European Heart Journal Advance Access originally published online on July 4, 2005
European Heart Journal 2005 26(17):1808; doi:10.1093/eurheartj/ehi400
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Heart rate reduction through lifestyle modification: reply
Department of Clinical and
Experimental Medicine
University of Padova
Padova
Italy
Tel: +39 049 8212278
Fax: +39 049 8754179
E-mail address:
palatini{at}unipd.it
In their letter, Drs Michalsen and Dobos correctly highlight the influence that several lifestyle-related factors may have on heart rate. Indeed, sedentary habits, unhealthy diet, excessive stress, smoking, high alcohol, and coffee consumption increase the sympathetic nervous system activity with consequent effects on resting heart rate.1 Therefore, improvement of unhealthy lifestyle might be an effective therapeutic approach in subjects with high heart rate. Among the non-pharmacological measures mentioned by Drs Michalsen and Dobos, regular endurance exercise appears to be the most effective one. Physical training causes a reduction of the sympathetic tone with beneficial effects not only on heart rate but also on abdominal visceral fat, blood pressure, and the other components of the metabolic syndrome. Recent data have shown that exercise programmes can be fruitfully followed also by elderly individuals2 and heart rate has been shown to be a strong predictor of mortality in the old age.3 Thus, at any age, sedentary subjects should be advised to start walking, jogging, swimming, or other types of aerobic exercise for 30–45 min, three to four times a week. Adoption of one such programme could reduce heart rate by 5–10 beats/min, avoiding the use of pharmacological therapy in subjects with mild elevations of heart rate. As mentioned by Drs Michalsen and Dobos, stress management in persons exposed to high level of occupational, ecological, or social stress is another potential mechanism through which a decrease in heart rate can be obtained. In this respect, various therapeutic approaches such as relaxation or biofeedback techniques, group support, individualized advice, yoga, meditation, and nutrition have been proposed.4 Although these behavioural techniques proved effective in subjects with anxiety disorders and symptoms of high sympathetic arousal,4 their effect on heart rate in unselected samples is less known. In the last decade, the protective cardiovascular effect of n-3 polyunsaturated fatty acids has been firmly established. One possible mechanism by which n-3 fatty acids may prevent sudden death and fatal cardiovascular events is by reducing heart rate. In support of this hypothesis, clinical evidence has been accumulated showing a significant impact of n-3 fatty acids on parameters of heart rate variability. Recent results have shown that regular consumption of fish can cause a 2–3 beats/min reduction in resting heart rate in a general male population.5 A greater effect may be expected in subjects with fast resting heart rate. In keeping with the remarks by Drs Michalsen and Dobos, adoption of healthy lifestyle including regular physical activity, healthy dietary habits, and stress management in subjects exposed to high levels of stress could revert to normal mild to moderate heart rate elevations without using pharmacological treatment. However, although this approach might represent the most physiological way to prevent cardiovascular events in subjects with tachycardia, long-term studies have shown that adherence to programmes of non-pharmacological measures is often poor and that in many subjects pharmacological therapy is finally instituted.
References
- Palatini P, Julius S. Heart rate and the cardiovascular risk. (Review). J Hypertens 1997;15:3–17.[CrossRef][Web of Science][Medline]
- Stewart KJ, Bacher AC, Turner KL, Fleg JL, Hees PS, Shapiro EP, Tayback M, Ouyang P. Effect of exercise on blood pressure in older persons: a randomized controlled trial. Arch Intern Med 2005;165:756–762.
[Abstract/Free Full Text] - Menotti A, Mulder I, Nissinen A, Giampaoli S, Feskens EJ, Kromhout D. Prevalence of morbidity and multimorbidity in elderly male populations and their impact on 10-year all-cause mortality: the FINE study (Finland, Italy, Netherlands, Elderly). J Clin Epidemiol 2001;54:680–686.[CrossRef][Web of Science][Medline]
- Manassis K. Childhood anxiety disorders. Approach to intervention. Can Fam Physician 2004;50:379–384.
[Abstract/Free Full Text] - Dallongeville J, Yarnell J, Ducimetiere P, Arveiler D, Ferrieres J, Montaye M, Luc G, Evans A, Bingham A, Hass B, Ruidavets JB, Amouyel P. Fish consumption is associated with lower heart rates. Circulation 2003;108:820–825.
[Abstract/Free Full Text]
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