Academy > Biometrics 101 > whitepaper

Heart Rate: What’s Normal and How Trends Relate to Health Status

Reading time: 4 min

What is it?

Heart rate is defined as the number of contractions of the heart, expressed in beats per minute (bpm). The heart rate is a function of local electrical signals in the cardiac cells, neural inputs, and hormonal influence.

Heart rate changes in response to stressors in order to increase circulation of blood, often by increasing cardiac output. This increase in cardiac output helps meet the demands of physiological responses to stress.

Therefore, heart rate can be a valuable metric in understanding the cumulative stress (e.g. emotional and physical stress) that is placed on the body.

How it’s measured

Heart rate can be measured through palpation, electrocardiography (ECG), and photoplethysmography (PPG). Biostrap measures heart rate using PPG, which captures pulse waves of blood flow using red and infrared light. By using the count of pulse waves per unit of time, heart rate in bpm can be obtained.

Heart rate can be measured during activity (active heart rate). However, resting heart rate (RHR) is most often used to clinically assess cardiovascular health, since extra stress on the cardiovascular system is absent. RHR can be subject to acute stress, including observation bias. Therefore, passive collection of RHR through wearables, particularly during sleep, allows for minimizing error that may artificially raise RHR.

Correlation with health conditions

Chronically increased resting heart rate has been correlated with many diseases and their outcomes, particularly hypertension, obesity, cardiovascular diseases, cancer, and metabolic disorders, among others. In many cases, the increased heart rate is not itself a contributor to the disease progression, but rather a signal that there are down-stream effects of the underlying disease.

Acutely increased resting heart rate may be an indication of altered blood flow, reduced plasma volume, psychological stress, activity, infection, and thermal stress. Monitoring heart rate trends can alert when heart rate has changed acutely, but may not be indicative of the cause of the increase. In times where no change in RHR is expected such as during sleep, follow-up evaluation may be warranted.

What is a “normal” range?

<60 bpm = Bradycardia
60-100 bpm = “Normal”
>100 = Tachycardia

A “normal” RHR is considered to be 60-100 beats per minute. Factors that may influence resting heart rate values include:

  • Fitness level
  • Room temperature
  • Body position
  • Emotional stress
  • Body size and/or composition
  • Use of medications

The Biostrap Buzz

Sign up to our email newsletter to receive curated content on the latest news in digital health and health optimization. Plus, special access to Biostrap offers and community updates.

Interpreting trends

Resting heart rate, measured over time, provides insights into cardiovascular changes in response to lifestyle or disease progression. Since RHR responds relatively quickly to lifestyle changes, tracking resting heart rate over time is recommended in order to monitor positive and negative health adaptations.

Although RHR alone is not enough to diagnose any particular disease, the American Heart Association recommends lowering resting heart rate as much as possible. Exercise training, dietary changes, meditation, and reducing stress are examples of ways to reduce RHR. The decrease in heart rate reflects increased cardiovascular efficiency and decreased systemic stress.

Increases in RHR over time could be an indication of negative cardiovascular changes, and may warrant follow-up testing or lifestyle intervention.


In a clinical study, the Biostrap PPG-based resting heart rate measurement matched within 1 +/- BPM to the reference research grade ECG.

In a small real-world cohort of elderly people, the standalone Fibricheck AF algorithm can accurately detect AF using Wavelet wristband-derived PPG data. Results are comparable to the Alivecor Kardia one-lead ECG device, with an acceptable unclassifiable/bad quality rate. This opens the door for long-term AF screening and monitoring.


  1. Lakatta EG, Vinogradova TM, Maltsev VA. The Missing Link in the Mystery of Normal Automaticity of Cardiac Pacemaker Cells. Annals of the New York Academy of Sciences. 2008;1123(1):41–57. doi:
  2. Brack KE, Coote JH, Ng GA. Interaction between direct sympathetic and vagus nerve stimulation on heart rate in the isolated rabbit heart. Experimental Physiology. 2004;89(1):128–139. doi:
  3. Furnival CM, Linden RJ, Snow HM. The inotropic and chronotropic effects of catecholamines on the dog heart. The Journal of Physiology. 1971;214(1):15–28.
  4. Sneddon G, Mourik R van, Law P, Dur O, Lowe D, Carlin C. P177 Cardiorespiratory physiology remotely monitored via wearable wristband photoplethysmography: feasibility and initial benchmarking. Thorax. 2018;73(Suppl 4):A197–A197. doi:10.1136/thorax-2018-212555.334
  5. Lequeux B, Uzan C, Rehman MB. Does resting heart rate measured by the physician reflect the patient’s true resting heart rate? White-coat heart rate. Indian Heart Journal. 2018;70(1):93–98. doi:10.1016/j.ihj.2017.07.015
  6. Paul Laura, Hastie Claire E., Li Weiling S., Harrow Craig, Muir Scott, Connell John M.C., Dominiczak Anna F., McInnes Gordon T., Padmanabhan Sandosh. Resting Heart Rate Pattern During Follow-Up and Mortality in Hypertensive Patients. Hypertension. 2010;55(2):567–574. doi:10.1161/HYPERTENSIONAHA.109.144808
  7. Aune D, Sen A, ó’Hartaigh B, Janszky I, Romundstad PR, Tonstad S, Vatten LJ. Resting heart rate and the risk of cardiovascular disease, total cancer, and all-cause mortality – A systematic review and dose-response meta-analysis of prospective studies. Nutrition, metabolism, and cardiovascular diseases: NMCD. 2017;27(6):504–517. doi:10.1016/j.numecd.2017.04.004
  8. Lee DH, Park S, Lim SM, Lee MK, Giovannucci EL, Kim JH, Kim SI, Jeon JY. Resting heart rate as a prognostic factor for mortality in patients with breast cancer. Breast Cancer Research and Treatment. 2016;159(2):375–384. doi:10.1007/s10549-016-3938-1
  9. Hillis GS, Woodward M, Rodgers A, Chow CK, Li Q, Zoungas S, Patel A, Webster R, Batty GD, Ninomiya T, et al. Resting heart rate and the risk of death and cardiovascular complications in patients with type 2 diabetes mellitus. Diabetologia. 2012;55(5):1283–1290. doi:10.1007/s00125-012-2471-y
  10. Jiang X, Liu X, Wu S, Zhang GQ, Peng M, Wu Y, Zheng X, Ruan C, Zhang W. Metabolic syndrome is associated with and predicted by resting heart rate: a cross-sectional and longitudinal study. Heart. 2015;101(1):44–49. doi:10.1136/heartjnl-2014-305685
  11. Lee B-A, Oh D-J. The effects of long-term aerobic exercise on cardiac structure, stroke volume of the left ventricle, and cardiac output. Journal of Exercise Rehabilitation. 2016;12(1):37–41. doi:10.12965/jer.150261
  12. Target Heart Rates Chart. [accessed 2021 Apr 15].
  13. Reimers AK, Knapp G, Reimers C-D. Effects of Exercise on the Resting Heart Rate: A Systematic Review and Meta-Analysis of Interventional Studies. Journal of Clinical Medicine. 2018;7(12). doi:10.3390/jcm7120503

Did we miss anything?

If you have any questions, suggestions or topic requests, please reach out.