whether the heart rate is regular also matters. An irregular rhythm may suggest atrial fibrillation, which I sometimes see even in young patients, so young age alone is not a reason to dismiss it. On the other hand, frequent extra beats can also make the pulse irregular; on auscultation, the underlying rhythm is usually regular with occasional extra beats. In my experience, some young patients have supraventricular tachycardia, in which the rate is usually very high, often well over 100 bpm and in fast cases approaching 200 bpm. It typically causes symptoms, although in some patients surprisingly few.

A very low resting heart rate can also need attention. According to the international athlete ECG criteria, sinus bradycardia (below 60 bpm) is present in up to 80% of highly trained athletes, and rates of 30 bpm or more are considered normal in the absence of symptoms such as fatigue, dizziness or fainting.[9] A resting heart rate of 30 bpm or less, or a pause of 3 seconds or more, may still be normal in a well-trained athlete but should prompt further evaluation, starting with whether the heart rate rises appropriately with light activity.[9] These criteria were developed for asymptomatic athletes aged 12–35 years, and the document notes that training-related ECG changes are more common in athletes exercising intensively at least 4–8 hours per week, so they do not automatically apply to untrained or older people.

Endurance athletes often have a slow resting heart rate, and in my understanding a larger heart with a larger stroke volume helps explain this. Still, a very low resting heart rate may warrant investigation at least once. Context matters: in a young, otherwise healthy, athletic man, a low rate may well be physiological, but in an older patient I would check at least one ECG to look for sick sinus syndrome, slow atrial fibrillation or another rhythm disturbance.

In athletes, a systematic review of overload studies found a moderate increase in resting heart rate after short-term overload, whereas resting values were not altered after longer overload periods, and the authors noted that expected differences may fall within the day-to-day variability of the measure.[14] See resting heart rate changes in overtrained athletes and functional vs. non-functional overreaching.

How to Lower Resting Heart Rate: What the Evidence Suggests in Practice

• Endurance training and yoga were the only forms of exercise that significantly lowered resting heart rate in both sexes in the meta-analysis reviewed here; reductions were a few beats per minute, and the authors noted that the effect appeared after a few months, on average about three months.[2]
• Alcohol and short sleep are linked with higher heart rates in the hours and days that follow, which may contribute to day-to-day fluctuations in wearable data.[3][4]
• Large weight loss and short-term smoking abstinence were both associated with sizable heart rate differences in the studies reviewed here, although the findings are not directly comparable.[6][7]
• One’s own usual level may provide useful context alongside population ranges, because resting heart rate varied widely between people but was much more consistent within individuals.[8]
• A very high resting rate, or a very low rate with symptoms, may warrant medical assessment rather than self-treatment.[9]

Conclusion: How to Lower Resting Heart Rate With Realistic Expectations

A higher resting heart rate is associated with higher mortality,[1] but evidence that lowering the number itself improves outcomes is still lacking.[2] Among the interventions studied for how to lower resting heart rate, endurance training and yoga showed significant reductions of a few beats per minute in controlled trials. Alcohol intake was associated with a dose-dependent increase in sleeping heart rate and short sleep was associated with a higher heart rate, while large weight loss and short-term smoking abstinence were associated with sizable heart rate differences. Because normal values differ so much between individuals, one’s own usual level, interpreted together with symptoms and overall health, may be a useful reference point.

From my own clinical perspective, resting heart rate is one part of an overall assessment rather than a number to chase. In my experience, a low reading in an otherwise healthy, highly trained person is often physiological, whereas in an older patient a very low rate may warrant at least one ECG. A persistently elevated rate, especially when it represents a change from the person’s usual level, may have an identifiable background cause such as stress or hyperthyroidism, and symptoms such as chest pain, shortness of breath or an irregular pulse may warrant clinical assessment rather than self-treatment.

References

1. https://doi.org/10.1503/cmaj.150535
2. https://doi.org/10.3390/jcm7120503
3. https://doi.org/10.2196/mental.9519
4. https://doi.org/10.1007/s41105-017-0122-x
5. https://doi.org/10.1038/s41598-023-33013-5
6. https://doi.org/10.1016/j.jchf.2019.04.019
7. https://doi.org/10.1093/ntr/ntaa021
8. https://doi.org/10.1371/journal.pone.0227709
9. https://doi.org/10.1136/bjsports-2016-097331
10. https://www.nice.org.uk/guidance/cg113/ifp/chapter/What-treatments-should-I-be-offered-for-panic-disorder
11. https://doi.org/10.1016/j.jacc.2018.10.044
12. https://doi.org/10.1038/ncomms4775
13. https://doi.org/10.1016/j.neubiorev.2022.104711
14. https://pubmed.ncbi.nlm.nih.gov/18308872/