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

Abstract

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. This prospective cohort included 615,730 cancer-free Taiwanese aged ≥20 years who attended a medical screening program between January 1, 1994, and December 31, 2017. Participants were followed through December 31, 2020 (maximum 26 years; median 17 years). RHR was measured by resting electrocardiogram. Self-reported PA was categorized as inactive, low active, or active. Cox models estimated hazard ratios (HRs) for cancer mortality adjusting for demographic, lifestyle, and clinical factors. Each 10 bpm increase in RHR was associated with 10% higher cancer mortality and a 3-4-year shorter life expectancy. Inactivity was associated with 14-30% higher cancer mortality versus being active (P< .001). Inactive adults with RHR 90-99 bpm had a 56% higher cancer mortality risk than active adults with RHR 60-69 bpm (P< .001). Among individuals with initial RHR 90-99 bpm, PA was associated with 47-84% lower cancer mortality (P< .001), depending on the initial RHR level. Higher PA volume and lower RHR showed consistent dose-response associations across several cancer sites. Elevated RHR independently predicts higher cancer mortality. Regular PA is associated with lower risk, particularly when accompanied by lower RHR. RHR may serve as a practical marker to guide and motivate effective PA for cancer prevention.