You might think that diet and exercise are the best ways to avoid a heart attack.

And yes that research is well understood. But this another way.  This is to be aware of the environments that can either help or harm your heart.  Do you know that your heart is under attack every day by hidden threats that you cannot see  in your environment?  This is what my new  book Optimize Your Heart Rate is all about. In it I tell the story of my life-long friend Leslie’s sudden cardiac arrest at the age of 63. I want you to know what Leslie didn’t know. By the end of the book you will know how to use green space and your own heart rate numbers to:  avoid these hidden threats, protect your heart, know when your heart is in danger and what to do about it. I wrote this book so that what happened to Leslie does not happen to you—so that you can live your best life possible.

I didn’t know anything about green space research  before Leslie died.  Although, as many of you know,  I had worked in health care for forty years, first as a nurse then as a health care administrator and university nursing professor, I had never heard of the science of green space. It wasn’t until my diagnosis of systemic lupus erythematosus (SLE), that I discovered a new generation of green space scientists who were publishing about the profound impact spending time near trees. For this reason, I feel lucky that I was diagnosed with the most common and serious type of lupus. It is so named because it affects all the different organ systems in the body. Had I not been diagnosed and gone through this personal journey, I would not have the rich and happy life that I have today. I believe that spending time close to trees, shrubs, and plants actually saved my life. The effects of green space on my health were so profound that in 2019 I wrote a book called Take Back Your Outside: Live Longer, Stress Less, and Control Your Chronic Illness which many of you have read. And two years later, my health changing experience with spending time in green space made me want to start this podcast, to learn more by talking with others about their work in this area.  

I wrote this new book Optimize Your Heart Rate: Balance Your Mind and Body With Green  Space  because Leslie went on  a three day  road trip and never came back. Leslie had a healthy lifestyle  and no diagnosis of heart disease.  I could not understand or accept what could have happened to her in mere days.  Leslie died of a sudden cardiac arrest on  day  3 of her road trip.  What I learned after Leslie’s death was how tightly our hearts are tied to our environment. As pioneer of environmental cardiology, Professor Bhatnagar says that evidence has slowly been building to show that our environment can have a profound impact on heart health.  As Bhatnagar says on my podcast:

When I started in this field in the ’90s, there was a little bit of disbelief that breathing polluted air could increase the risk of heart disease. They thought that not exercising for decades was how you got heart attacks. But the data started to emerge from several studies showing that those people who live in more polluted areas die earlier. This level of air pollution does not have to be very high. These are levels of pollution that we see around us in the United States. (Fortier, 2022, 4:12)

Professor Bhatnagar goes on to say that even short-term exposure to air pollution can injure heart tissue. He says this:  

The data started to show that episodic (short-term) exposure to air pollution can injure heart tissue (cardiovascular tissue). This can alter the blood pressure, change the electrical activity of the heart, induce inflammation, and cause damage to the lining of the blood vessels. (Fortier, 2022, 5:45)

Bhatnagar points to a study out of Boston (Zanobetti & Schwartz, 2006) that shows whenever you see a spike in air pollution, you see a spike in heart attacks within six hours.

So this means that holy smokes, mere hours in air pollution can have an effect  on heart. On it’s electrical  system –  that creates  our heart regular beats, and on  the lining of the blood vessels that we need to be open for our blood to  around our body.

But the good news is that mountains (studies of many studies) of peer-reviewed research show that just looking at green space and being in green space helps to bring our heart rates and our nervous system into balance in just 5 minutes.  

The simple fact that just looking at or being in green space changed heart  rate  –  slowing it down  – bringing it back into  balance had heft for me as a nurse. I knew that  this effect on the  heart was something big and  I was on to something new and important, not just for me but for others as well. 

Why?   And as a nurse, our primary patient goal is always to help the patient’s heart rate get back to normal. We know that when someone has a good heart rate, the body is usually back in balance and the patient is likely out of danger. Heart rate is the nurse’s key measure of patient stability. Heart rate is aptly named a vital sign.

You might think of your heart rate when you are exercising, and maybe trying to get up higher during a workout. Yes you are right. Your heart needs regular work outs to stay healthy. But there are other important reasons to know your heart rate when you are at rest. Your resting heart rate, like what we as nurses measure,  is the number of times your heart beats each minute when you are sitting or lying down, and calm, relaxed, and not ill (Heart Attack and Stroke Symptoms, n.d.). For most people, it is considered normal to have a resting heart rate between 60 and 100 beats per minute (BPM) while awake. While sleeping, a slower heart rate between 40 and 60 BPM is considered normal.

This is why it is  important for you to know your baseline resting heart rate. When your resting heart rate is low that means that your heart is pumping blood efficiently to the rest of your body and that your nervous system is in balance. When your resting heart rate is high, this is your warning sign that your heart is working harder than expected at a state of rest. It could mean that your nervous system is out of balance.

Here’s a study to show that: When researchers examined data on 129,135 postmenopausal women, they found that those with the highest resting heart rates—greater than 76 beats per minute—were 26% more likely to have and/or die from a heart attack compared to those with the lowest resting heart rates—62 beats per minute or less (Harvard Health, 2020).

This means that knowing your resting heart rate matters. So when you are relaxed and doing absolutely  nothing, see if your heart rate is greater than 76  bpm.

