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Assessment of heart rate variability for different somatotype category among

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Article in Journal of Basic and Clinical Physiology and Pharmacology · November 2018
DOI: 10.1515/jbcpp-2018-0104

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Senthil Kumar Subramanian, Vivek Kumar Sharma* and Rajathi Rajendran
Assessment of heart rate variability for different
somatotype category among adolescents
https://doi.org/10.1515/jbcpp-2018-0104
Received June 7, 2018; accepted October 1, 2018
Abstract
Background: Somatotype is a quantified expression of
the morphological conformation of a person in terms of
three-numeral rating each representing one component;
fat (endomorphy), muscle mass (mesomorphy) and bone
length (ectomorphy) in the same order. Certain somato-
types are more prone to develop the particular disease.
Obesity and overweight are already epidemic among
Indian adolescents and are increasing at an alarming rate,
and obesity is linked to cardiovascular (CV) risk in this age
group. Identifying the heart rate variability (HRV) is an
established non-invasive test to identify the CV risk. The
objective of this study is to record the HRV data for each
somatotype category and to compare the HRV data among
these somatotype categories in adolescents.
Methods: The volunteer adolescents in the age group of
12–17 years were classified into a different somatotyp-
ing categories based on the Heath Carter somatotyping
method. The short-term HRV was recorded in all the sub-
jects using wireless BioHarness 3.0.
Results: Based on the time domain and frequency domain
parameters, the parasympathetic activity showed decreas-
ing order as follows: central > ectomorphy > mesomor-
phy > endomorphy, whereas sympathetic activity showed
increasing order as follows: central < ectomorphy < meso-
morphy < endomorphy in both boys and girls. Girls have
higher parasympathetic activity and lesser sympathetic
activity than boys in ectomorphy and mesomorphy. In the
central somatotype and endomorphy categories, genders
were comparable.
*Corresponding author: Dr. Vivek Kumar Sharma, Professor and
Head, Government Institute of Medical Sciences, Department of
Physiology, Greater Noida, Uttar Pradesh 201310, India,
Phone: 9442529673, E-mail: drviveksharma@yahoo.com
Senthil Kumar Subramanian: Department of Physiology, AIIMS,
Mangalagiri, Andhra Pradesh, India.
http://orcid.org/0000-0001-7990-611X
Rajathi Rajendran: Department of Physiology, JIPMER, Puducherry,
India
J Basic Clin Physiol Pharmacol 2018; aop
Conclusion: Our study suggests that endomorphy and
mesomorphy have poorer autonomic tone when com-
pared to other somatotype categories.
Keywords: body build; body composition; body types;
cardiovascular autonomic function; ectomorph; endo-
­
morph; HRV; mesomorph.
Introduction
Worldwide obesity is on the rise, and it is associated with
cardiovascular (CV) risk [1–3], which mandates the assess-
ment of body composition. Most commonly used indices
to assess obesity/overweight could not accurately define
the body composition. BMI cannot differentiate fat mass
from muscle mass, which misclassifies the apparently
healthy muscular individual under the obese categories
[4, 5]. Body fat percentage (BF%) and waist-hip ratios
cannot consider the role of muscular mass and bone mass
in energy meta­bolism [6, 7]. This necessitates the need to
have a body composition analysis tool, such as ‘Somato-
type,’ which considers the adiposity (fat mass), linearity
(bone mass) and the muscle mass [8].
A somatotype is a quantified expression of the present
morphological conformation of a person. It consists of a
three-numeral rating, (for example, 3.5-5-1), each repre-
senting one component: endomorphy, mesomorphy and
ectomorphy in the same order [8]. Endomorphy, describes
the relative degree of adiposity of the body, regardless of
where or how it is distributed. It also describes correspond-
ing physical aspects, such as roundness of the body, the
softness of the contours, the relative volume of the abdom-
inal trunk and distal tapering of the limbs. Mesomorphy
describes the relative musculoskeletal development of
the body. It also describes the apparent robustness of the
body in terms of muscle or bone, the relative volume of the
thoracic trunk and the possibly hidden muscle bulk. Ecto-
morphy describes the relative slenderness of the body. It
also describes the apparent linearity of the body or fragil-
ity of the limbs, in the absence of any bulk, be it muscle,
fat or other tissues [8].
The Southeast Asian population has been found
to have higher centripetal obesity [9, 10], increased fat
mass [11] and decreased lean mass [12] as compared to
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2 Subramanian et al.: Somatotype and Heart rate variability
the Western population. Even the cut-off point to define
obesity is different for the Southeast Asian population [13,
14]. Most of the somatotyping studies in India are done on
individuals involved in sports [15–19]. Only a few studies
have been done in the adolescent population [20–23].
Adolescence is a crucial period, in which growth speeds
up, and the body composition begins to differ between
boys and girls [24]. Obesity and CV risk originate from
