VOLUME 14.

1, 2018

D.O.I: https://doi.org/10.4127/jbe.2018.0132
Resting Pulse Rate Analysis for an Individual

John Hart, DC, MHSc1-2

1
Hart Chiropractic, Greenville, South Carolina
2
Adjunct Faculty, Southern New Hampshire University, Manchester,
Undergoing Different Types of Exercise:

New Hampshire

Abstract

Introduction: Resting pulse rate (RPR) is a user-friendly

method of assessing neurological fitness. RPR tends to be low
in athletes and healthy people. A novel method for monitoring
A case study in Methodology

an individual’s RPR over time is presented, where the subject

experienced different levels of exercise rigor. The method may
be of interest to those who would also like to monitor their level
of neurological fitness using RPR.
Methods: An adult male, who is a chiropractor and author of
this paper, self-measured and analyzed his RPR over a 1.6 year
period (293 RPR measurements). Four phases of exercise that
differed in rigor were analyzed: Low rigor solo (Phase 1); high
rigor solo (Phase 2); high rigor solo + a structured running pro-
gram (Phase 3) 6 days total per week running; and alternating
run and bicycling (Phase 4). Consecutive phases were analyzed
using the two sample t test and effect size statistics.
Results: RPR decreased (improved) steadily from Phase 1
to Phase 3. The difference between consecutive phases was
statistically significant (P < 0.0001) with large effect sizes (of
> 0.5). There was no statistical difference between phases 3
and 4.

Key Words: Pulse rate, Self-assessment, Biostatistics, Exercise,

Running
76 JBE – VOL. 14.1, 2018

Conclusion: The method presented is feasible for personal use and may be of
interest to those seeking to self-monitor their level of neurological fitness during
their exercise program.

Introduction

Resting heart rate, also known as resting pulse rate (RPR) when obtained by
counting beats while palpating a peripheral artery (e.g. the radial artery at the
wrist), is considered a measure of neurological fitness since the nervous system
controls heart rate. [1-4] RPR is evidence-based from a clinical standpoint in that
people with lower RPR tend to be healthier (e.g., live longer) than their counter-
parts who have a higher RPR. [5-7] In addition, RPR has: a) good agreement with
resting heart rate derived from the electrocardiogram; [8] and b) good (inverse)
agreement with heart rate variability, where lower RPR (a healthy finding) corre-
lates with higher heart rate variability (also a healthy finding). [9]
The author, who is also a chiropractor, uses RPR in his neurologically-based
practice in a novel way – as an added tool to help him determine when his patients
need a chiropractic adjustment. The working theory in this approach is that stress
in the patient’s nervous system could be due to a misaligned vertebra that dis-
turbs spinal nerve function, resulting in elevated (worsened) RPR measurements.
The remedy for this condition would be a chiropractic adjustment to realign the
offending vertebra, to improve nervous system function evidenced by a subse-
quent reduction (improvement) in RPR. [10-12] Obviously there are a number of
other factors that can affect RPR such as exercise. Of course during exercise RPR
increases but over time, true resting heart rate tends to decrease in physically fit
persons. The author has noticed this in his own case and presents his data as a
case example on how one’s RPR can be analyzed.
Self-measured clinical tests, such as blood pressure and RPR, can provide
important information for clinicians and researchers. [13-14] Since RPR is user-
friendly, requiring no special equipment, individuals can readily measure their own
level of neurological fitness using RPR, as was done in the present study. Smart
watches that measure RPR are common these days and can be tested against the
gold standard of RPR (manual palpation at the radial artery [wrist]).
Statistical analysis is typically used at the group level rather than the individual
level. However, if assumptions, such as normal distribution for a t test are satisfied,
then statistical analysis is appropriate at the level of the individual. Typically a case
study does not have so many data points as the present study does. This author
has previously applied statistical analysis at the level of the individual, indicating
precedence for this approach. [15-16]
RESTING PULSE RATE ANALYSIS FOR AN INDIVIDUAL UNDERGOING DIFFERENT TYPES OF EXERCISE 77

Purpose
A novel method of RPR analysis is presented in this case study. The method
compares different phases of exercise activity. Research indicates that RPR tends
to improve (decrease) over time in those who exercise. [17] The self-measurement
method in this study may be of interest to those who wish to monitor their own level
of neurological fitness.