Right now You might be wondering how to get your resting rate. It’s literally at your  fingertips. To measure your own resting heart rate, you can:

– Take your heart rate the old-fashioned way. Place two fingers lightly below your thumb on your wrist until you feel a pulse. Count the number of pulsations for 30 seconds, then multiply that number by two.

– Purchase a finger clip called a pulse oximeter, which measures your heart rate and the amount of oxygen in your blood stream (Gotter, 2021). Pulse oximeters are what we nurses use in hospital units to take patients’ vital signs.

– Check your wearable fitness watch, such as a Fitbit or Apple Watch. Most models measure and collect heart rate information for you. You don’t have to do anything but check it.

You might be thinking, right, but how reliable are these new wearables devices?

In 2019, a research team specializing in heart medicine and led by Robert Avram out of San Francisco School of Medicine in California, published a ground-breaking study on wearable devices (such as Fitbits, and Apple and Garmin watches) and smart phone apps. To assess the devices’ reliability, Avram et al. (2019) compared the data from the smart phone apps simultaneously with gold-standard electrocardiograms (ECG or EKG). The data came from a total of over 65k participants, and heart rate measurements over three years (2015-2018). In this  first and largest research study conducted on personal wearable device heart rate data, they say “Our validation demonstrated that smartphone-based [heart rate data] strongly correlates with [heart rate data] from the gold-standard ECG” (Avram et al., 2019, p. 3).

These findings are revolutionary. This gives us as patients, access to information on our heart rates that previously only hospitals had. Not only that – we don’t just have snapshots of our heart rates – we have our own  real-life heart readings with us wherever we go. And to top that off,  we have apps to interpret the heart rate data and give us tips on what to do when our heart rates are different than our  normal.  This means that all of a sudden, for the first time in history, patients have proof of our own powerful and reliable personal information in order to understand our own heart rates. And we can put that information in the context of where we are, what  we are doing and how we are feeling.

Could this mean a complete shift in the worldview of heart health? Has this happened before in history? The answer is yes. Avram et al. (2019) described their Health eHeart study as a Framingham-type study.The landmark Framingham study shifted the patient paradigm to preventing disease. It was the first to discover and name influences in our environment that can make heart disease worse. These risk factors included smoking, drinking too much, inactivity, and poor diet. These are all things that the patient has control over and can do without a doctor’s prescription (“Framingham Heart Study,” 2021). These studies shifted the paradigm care to patients helping themselves stay well and avoid heart problems.

This means that access to your simple resting heart rate, which we all have, can help you to see what you can’t normally see is going on in  your body. And this means that your resting heart rate can tip you off, when you need to do something to help it.

You might think this idea of knowing when your heart and your health is in danger through a simple heart rate measure is a little far fetched…

Just as this book was about to go to press, a new research paper came out from Stanford by Dr Snyder on the value of tracking your resting heart rate as a real-time illness warning system. In November 2021, a research team led by Dr Michael Snyder of the that  published “Real-Time Alerting System for COVID-19 and other Stress Events using Wearable Data” (Alavi et al., 2021).

In over 3,000 study participants, resting heart rate detected 80% of the people infected with COVID-19. Resting heart rate went up on an average of three days before the person felt ill. Resting heart rate even detected COVID-19 when the infected person was feeling okay or just fine. And they found that resting heart rate also went up with other infections, such as flu, poor sleep, stress, excessive alcohol consumption, and travel.

Alavi et al. (2021) go on to say that “[with] continued development, wearable [devices] . . . can be used as a general method to monitor infectious diseases, chronic inflammation-related flares and other health-related signals to improve healthcare at both the personal and population levels” (p. 9).

After the publication of this study in 2021, an article  in the Journal Body Count was published titled “How Michael Snyder’s self-monitoring project could transform human health.” And this new ability of ours to look into our heart rates, combined with the balancing effects of green space I believe is monumental.

So Again How Does This Self Monitoring Fit With Green Space?

Researchers often use the autonomic nervous system to understand the impact of green space on our bodies. Studies since 2003 have shown that viewing nature (in just 5 minutes) significantly improves our resting heart rate (decreases our RHR) and improves our heart rate variability (increases our HRV). In one measurement, HRV tells us how we are doing emotionally (psychologically) and how our whole body is functioning (physically).

As a practicing critical care nurse, I was not familiar with HRV. I learned that, up until quite recently, HRV had remained in the medical research domain. In my next solo podcast I will discuss heart rate variability and green space. But if you would like you can read more about all of this through the story of my friend Leslie, whose life is helping us still. The link to my new book is in the show notes. If you’d like, please join my email list on my website https://treesmendus.com.

My new book is here on Amazon: Optimize Your Heart Rate: Balance  Your  Mind and Body With Green  Space

Podcast episode time stamps:

9:09     Why nurses use resting  heart rates 
10:59   What low and high  resting heart rates  mean for you
13:00   Is heart  rate data from wearables reliable?
14:00   U of C smart phone heart rate apps compared  to gold standard ECG.
15:15  A  patient care revolution 
17:00 Stanford study, Snyder,  resting  heart rate, your  early warning system
18:31  Your resting  heart rate in  green space