childhood or adolescent obesity [25]. This emphasizes the
importance of determining the somatotype category in
adolescents [15].
Certain somatotypes are more prone to develop the
particular disease [26, 27]; for example, persons with
dominant mesomorphy (more muscle component) or
dominant endomorphy (more fat component) suffer from
arterial hypertension and liver disease [26]. Obesity and
overweight are already epidemic among Indian adoles-
cents and are increasing at an alarming rate [28], and
obesity is linked to CV risk in them [3]. Identifying heart
rate variability (HRV) is an established non-invasive test
to identify the CV risk [29] and is associated with CV risk
factors in adolescents [30]. To the best of our knowledge,
no HRV data have been collected for each somatotype
category. Hence, in this study, we present the HRV data
for each somatotype category from the baseline data of
a randomized control trial (RCT, CTRI Registration No:
CTRI/2013/08/003897) and compared the HRV data among
these somatotype categories.
Materials and methods
Study design
The study was conducted in the Department of Physiology, JIPMER,
Puducherry, in collaboration with the Jawahar Navodaya Vidyalaya
(JNV), a rural residential school for the low socioeconomic commu-
nity in Puducherry. The study began after getting approval from the
JIPMER Scientific Advisory committee and the JIPMER Ethics Com-
mittee for Human Studies.
Participants
We have recruited apparently healthy adolescent school children in
the age group of 12–17 years of either gender, residing in JNV, Puduch-
erry. We obtained written informed assent from the volunteered chil-
dren and written consent from their local guardian or parents after
explaining the study to them. The volunteer students underwent
a general physical examination and were screened for any physi-
cal or mental ailments. We excluded athletes as physical activity is
known to influence HRV. Previous studies have shown the influence
of gender on HRV [29] and somatotype category [15]. Hence, we strati-
fied our data based on gender (n = 220; 129 boys and 91 girls).
Sample size
The sample size calculation for the RCT was done with another
parameter, which was not included in this publication [31]. The
students who volunteered for the study underwent a general physi-
cal examination and were screened for any physical or mental
ailments. The participants with a history of previous or current neu-
rological disorder, alcohol abuse, epilepsy, mental retardation or any
drug intake were excluded from the study, and 439 students were
recruited. Due to the influence of physical activity on HRV and soma-
totype category [15], we excluded athletes. We are presenting only
four major somatotype categories (central, mesomorphy, endomor-
phy and ectomorphy) out of seven mentioned in Table 3 due to the
lower number of participants under other less prevalent somatotype
categories (endomorph-mesomorph, mesomorph-ectomorph, ecto-
morph-endomorph). Hence, the final sample size was n = 220 with
129 boys and 91 girls.
Procedure
Somatotyping: The somatotype category is the more qualitative
description of the individual somatotype, in terms of the dominant
component or components among the three components (ectomor-
phy, endomorphy and mesomorphy). For example, a subject with
a high rating on mesomorphy and an equally low rating on endo-
morphy and ectomorphy will be called a mesomorph or a balanced
mesomorph [32]. The complete list of possible categories and corre-
sponding dominance variations is given in Table 3.
To obtain these numerical ratings we took 10 anthropometric
measurements, which included height, weight, four skinfold thick-
ness (triceps, subscapular, supraspinale and medial calf), two bie-
picondylar breadths (humerus and femur) and two girths (upper
arm flexed and tensed and calf). The measurements were made by
personnel certified by the International Society for the Advancement
of Kinanthropometry (ISAK). The anthropometric measurements and
somatotyping were done based on the Heath-Carter anthropometric
somatotype instruction manual [8]. Height was measured using a
wall-mounted Stadiometer that was accurate to the nearest 0.1 cm
(VM Electronics Hardware, Ltd., Chicago, IL, USA). Weight was meas-
ured using a digital weighing scale (Charder Electronic Co., Ltd.,
Taichung, Taiwan). Skinfold thickness was measured using clini-
cal plicometer Innovare (CESCROF Sports Equipment Limited, Porto
Alegre-Rio Grande do Sul, Brazil). Flexed, tensed arm and calf girth
were measured using non-stretchable anthropometric tape (CESCROF
Sports Equipment Limited, Porto Alegre-Rio Grande do Sul, Brazil).
Breadths were measured using small bone calipers (CESCROF Sports
Equipment Limited, Porto Alegre-Rio Grande do Sul, Brazil).
The formulae given in Table 2 were used to obtain the three com-
ponents (endomorphy, mesomorphy and ectomorphy) of the somato-
type for each child. Then based on the three numerical values, they
were categorized into various somatotype categories using the guide-
line given in Table 2. For example, a child with somatotype 4-5-4.5 is
considered to be under the central somatotype category as no compo-
nent differs from each other by one unit (Table 3) [8].
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Heart rate variability: The short-term HRV was recorded according