Methods

A 60-year old male and author of this paper, self-measured and analyzed his
RPR over a 1.6 year period, from 5-10-16 to 12-11-17, for a total of 293 RPR meas-
urements. Measurements for RPR were taken: a) in the seated position, after at
least 5 minutes of seated rest, and b) using a digital timer, palpating and counting
beats at the radial artery for either 30 seconds, then multiplying by 2 to achieve a
beats per minute [BPM] value – the method used for readings obtained in 2016; or
for a full 60 seconds to obtain the BPM value – the method used for readings ob-
tained in 2017. Agreement between these two different time counts (30 x 2 versus
the full 60 second count) is good. [18] Reference RPR for this subject’s demo-
graphic group, based on other research of healthy individuals, is 71.0 BPM. [19]
The four phases of activity during the study period were as follows, one occur-
ring right after the other:
1. Phase 1: 5-10-16 to 8-3-16: low rigor solo, 5 minutes per time, 3 times per
week, consisting of bicycling and walking. This phase is referred to as the
low solo phase.
2. Phase 2: 8-4-16 to 2-23-17: High rigor solo, consisting of running 1-2 miles
(approximately the first half of his phase); elliptical workouts, stairs running,
and bicycling (the second half of this phase); 6 times per week, about 20
minutes per time. This phase is referred to as the high solo phase.
3. Phase 3: 2-24-17 to 7-19-17. This phase consisted of high rigor solo running
4 times per week along with a structured program that met two times per
week and ran with high rigor (total of 6 time per week running), approxi-
mately 30 minutes (3 miles) per time. The structured program is called No
Boundaries (NoBo) and is sponsored by Fleet Feet Sports of Greenville,
South Carolina. [20] Compared to solo running, the NoBo program has
some additional rigor such as sprints, including uphill sprints. This phase is
referred to as the NoBo phase.
4. Phase 4: 7-20-17 to 12-11-17. This phase consisted of medium-to-high rigor,
78 JBE – VOL. 14.1, 2018

alternating between running 30 minutes per time, 3 days per week; and bi-
cycling the other days per week, 30 minutes per time for a total of 6 exercise
times per week. The selection of 12-11-17 end date was based on the aver-
age number of days in phases 1-3 (n = 144 days from 7-20-17 to 12-11-17).
This phase is called run-bike (Table 1).

Analysis
Phases were compared in the statistical software program Stata (StataCorp,
College Station, TX). One way analysis of variance (ANOVA), with Bonferroni cor-
rection, was used to determine whether differences between consecutive phases
were statistically significant at the 0.05 alpha level. Since there were at least 30
observations (RPR measurements) in each phase, data normality is assumed. [21]
To assess the magnitude of differences between phases, an effect size statistic,
using a pooled standard deviation was also performed (in Excel 2016, Microsoft
Corp, Redmond, WA). Effect sizes greater than 0.5 were considered large. [22] All
reported p-values are two-tailed.
Outlier analyses were performed for the subject’s four race times [23-26] and
five heart rate variability during the study period. Both of these (race times and
heart rate variability) occurred only in phases 3 and 4, and thus are outcome
measures comparing these two phases. His previous races occurred about 45
years prior when he was in junior high track. Total seconds were used for analysis
in the races. The measure for heart rate variability was the standard deviation of
normal-to-normal beats (SDNN) using the Biocom Heart Rhythm Scanner, clinical
edition 1.0, a 5 minute seated test. A larger SDNN indicates a more adaptive, and
therefore a healthier nervous system. [27] The outlier analysis took the form of:
Quartile 1 – (1.5 * interquartile range) for lower fence
Quartile 3 + (1.5 * interquartile range) for upper fence

RESULTS

A scatter plot of all RPR measurements is provided in Figure 1. Average RPR

for all 293 RPR readings over the 1.6 year study period was 62.3 BPM, represented
by the horizontal line in Figure 1 placed at the exact point of this average. Vertical
lines in Figure 1 are placed at the exact point of the last RPR measurement in the
phase. Mean RPR by phase is provided in Figure 2.
RESTING PULSE RATE ANALYSIS FOR AN INDIVIDUAL UNDERGOING DIFFERENT TYPES OF EXERCISE 79

Phases: 1 2 3 4

Figure 1. Scatter plot for all RPR over the 1.6 year study period. Vertical lines are software-
constructed at exact data point for last observation in a phase and separate the phases. The
horizontal line, also software-constructed, is placed at exact location for mean RPR for all
293 RPR measurements (at 62.3 BPM). Phase 1 = low rigor solo, Phase 2 = high rigor solo,
Phase 3 = NoBo phase (high rigor solo + NoBo), Phase 4 = run-bike.

