Which positions or activities are considered resting for measuring heart rate?

Resting Heart Rate Measurement: Acceptable Positions and Activities

For resting heart rate measurement, lying down (supine position) is the gold standard, with sitting as an acceptable alternative when supine measurement is not feasible; standing and walking are NOT considered resting states. 1

Hierarchy of Resting Positions

Supine Position (Lying Down) - Gold Standard

• Resting HR assessments should involve a resting period between 5 and 10 minutes while participants are in a supine position, with HR obtained from the last minute of measurement. 1
• The supine position consistently yields the lowest resting HR values compared to other positions during daytime measurement. 2
• This position is recommended in standardized ambient conditions (temperature 20-22°C) with acceptable ambient light, avoiding unnatural light sources. 1

Seated Position - Acceptable Alternative

• Seated position produces higher HR values than supine but is still considered a resting state. 3
• When supine measurement is not possible, seated rest for 5 minutes can be used, though values will be systematically higher than supine measurements. 1
• Research protocols have validated 5-minute seated rest periods for resting HR measurement. 4

Standing Position - NOT Resting

• Standing produces significantly elevated HR compared to supine or seated positions and should not be considered a resting state. 1
• The orthostatic position (standing) activates different autonomic responses that increase HR above true resting values. 3

Walking - NOT Resting

• Any ambulatory activity, including walking, represents physical activity and is explicitly excluded from resting HR definitions. 1
• Even light walking to the laboratory should be avoided before resting HR measurement, with participants refraining from commuting-related activity. 1

Nocturnal HR: The Lowest Physiological State

Nocturnal HR during sleep represents the lowest physiological HR and is more reliable than daytime resting measurements. 1

Why Nocturnal HR is Superior

• Nocturnal HR is lower than both basal and resting HR measured during the day, with the lowest values occurring during deep sleep (NREM). 1
• Sleep-based measurements show superior repeatability with average repeatability coefficient of 5 bpm and standard deviation of 2 bpm, compared to 12 bpm and 5 bpm for daytime resting measurements. 5
• HR measured by palpation directly after awakening is statistically lower than HR measured later in the day. 1

Nocturnal Measurement Protocol

• Use continuous HR recordings during sleep with 2-hour rolling averages for the duration of reported bedtime. 1
• Measurements should commence 30 minutes after reported bedtime and continue for at least 4 hours, accounting for 90-minute sleep cycles. 1
• Deep sleep (NREM) produces lower HR than REM sleep, so sleep quality must be considered. 1

Critical Pre-Measurement Standardization

Activity Restrictions

• Participants must refrain from intense physical activity for 48 hours prior to resting HR measurement. 1
• Avoid commuting-related physical activity immediately before measurement. 1

Medication Considerations

• Regular cardiovascular medications (e.g., beta blockers) should be continued as usual and documented. 1
• Avoid transient medications (NSAIDs, stimulants, antihistamines, cold medications) for at least 24 hours before testing. 1

Timing and Nutritional Factors

• Resting HR should preferably be assessed in early morning, close to awakening when HR is naturally lower. 1
• Habitual caffeine intake does not need to be restricted. 1
• Restrict nutritional intake 3 hours prior to formal testing to avoid gastric complications. 1

Common Pitfalls to Avoid

• Do not use standing position - this activates orthostatic responses that elevate HR above true resting values. 1
• Do not measure immediately after position changes - allow full stabilization period of 5-10 minutes. 1
• Do not ignore body position effects - supine measurements are 10+ bpm lower than standing in the same individual. 2
• Do not measure after recent activity - even light walking elevates HR above resting baseline. 1

Practical Clinical Recommendation

For clinical practice, measure resting HR after 5-10 minutes of supine rest, taking the value from the last minute of measurement. 1 If nocturnal data from wearable devices are available, these provide the most reliable and repeatable resting HR values. 5 When supine measurement is impractical, seated rest for 5 minutes is acceptable but will yield systematically higher values. 3