22.82 ± 4.82
29.00 ± 5.35
6.22 ± 0.76
8.78 ± 1.00
44.89 ± 11.58

8.43 ± 2.35
8.78 ± 3.32
5.74 ± 2.29
7.92 ± 3.64
Male

Mesomorph (36)
Mean ± SD

14.56 ± 2.08
1.50 ± 0.16
to the guidelines formulated by the European Society of Cardiology
and the North American Society of Pacing and Electrophysiology
1996 [33]. We instructed the participants to abstain from caffeine,
alcoholic beverages, smoking and exercise 24 h before the recording.
The participants with any minor ailments like fever, cold, corrizha
or sleep disturbances due to their academic works were requested
to report on another day after getting a good night’s sleep and hav-

8.99 ± 0.68

22.38 ± 3.87
28.66 ± 3.71
16.29 ± 3.39

6.24 ± 0.56
50.76 ± 10.16

16.82 ± 4.07
17.47 ± 3.62
13.35 ± 4.96
Endomorph (17)
Mean ± SD

14.29 ± 1.45
1.57 ± 0.10
ing apparent good health for the recording. The tests were explained
to the participants. The tests were done with participants in loose
clothing and after voiding urine.
Data acquisition was done using BioHarness 3.0 (Zephyr
Technology Corporation, Annapolis, MD, USA). The chest strap was
placed at the lower part of the chest, as indicated in the BioHarness
3.0 user manual, after which the electronic module was fitted. The

21.04 ± 3.58
27.87 ± 4.17
6.12 ± 0.64
8.78 ± 0.55
6.08 ± 2.57
7.63 ± 2.70
46.28 ± 7.99

8.38 ± 2.59
8.71 ± 2.68
Ectomorph (68)
Mean ± SD

14.71 ± 1.71
1.59 ± 0.11
device stores and transmits vital sign data, including ECG, heart
rate, RR interval, respiration rate, body orientation and activity.
The physiological data were sent by Bluetooth radio protocol and
monitored in a laptop using the Bluetooth Test Application software
(Zephyr Technology Corporation, Annapolis, MD, USA). A 5-min ECG
was recorded after 10 min of rest in supine position. The BioHar-
ness Log Downloader software (Zephyr Technology Corporation,

22.28 ± 3.24
29.56 ± 3.81
9.25 ± 1.16

6.13 ± 0.64
9.04 ± 0.75
47.88 ± 8.84

11.13 ± 3.14
12.38 ± 1.69
9.50 ± 3.02
Central (8)
Mean ± SD

15.25 ± 1.75
1.57 ± 0.11
Annapolis, MD, USA) was used to download the RR interval data
after manually removing artefacts and ectopics.
The offline HRV analysis of the RR tachogram was done for
frequency domain (by power spectral analysis using fast Fourier
transformation) and time domain measures using the Kubios soft-
ware version 1.1 (Bio-signal Analysis Group, Kuopio, Finland). The

22.00 ± 2.16
28.50 ± 1.91
6.00 ± 0.00
7.33 ± 0.46
11.00 ± 6.73
18.33 ± 2.08
41.25 ± 5.56

11.25 ± 3.50
11.75 ± 3.86
Female

Mesomorph (4)
Mean ± SD

13.25 ± 0.96
1.43 ± 0.07
time domain parameters, such as standard deviation of RR interval
(SDNN), the square root of the mean of the sum of the squares of the
differences between adjacent NN intervals (RMSSD), the mean HR,
the number of pairs of adjacent NN intervals differing by more than
50 ms in the entire recording (NN50) and the percentage of NN50
counts, which is given by NN50 count divided by total number of

23.36 ± 2.41
30.72 ± 3.80
5.68 ± 0.47
7.69 ± 0.80
49.16 ± 6.42

18.20 ± 3.60
16.68 ± 4.06
12.46 ± 4.21
16.96 ± 5.00
Endomorph (50)
Mean ± SD

15.14 ± 1.67
1.53 ± 0.07

all NN intervals (pNN50) representing the cardiovagal modulation.

