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Here we examine cross-sectional and longitudinal relationships between RHR and fitness, explore factors that influence these relationships, and demonstrate the utility of RHR for remote population monitoring.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>In cross-sectional analyses (The UK Fenland Study: 5,722 women, 5,143 men, aged 29-65y), we measured RHR (beats per min, bpm) while seated, supine, and during sleep. Fitness was estimated as maximal oxygen consumption (ml\u22c5min<jats:sup>-1<\/jats:sup>\u22c5kg<jats:sup>-1<\/jats:sup>) from an exercise test. Associations between RHR and fitness were evaluated while adjusting for age, sex, adiposity, and physical activity. In longitudinal analyses (6,589 participant subsample), we re-assessed RHR and fitness after a median of 6 years and evaluated the association between within-person change in RHR and fitness. During the coronavirus disease-2019 pandemic, we used a smartphone application to remotely and serially measure RHR (1,914 participant subsample, August 2020 to April 2021) and examined differences in RHR dynamics by pre-pandemic fitness level.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Mean RHR while seated, supine, and during sleep was 67, 64, and 57 bpm. Age-adjusted associations (beta coefficients) between RHR and fitness were -0.26, -0.29, and -0.21 ml\u22c5kg<jats:sup>-1<\/jats:sup>\u22c5beat<jats:sup>-1<\/jats:sup> in women and -0.27, -0.31, and -0.19 ml\u22c5kg<jats:sup>-1<\/jats:sup>\u22c5beat<jats:sup>-1<\/jats:sup> in men. Adjustment for adiposity and physical activity attenuated the RHR-to-fitness relationship by 10% and 50%, respectively. Longitudinally, a 1-bpm increase in supine RHR was associated with a 0.23 ml\u22c5min<jats:sup>-1<\/jats:sup>\u22c5kg<jats:sup>-1<\/jats:sup> decrease in fitness. During the pandemic, RHR increased in those with low pre-pandemic fitness but was stable in others.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>RHR is a valid population-level biomarker of cardiorespiratory fitness. Physical activity and adiposity attenuate the relationship between RHR and fitness.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0285272","type":"journal-article","created":{"date-parts":[[2023,5,11]],"date-time":"2023-05-11T17:42:57Z","timestamp":1683826977000},"page":"e0285272","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":44,"title":["Resting heart rate is a population-level biomarker of cardiorespiratory fitness: The Fenland Study"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0085-8771","authenticated-orcid":true,"given":"Tomas I.","family":"Gonzales","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin 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