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Objectives  We assessed the prospective association of resting heart rate (RHR) at baseline with peak oxygen uptake (VO 2peak ) 23 years later, and evaluated whether physical activity (PA) could modify this association.    Background  Both RHR and VO 2peak  are strong and independent predictors of cardiovascular morbidity and mortality. However, the association of RHR with VO 2peak  and modifying effect of PA have not been prospectively assessed in population studies.    Methods  In 807 men and 810 women free from cardiovascular disease both at baseline (1984–86) and follow-up 23 years later, RHR was recorded at both occasions, and VO 2peak  was measured by ergospirometry at follow-up. We used Generalized Linear Models to assess the association of baseline RHR with VO 2peak , and to study combined effects of RHR and self-reported PA on later VO 2peak .    Results  There was an inverse association of RHR at baseline with VO 2peak  (p<0.01). Men and women with baseline RHR greater than 80 bpm had 4.6 mL·kg −1 ·min −1  (95% confidence interval [CI], 2.8 to 6.3) and 1.4 mL·kg −1 ·min −1  (95% CI, −0.4 to 3.1) lower VO 2peak  at follow-up compared with men and women with RHR below 60 bpm at baseline. We found a linear association of change in RHR with VO 2peak  (p = 0.03), suggesting that a decrease in RHR over time is likely to be beneficial for cardiovascular fitness. Participants with low RHR and high PA at baseline had higher VO 2peak  than inactive people with relatively high RHR. However, among participants with relatively high RHR and high PA at baseline, VO 2peak  was similar to inactive people with relatively low RHR.    Conclusion  RHR is an important predictor of VO 2peak , and serial assessments of RHR may provide useful and inexpensive information on cardiovascular fitness. The results suggest that high levels of PA may compensate for the lower VO 2peak  associated with a high RHR.

A Prospective Population Study of Resting Heart Rate and Peak Oxygen Uptake (the HUNT Study, Norway)