Counting steps is good — is combining steps and heart rate better?

A new way to assess fitness and estimate health risks

By Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Have you met your step goals today? If so, well done! Monitoring your step count can inspire you to gradually increase your physical activity.

But when it comes to assessing fitness or cardiovascular disease risk, counting steps might not be enough. Combining step count and average heart rate (measured by a smart device) may offer a better way to evaluate fitness and gain insights into your risk for major illnesses like heart attack or diabetes. Read on to find out how many steps support better health — and why heart rate matters.

Steps alone vs. steps plus heart rate

First, how many steps should you aim for each day? The often-recommended 10,000-step goal isn’t necessarily magic: while it’s memorable and tied to some health benefits, research shows that fewer daily steps — around 4,000 to 7,000 — may already support better health. And of course, more than 10,000 steps can be even better.

Second, not all steps are created equal. A person walking briskly on hilly terrain will get significantly more exercise than someone walking slowly on flat ground — even with the same step count.

So in an age when millions wear smartwatches or carry smartphones that track physical activity and bodily functions, can we find a better way to assess fitness and disease risk than simply counting steps?

A new study says: yes.

A new metric: Daily Heart Rate Per Step (DHRPS)

Published in the Journal of the American Heart Association, a recent study suggests that a simple ratio combining heart rate and step count — called DHRPS (Daily Heart Rate Per Step) — is a better predictor of health risks than either metric alone.

How do you calculate it?
Take your average daily heart rate and divide it by your average daily step count.

To monitor this, you’ll need a device that continuously tracks heart rate (like a smartwatch or Fitbit). Then you just do some basic math:

Let’s say your average daily heart rate is 80 bpm, and you take 4,000 steps per day:
80 / 4,000 = 0.0200
If you increase your step count to 6,000 while your heart rate remains at 80:
80 / 6,000 = 0.0133
Since lower DHRPS values are better, this is a positive trend.

What did the study find?

The study included nearly 7,000 participants (average age: 55), each of whom wore a Fitbit device to record steps and heart rate over a five-year period — totaling over 50 billion steps.

When researchers compared each person’s DHRPS score with their health records, they found higher scores were strongly linked to increased risk of:

• Type 2 diabetes

• High blood pressure (hypertension)

• Coronary atherosclerosis, heart attacks, and heart failure

• Stroke

In fact, DHRPS was more strongly associated with these conditions than step count or heart rate alone.

Additionally, people with higher DHRPS scores were less likely to report feeling healthy, and among the 21 participants who underwent exercise stress testing, those with the highest DHRPS had the lowest exercise capacity.

What’s a “high” DHRPS score?

In the study, scores were grouped as:

• Low: 0.0081 or lower

• Medium: 0.0081 to 0.0147

• High: 0.0147 or higher

Should you start tracking your DHRPS?

This new metric is promising, but it's not ready to become your primary health tool just yet. Here's why:

• The study only shows a correlation, not causation. A high DHRPS might indicate higher disease risk, but it doesn’t necessarily cause those illnesses.

• Study limitations:

  • Participants were more health-conscious than the general population.

  • Over 70% were women and more than 80% were white — results might vary in a more diverse group.

  • It didn’t compare DHRPS with traditional risk factors (e.g., smoking, family history).

  • Only 21 participants did exercise stress tests — too few to draw strong conclusions.

  • Continuous monitoring devices can cost hundreds of dollars — not accessible to all.

Bottom line

Tracking DHRPS might motivate some people to make healthier choices, like increasing physical activity. It may also help healthcare providers better monitor patient fitness and disease risk — but we need more research to know if it truly improves health outcomes.

If you already wear a device that tracks your heart rate and steps, feel free to calculate your DHRPS — and see if it inspires you to improve your numbers. But don’t be discouraged if it doesn’t change your habits right away.

We’re still learning whether this metric lives up to its promise.

No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

source: Harvard Health Publishing