Figure 2. Mean RPR by phase. Phase 1 = low rigor solo, Phase 2 = high rigor solo, Phase 3
= NoBo phase (high rigor solo + NoBo), Phase 4 = run-bike. Differences between phases
were statistically significant with large effect sizes, with the exception of Phases 3 versus 4.
80 JBE – VOL. 14.1, 2018

Table 1
Summary statistics for RPR.

Phase Days Obs Mean SD Diff p ES

1 85 48 70.3 4.7

2 203 120 62.5 4.6 -7.8 < 0.0001 1.7

3 145 75 58.8 4.0 -3.7 < 0.0001 0.8

4 144 50 59.5 3.6 0.7 0.2 0.2

Phase 1 = low rigor solo, Phase 2 = high rigor solo, Phase 3 = NoBo phase (high rigor solo + NoBo),
Phase 4 = run-bike. Days = number of days in the phase. Obs = number of observations (RPR meas-
urements). Mean and SD (standard deviation) pertain to RPR in the phase. Diff is the mean RPR dif-
ference between consecutive phases. p = p value, and ES = effect side, both of which also pertain to
RPR difference between consecutive phases.

Statistically significant changes (p < 0.0001), even at the Bonferroni-corrected

alpha, with large effect sizes (of > 0.5) were observed between the first three con-
secutive phases. Phases 3 and 4 were essentially the same (p = 0.2, effect size =
0.2); (Figures 1-2, Table 1). In addition, similar to Phase 3, Phase 4’s lower RPR
compared to Phase 2 (solo high rigor) was also statistically significant (p < 0.001)
with a large effect size (of 0.7). Overall reduction, from Phase 1 to Phase 4 was
by 10.8 BPM, which was also statistically significant (p < 0.001) with a very large
effect size (of 2.6).
Race times (in total seconds) were as follows. Race 1, in Phase 3: 1717; Race 2,
in Phase 3: 1683; Race 3, 17 days into Phase 4: 1705; Race 4, five weeks into Phase
4: 1569. In this analysis, one outlier was detected for the race times – in the last race
that showed the fastest time, of 1569 seconds (26 minutes, 9 seconds; Table 2). No
outliers were detected for the heart rate variability test results. (Table 3)
RESTING PULSE RATE ANALYSIS FOR AN INDIVIDUAL UNDERGOING DIFFERENT TYPES OF EXERCISE 81

Table 2
Outlier analysis of race times in phases 3 and 4.

Race Total seconds

1 1717
2 1683
3 1705
4 1569
Quartile 1 1654.1
Quartile 3 1708.0
Interquartile range 53.5
Lower fence 1574.3
Upper fence 1788.3
Race 4 time is an outlier, where it is less than the lower fence time.

Table 3
Outlier analysis of heart rate variability (SDNN) in phases 3 & 4.

Date SDNN
2-28-17 25.9
4-7-17 38.2
9-22-17 29.7
9-25-17 38.2
11-13-17 42.1
Quartile 1 28.1
Quartile 3 38.2
Interquartile range 10.1
Lower fence 13.0
Upper fence 53.3
No outliers observed.
82 JBE – VOL. 14.1, 2018