The frequency domain parameters show low frequency (LF; 0.04–
Table 1: Anthropometric measurements stratified by gender and somatotype.

0.15 Hz, (ms2) and LF in normalized units (LFnu) reflects the sym-
pathetic tone. The high frequency (HF; 0.15–0.4 Hz, (ms2) and HF in
normalized units (HFnu) reflect the parasympathetic tone. The LF/
HF ratio represents the sympathovagal balance.
20.05 ± 1.80
26.48 ± 2.26
14.54 ± 5.98

5.61 ± 0.50
7.35 ± 0.62
38.61 ± 4.91

10.36 ± 2.26
9.82 ± 3.06
7.21 ± 2.51
Ectomorph (28)
Mean ± SD

13.54 ± 1.62
1.50 ± 0.08

Statistical analysis

The data were analyzed using the Statistical Package for Social Sci-
ences Version 19 (SPSS Software Inc., Chicago, IL, USA). The nor-
mality of the data was tested by the Kolmogorov-Smirnov test. The
data were non-normally distributed, hence, we have expressed the
20.67 ± 1.41
26.56 ± 3.13
5.67 ± 0.50
7.26 ± 0.80
7.22 ± 2.64
14.89 ± 5.69
11.33 ± 1.41
11.22 ± 3.60
Central (9)
Mean ± SD

13.33 ± 1.22
1.44 ± 0.06
39.11 ± 3.10

data in median (IQR). The Kruskal-Wallis test was performed to com-

pare the parameters among the groups. The post-hoc test was done
using Mann-Whitney U-test to compare the parameters between the
groups. The p-value significance was set at p < 0.05.
Supraspinale, mm
Subscapular, mm
Skinfold thickness

Medial calf, mm

Results
Humerus, cm

Circumference
Triceps, mm
Somatotype

Femur, cm
Weight, kg
Parameter

Age, years

Arm, cm
Calf, cm
Height, m
Gender

Table 1 shows the anthropometric parameters for both

Width

genders, which are used to calculate somatotype. Table 2

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4 Subramanian et al.: Somatotype and Heart rate variability

Table 2: Formulae used for calculating the somatotype components. and girls were classified into one of the seven somatotype
categories [8].
Endomorphy −0.7182 + 0.1451 X − 0.00068 X2 + 0.0000014X3
Mesomorphy 0.858 HB + 0.601 FB + 0.188AG + 0.161CG − 0.131
SH + 4.5
Ectomorphy 0.732 HWR − 28.58; If HWR ≥ 40.75 Comparison of heart rate variability among
0.463 HWR − 17.63; If HWR < 40.75 but > 38.25 four somatotype categories in girls
0.1; If HWR ≤ 38.25

X, (sum of triceps, subscapular and supraspinale skinfolds

multiplied by (170.18/height in cm); HB, humerus breath (cm); FB,
femur Breadth (cm); AG, corrected arm girth (cm) (arm girth –triceps
skinfold (mm)/10); CG, corrected calf girth (cm) (calf girth – medial
calf skinfold (mm)/10); SH, standing height (cm); HWR, height in cm
over cuberoot of weight.
Table 4 shows a comparison of HRV parameters among
the four somatotype categories in girls. Table 5 shows the
post-hoc analysis between four somatotype categories in
girls.

Time domain parameters

shows the formulae used for calculating the numerical
ratings in somatotype. Table 3 shows the description of Upon comparison, the somatotype categories are signifi-
each somatotype category based on the three numerical cantly different in most of the time domain parameters.
ratings obtained by using the formulae in Table 1. Boys The central somatotype had significantly higher SDNN

Table 3: The somatotype categories and their descriptions.

