Fit to Practice: Lower your heart rate, live longer

“Quick, grab the crash cart! He’s coding!”

This was my introduction to the one and only surgery I’ve ever undergone. I was slumped over in a wheelchair, clutching my stomach. I was half-delirious from pain and only snapped to attention when I heard my wife shriek.

“What’s going on?” I asked weakly.

“Sir, you may be having a cardiac event,” a nurse said. “Your pulse rate is in the low 40s. I’ve just summoned the cardiac team.”

“My heart rate in the 40s?” I responded. “Sounds about right to me. Normal rhythm?”

The nurse gave me a puzzled look. “Your pulse feels strong and regular. But, sir, with the amount of pain you’re in, your heart should be racing. Something’s obviously wrong with your heart.”

My wife, sensing I wasn’t really in danger, piped up. “He’s used to pain,” she said. “He does the Ironman.”

“I’m betting my low heart rate gets me out of here quickly,” I added.

I also should’ve added that I bet a low heart rate will help me live longer—at least if the latest research and decades of similar findings are true. For almost 90 years, scientists have postulated that a lower resting heart rate (RHR) signals a longer life. (Here’s to living like a tortoise: RHR 6 bpm, life expectancy 150-plus years.)

The magic formula for longevity

In the April 17 edition of the journal Heart, you’ll find a prospective cohort study by Danish researchers who’ve followed roughly 2,800 men for 16 years (the Copenhagen Male Study). They wanted to investigate the role of RHR on longevity. Many studies have shown a link between a lower RHR and a longer, disease-free life. These Danes added a twist to their evaluation.

They wanted to remove, as much as scientifically possible, the effects of physical fitness on longevity. Maybe earlier studies found that people lived longer with lower RHR simply because they were fitter or had a more active lifestyle. They adjusted for physical fitness, leisure-time physical activity and other cardiovascular risk factors. To accomplish this, they used a standardized test for cardiovascular fitness, the VO2 max test, to compare subjects based on fitness levels, regardless of resting heart rate and other factors. As an additional finding, this study reinforced the notion that a lower RHR is inversely proportional with cardiovascular fitness. In other words, the lower your RHR, the more likely you are to be in good physical and cardiovascular shape.

After eliminating physical fitness, physical activity and other factors, the scientists found that a low RHR was related to a longer relative life expectancy. The take-home message was that you could examine a test subject at the beginning of the 16-year study, remove any other major factors and predict that a man with a lower RHR would live longer than a comparable man with a higher RHR. The lead researcher commented, “If you have two healthy people exactly the same in physical fitness, age, blood pressure and so on, the person with the highest resting heart rate is more likely to have a shorter life span.”

But why? We don’t know. My own interpretation of numerous studies in this area leads me to believe that a higher RHR is a symptom of other maladies. By keeping my RHR low, there’s a good chance I’m reducing all sorts of risk factors, both known and unknown, that help me live longer and healthier. So how do you lower your RHR? By being physically active, managing stress and living a healthy lifestyle.

But what about drugs to lower the resting heart rate? Would that help a person live longer? Probably not. Most experts aren’t willing to suggest a causal relationship between RHR and longevity—and I agree. There are innumerable variables that influence life expectancy—RHR is most likely just an indicator of what’s going on in your life and how long that life is likely to last. Drugs to lower RHR would likely have unintended consequences that could decrease life expectancy. Small studies in laboratory animals seem to support this notion. But longevity probably won’t be found in a pill. The fountain of youth is found mainly in how we live.

So back to my story: As you may have guessed, I had an emergency appendectomy after they confirmed that my pumper was fine. What you may not have deduced is that I had just completed an Olympic-distance triathlon the day before. I had blamed the pain on cramping as I willed myself home that day—a four-hour drive alone. I recall stopping for gas and vomiting in the trash can and unable to stand upright, and all I could think about was whether I could make the 18-mile run I had scheduled for Father’s Day (I didn’t). By the time I got home, I collapsed in bed and told my wife I must’ve taken in too many carbs. She didn’t buy it and the trip to the emergency room followed.

Wellness is not the absence of illness

Within five days of discharge I was back on the bike. One week later and I was seeing patients again. Ten days later and I was on the treadmill. In eight weeks I completed a sprint-distance triathlon (shake the old adhesions off). Just 18 weeks after having my guts examined and parts yanked out, I completed an Ironman (2.4-mile swim, 112-mile bike and 26.2-mile run). I’m happy to report my surgeon shared that he was getting in shape by running and swimming the day after he removed my skin staples. He wanted some of my special sauce. I tell you this not to boast, but to stress the importance of being “emergency-room ready” at all times. I’m convinced, as was my surgeon, that maintaining optimal wellness is essential in healing. I don’t know why my appendix ruptured—I do have a few guesses and a lousy family history of GI issues—but when it did, I was prepared. My low RHR confirmed it.

I also apply this philosophy to my pet patients. Wellness is not the absence of illness. I strive to achieve optimal well-being in both my veterinary practice and personal life. Start monitoring the pulse rate and quality of each patient. Check your own. Train with a heart rate monitor. Wear it at night occasionally and record your RHR when you’re just waking. Learn to relax. Meditate. Successfully managing practice and life stress can lower your RHR and save those precious beats for more important things—like time with your family. (My heart rate just spiked to 48 bpm as I wrote this last paragraph—must be getting excited.)

Start lowering your heart rate today. You just might live longer.