Discussion

The highest (worst) mean RPR was observed in the low solo (initial) phase,
where it was 70.3 BPM, when exercise exertion level was at its lowest. This RPR
mean was nonetheless better (lower), though only slightly, than the normative
mean for this individual, as previously mentioned, of 71.0 BPM, [19] This suggests
that improvement (decrease) in RPR is possible, at least for this individual, even
when the RPR is initially better than the norm for his demographic group.
Reductions (improvements) in mean RPR were 7.8 BPM from Phase 1 to Phase
2, and then 3.7 BPM from Phase 2 to Phase 3. The reductions were statistically
significant, meaning they probably did not happen by chance alone. Nonethe-
less, there may be a question of whether such changes are clinically significant. It
should be noted that a change in resting heart rate as small as 1 BPM is associated
with a change in mortality risk by 1%, at least at the group level for hypertensive
patients. [28]
There was no statistical difference between RPR in Phase 3 (6 days of running,
in NoBo) versus Phase 4 (running 3 days per week – biking 3 days per week). This
would appear to be a good thing since less running would seem to lessen the risk
of injury, particularly at this individual’s age, where he is no spring chicken. Also
similar to Phase 3, Phase 4’s lower RPR compared to Phase 2 (solo high rigor) was
also statistically significant with a large effect size. Overall reduction in mean RPR
was by almost 11 BPM over the study period of 1.6 years.
Two phases noticeably (in Figure 1) had most of their RPR below the mean line:
NoBo and run-bike (Figure 1). There may be a question of whether improvements
in the various phases were related to trends that began in the previous phases.
The scatter plot (Figure 1) would seem to answer this in that there were no notice-
able trends in prior phases that would indicate such a phenomenon.
The decreased rigor in Phase 4 did not adversely affect race time performance.
Race 3, which was the first of two races in this phase, was essentially the same
time as the previous two races. Race 3 however occurred after only 17 days into
Phase 4. Thus, any benefit that Phase 4 may have had, this amount of time (17
days) may not have been long enough to measure an effect in the way of race
times. The last race in the study, in Phase 4 did show a statistical difference, in the
way of an improved race time. Thus, for this subject, it could be that a medium-
high rigor 6 days per week approach may be ideal compared to high rigor 6 days
per week approach. The reason for the improvement may pertain to increased
recovery time between the high rigor running days. This in turn could result in a
stronger runner, paradoxically, amid a lower rigor.
The mechanism for long term improvement (reduction) in resting heart rate
following an exercise program is likely due to a prevailing effect of vagal (para-
RESTING PULSE RATE ANALYSIS FOR AN INDIVIDUAL UNDERGOING DIFFERENT TYPES OF EXERCISE 83

sympathetic) tone. [27] This tone, when it predominates (versus a predominating

sympathetic tone), has a slowing effect on RPR.
Resting pulse rate measurement is sufficiently user-friendly for personal use
(self-measurement). For those who might be experienced in basic statistical analy-
sis, common spreadsheets (such as Excel) allow for convenient numerical assess-
ment. Alternatively, the RPR can be simply written down, and progress, or lack
thereof can be ascertained by merely viewing the numbers in a list. As a side-note,
I have my patients who are interested, keep track of theirs.
Limitations to the study include those that typically pertain to a case study, e.g.
a convenience sample of only one individual. Similarly, the statistical results apply
only to this individual. Thus, results in this study may not apply to other individuals.
In addition, if the order of the phases was different, the results may have been dif-
ferent. For example, if Phase 1 (low rigor) became the last phase, where it followed
the more rigorous phases, it might have had the lowest RPR instead of the highest.
In either case it is reasonable to conclude that higher rigor exercise has a greater
effect on lowering RPR compared to lower rigor.

Conclusion

The method of self-measurement and analysis of resting pulse rates in this

study is feasible for personal use, to monitor one’s level of neurological fitness,
and is conducive to statistical analysis. Future application of the method in other
individuals is a reasonable next step.

References

1. Mensink GBM, Hoffmeister H. The relationship between resting heart rate and
all-cause, cardiovascular and cancer mortality. Eur Heart J 1997; 18: 1404-
1410.
2. Carney RM, et al. Major depression, heart rate, and plasma norepinephrine in
patients with coronary heart disease. Biol Psychiatry 1999; 45: 458-463.
3. Hsia J, Larson JC, Ockene JK, Sarto GE, Allison MA, Hendrix SL, Robinson JG,
LaCroix AZ, Manson JE. Resting heart rate as a low tech predictor of coronary
events in women: prospective cohort study. BMJ 2009; 338: 577-580.
4. Zhang GQ, Zhang W. Heart rate, lifespan, and mortality risk. Ageing Res Rev
2009: 52-60.
5. Jouven X, Empana JP, Escolano S, Buyck JF, Tafflet M, Desnos M, Ducime-
tiere P. Relation of heart rate at rest and long term (> 20 years) death rate in
84 JBE – VOL. 14.1, 2018

initially healthy middle –aged men. Am J Cardiol 2009; 103:279-283.