Central No component differs by more than one unit from the other two
Endomorph Endomorphy is dominant; mesomorphy and ectomorphy are more than one-half unit lower
Endomorph-mesomorph Endomorphy and mesomorphy are equal (or do not differ by more than one-half unit and ectomorphy is smaller
Mesomorph Mesomorphy is dominant; endomorphy and ectomorphy are more than one-half unit lower
Mesomorph-ectomorph Ectomorphy and mesomorphy are equal (or do not differ by more than one-half unit) and endomorphy is smaller
Ectomorph Ectomorphy is dominant; mesomorphy and endomorphy are more than one-half unit lower
Ectomorph-endomorph Ectomorphy and endomorphy are equal (or do not differ by more than one-half unit and mesomorphy is smaller

Table 4: Comparison of the heart rate variability parameters among female subjects stratified based on the somatotype category.

Parameters Central (9) Ectomorphy (28) Endomorphy (50) Mesomorphy (4) p-Value
Median (IQR) Median (IQR) Median (IQR) Median (IQR)

Time domain parameters

SDNN, ms 174.10 (37.15) 96.60 (59.95) 56.60 (19.10) 78.05 (28.03) <0.001
Mean HR 106.15 (14.32) 95.18 (24.57) 87.21 (13.13) 88.12 (19.55) 0.005
RMSSD, ms 189.10 (40.40) 116.10 (86.90) 62.60 (35.35) 88.10 (30.28) <0.001
NN50 (Count) 174.00 (121.50) 180.00 (113.50) 113.00 (101.50) 151.50 (47.00) 0.005
pNN50, % 46.44 (25.67) 41.43 (32.30) 27.71 (25.23) 34.75 (18.35) 0.044
Frequency domain parameters
VLF (0–0.4 hz), ms2 4084.00 (2873.00) 1785.00 (1605.75) 876.00 (593.00) 1096.00 (318.50) <0.001
LF (0.04–0.15 hz), ms2 4829.00 (1590.50) 2381.50 (1727.56) 875.13 (443.50) 2017.00 (948.25) <0.001
HF (0.15–0.4 hz), ms2 7400.00 (1773.50) 4233.38 (3631.56) 1139.00 (540.25) 2361.50 (1319.75) <0.001
Total power, ms2 14968.00 (4211.00) 8061.00 (4584.00) 2992.50 (729.25) 5351.00 (311.50) <0.001
LF/HF ratio 0.64 (0.33) 0.61 (0.46) 0.83 (0.42) 0.85 (1.54) 0.078
LFnu 0.39 (0.11) 0.38 (0.18) 0.45 (0.13) 0.46 (0.27) 0.078
HFnu 0.61 (0.11) 0.62 (0.18) 0.55 (0.13) 0.54 (0.27) 0.078

SDNN, standard deviation of all NN intervals; RMSSD, square root of mean of the sum of the squares of differences between adjacent NN
intervals; NN50 count, number of pairs of adjacent NN intervals differing by more than 50 ms in entire recording; pNN50, percentage of NN50
counts, which is given by NN50 count divided by total number of all NN intervals; Total power, the variance of NN intervals over the temporal
segment; LF, power in low frequency range (0.04–0.15 Hz); HF, power in high frequency range (0.15–0.4 Hz); LFnu, LF power in normalized
units (LF/(TP-VLF)*100); HFnu, HF power in normalized units (HF/(TP-VLF)*100); LF/HF ratio, ratio LF (ms2)/ HF (ms2). Comparison between the
group was done using the Kruskal-Wallis test.

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 Subramanian et al.: Somatotype and Heart rate variability 5

Table 5: Post-hoc analysis using the Mann-Whitney U-test for heart rate variability parameters among female subjects stratified based on
the somatotype category.

Parameters Central vs. Central vs. Central vs. Ectomorphy vs. Ectomorphy vs. Endomorphy vs.
ectomorphy endomorphy mesomorphy endomorphy mesomorphy mesomorphy

