From the Guidelines
Heart rate typically decreases with advancing age, with the maximum heart rate achievable during exercise declining at a rate that can be estimated using the formula 220 minus age. This decline in maximum heart rate reflects the heart's diminishing capacity to increase its pumping rate in response to physical demands as we age 1. In healthy adults, the average resting heart rate gradually declines from childhood through older adulthood, with newborns and infants having the highest resting heart rates, averaging 100-160 beats per minute, and elderly adults generally maintaining resting heart rates in the 60-100 beats per minute range, though often trending toward the lower end of this spectrum compared to younger adults.
Key Points
- The maximum heart rate achievable during exercise decreases with age, with a proposed formula of 208–0.7×age for healthy adults, 206–0.88×age for women, and 164 –0.72×age for patients with CAD 1
- Chronotropic incompetence, or the inability of the heart rate to increase commensurate with increased activity or demand, is predictive of cardiac events and all-cause death 1
- The proportion of heart rate reserve used at peak exercise can be used to determine chronotropic incompetence, with a proportional heart rate reserve of <80% considered significant chronotropic incompetence 1
Clinical Implications
- Elderly adults should undergo a medical evaluation before initiating an exercise program, including a focused physical examination and identification of any psychosocial limitations to participation 1
- Exercise training should focus on enhancing health-related fitness components, reducing the risk of chronic diseases, and improving overall quality of life, with consideration of the individual's dietary inadequacies and medication regimen 1
- The decline in maximum heart rate with age should be taken into account when prescribing exercise programs for elderly adults, with a goal of improving functional independence and overall well-being 1
From the Research
Heart Rate and Age
- The relationship between heart rate and age is complex, and various studies have investigated this topic 2, 3, 4, 5, 6.
- A study on heart rate variability in an ageing population found that heart rate variability decreases with age, and this decrease is associated with lifestyle and cardiovascular risk factors 4.
- Another study on the accuracy of age-predicted maximal heart rate equations found that these equations may not accurately predict maximal heart rate in a general population, and that the Fox equation may be the most accurate 5.
- A study on the relationship between exercise heart rate and age in men and women found that men and women have different heart rate responses to exercise, and that a separate formula for peak heart rate in women may be appropriate 6.
Changes in Heart Rate with Age
- Heart rate variability decreases with age, with a decrease in standard deviation of all normal RR intervals (SDNN) and total power (TP) 4.
- Maximal heart rate also decreases with age, with a regression line of peak HR = 220 - 0.95 × age for men, and a lower intercept and slower decrease with age for women 6.
- The decrease in heart rate variability and maximal heart rate with age may be associated with an increase in cardiovascular risk factors, such as high blood pressure, smoking, and obesity 4.
Sex Differences in Heart Rate and Age
- Men and women have different heart rate responses to exercise, with men having higher peak heart rates and heart rate reserves than women 6.
- The relationship between heart rate and age also differs between men and women, with women having a lower intercept and slower decrease in peak heart rate with age 6.
- These sex differences may be important to consider when interpreting heart rate data and developing equations to predict maximal heart rate 6.