6. Rogowski O, Steinvil A, Berliner S, Cohen M, Saar N, Bassat O, Shapira I.
Elevated resting heart rate is associated with the metabolic syndrome. Cardio-
vasc Diabetol 2009; 8:55.
7. Cooney MT, Vartiainen E, Laakitainen T, Juolevi A, Dudina A, Graham IM. Ele-
vated resting heart rate is an independent risk factor for cardiovascular disease
in healthy men and women. Am Heart J 2010; 159:612-619.e3.
8. Erikssen J, Rodahl K. Resting heart rate in apparently healthy middle-aged
men. Eur J Appl Physiol Occup Physiol 1979; 42(1):61-69.
9. Hart J. Association between heart rate variability and manual pulse rate. J Can
Chiropr Assoc 2013; 57(3): 243-250. PubMed: http://www.ncbi.nlm.nih.gov/
pubmed/23997250
10. Hart J. Comparison of resting pulse rates in chiropractic students versus the
general population. Topics in Integrative Health Care 2012; 3(4): ID 3.4005.
Journal: http://www.tihcij.com/Articles/Comparison-of-Resting-Pulse-Rates-in-
Chiropractic-Students-Versus-the-General-Population.aspx?id=0000379
11. Hart J. Reduction of resting pulse rate following chiropractic adjustment of atlas
subluxation. Annals of Vertebral Subluxation Research 2014; March 3: 16-21. Jour-
nal: http://vertebralsubluxation.sharepoint.com/Pages/2014_1298_scoh.aspx
12. Hart J. Neurological change according to resting pulse rate following chiro-
practic care: A case series. The Internet Journal of Neurology 2016; 19(1). DOI:
10.5580/IJN.41669. Journal: https://ispub.com/IJN/19/1
13. Guillaume B et al. Cardiovascular prognosis of “masked hypertension” de-
tected by blood pressure self-measurement in elderly treated hypertensive pa-
tients. JAMA 2004; 291:1342-1349.
14. Hozawa A, Ohkubo T, Kikuya M, et al. Prognostic value of home heart rate for
cardiovascular mortality in the general population: The Ohasama study. Am J
Hypertens 2004; 17:1005-1010.
15. Hart J. Using basic statistics on the individual patient’s own numeric data.
Journal of Chiropractic Medicine 2012; 11(4):306-309. PubMed: http://www.
ncbi.nlm.nih.gov/pubmed/?term=23843765
16. Hart J. Monitoring neurological function with resting pulse rates over a 2 year
period for an individual patient: A feasibility study. Internet Journal of Chiro-
practic 2017; 6 (1). DOI:  10.5580/IJCH.52237. Journal: http://ispub.com/
IJCH/6/1/52237#
17. Stein PK, Ehsani AA, Domitrovich PP, Kleiger RE, Rottman JN. Effect of exer-
cise training on heart rate variability in healthy older adults. Am Heart J. 1999
Sep;138(3 Pt 1):567-76.
18. Hwu YJ, Coates VE, Lin FY. A study of the effectiveness of different measur-
ing times and counting methods of human radial pulse rates. J Clin Nursing
2000;9: 146-152.
RESTING PULSE RATE ANALYSIS FOR AN INDIVIDUAL UNDERGOING DIFFERENT TYPES OF EXERCISE 85

19. Ostchega Y, Porter KS, Hughes J, Dillon CF, Nwankwo T. Resting pulse rate
reference data for children, adolescents, and adults: United States, 1999-2008.
Natl Health Stat Rep 2011; 41:1-16.
20. No Boundaries 5k Program. Fleet Feet of Greenville, SC. Cited 11-17-17 at:
http://www.fleetfeetgreenville.com/training/no-boundaries-program
21. Devore J, Peck R. Statistics: The exploration of data. 4th Edition. Pacific Grove,
CA: Duxbury. 2001: 111.
22. Acock A. A gentle introduction to Stata. Stata Press. 2010.
23. TD Bank Reedy River Race. 4-22-17. Results at: http://georesults.racemine.
com/SVE-Timing-East/events/2017/40th-Annual-TD-Bank-Reedy-River-Run/
results
24. GHS Swamp Rabbit Trail Run. 5-5-17. Results at: http://www.setupevents.com/
index.cfm?fuseaction=page&filename=SwampRabbitagegroups.html
25. Julie Valentine Run. 8-5-17. Results at: https://itsabouttime.run/wp-content/up-
loads/2014/08/run2overcomeresults17.htm
26. Spinx Run. 10-28-17. Results at: https://georesults.racemine.com/SVE-Timing-
East/events/2017/2017-Spinx-Runfest/results
27. Furlan R, et al. Early and late effects of exercise and athletic training on neural
mechanisms controlling heart rate. Cardiovasc Res 1993; 27(3): 482-488.
28. Paul L, Hastie CE, Weiling LS, Harrow C, Muir S, Connell J, Dominiczak AF,
McInnes GT, and Padmanabhan S. Resting heart rate pattern during follow-up
and mortality in hypertensive patients. Hypertension 2010; 55[part 2]:567-574.

Address for correspondence:

John Hart, DC, MHSc
Email: jhartdc@yahoo.com