Time domain parameters

SDNN, ms <0.001 <0.001 0.005 <0.001 0.154 0.041
Mean HR 0.229 0.001 0.045 0.029 0.210 0.741
RMSSD, ms 0.006 <0.001 0.005 <0.001 0.111 0.089
NN50 (Count) 0.595 0.126 0.355 0.001 0.254 0.418
pNN50, % 0.457 0.041 0.217 0.023 0.531 0.409
Frequency domain parameters
VLF (0-0.4 hz), ms2 0.001 <0.001 0.031 <0.001 0.171 0.198
LF (0.04–0.15 hz), ms2 <0.001 <0.001 0.005 <0.001 0.494 0.002
HF (0.15–0.4 hz), ms2 0.005 <0.001 0.005 <0.001 0.023 0.017
Total power, ms2 <0.001 <0.001 0.005 <0.001 0.001 0.001
LF/HF ratio 0.416 0.302 0.165 0.020 0.138 0.574
LFnu 0.416 0.302 0.165 0.020 0.138 0.574
HFnu 0.416 0.302 0.165 0.020 0.138 0.574

SDNN, standard deviation of all NN intervals; RMSSD, square root of mean of the sum of the squares of differences between adjacent NN
intervals; NN50 count, number of pairs of adjacent NN intervals differing by more than 50 ms in entire recording; pNN50, percentage of NN50
counts, which is given by NN50 count divided by total number of all NN intervals; Total power, the variance of NN intervals over the temporal
segment; LF, power in low frequency range (0.04–0.15 Hz); HF, power in high frequency range (0.15–0.4 Hz); LFnu, LF power in normalized
units (LF/(TP-VLF)*100); HFnu, HF power in normalized units (HF/(TP-VLF)*100); LF/HF ratio, ratio LF (ms2)/HF (ms2). Comparison between the
group was done using the Mann-Whitney U-test.

and RMSSD than ectomorphy, mesomorphy and endo-
morphy. In addition, pNN50 was higher in the central as
compared to the endomorphy. Ectomorphy had signifi-
cantly higher SDNN, RMSSD, NN50 and pNN50 than the
endomorphy category. The ectomorphy and mesomorphy
somatotype categories are comparable in terms of time
domain variables. Mesomorphy has significantly higher
SDNN than endomorphy while other parameters are
comparable.
Frequency domain parameters
variables than mesomorphy. Mesomorphy has signifi-
cantly higher LF, HF and TP values than endomorphy.
Comparison of heart rate variability among
four somatotype categories in boys
Table 6 shows a comparison of HRV parameters among
four somatotype categories in boys. Table 7 shows the
post-hoc analysis between four somatotype categories in
boys.

Upon comparing using the Kruskal-Wallis test, find that
the somatotype categories are significantly different in
most of the frequency domain parameters, except for the
LF/HF ratio, LFnu and HFnu. This shows that the somato-
type categories are comparable based on the sympatho-
vagal balance, relative sympathetic and parasympathetic
activity. They differ mainly in their absolute values of fre-
quency domain parameters.
On post-hoc analysis, central somatotype has higher
VLF, LF and HF values and total power than other soma-
totype categories. Ectomorphy category has significantly
higher VLF, LF, HF, TP and HF (nu) than endomorphy and
significantly lower LF (nu) and LF/HF ratio than endo-
morphy. Ectomorphy has significantly higher HF and TP
Time domain parameters
A comparison of the time domain parameters among boys
across the somatotype category has shown statistically
significant difference in SDNN, RMSSD, NN50 and pNN50.
The entral somatotype category had significantly higher
SDNN and RMSSD compared to ectomorphy, endomorphy
and mesomorphy. In addition, pNN50 is higher in central
as compared to endomorphy and mesomorphy. The ecto-
morphy somatotype has significantly higher SDNN and
RMSSD than endomorphy and mesomorphy. In addition,
NN50 and pNN50 are higher in ectomorphy than in meso-
morphy. Endomorphy and mesomorphy are comparable
based on time domain parameters.

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6 Subramanian et al.: Somatotype and Heart rate variability

Table 6: Comparison of the heart rate variability parameters among male subjects stratified based on the somatotype category.

Parameters Central (8) Ectomorphy (68) Endomorphy (17) Mesomorphy (36) p-Value
Median (IQR) Median (IQR) Median (IQR) Median (IQR)

Time domain parameters

SDNN, ms 170.25 (30.08) 85.05 (39.53) 53.70 (13.75) 60.50 (20.88) <0.001
Mean HR 96.02(16.28) 81.57 (24.75) 78.21 (9.98) 80.72 (12.70) 0.309
RMSSD, ms 193.55 (72.25) 89.40 (65.70) 51.50 (10.55) 50.00 (28.28) <0.001
NN50 (Count) 143.00 (173.50) 149.00 (88.25) 132.00 (71.00) 100.50 (95.68) 0.015
pNN50, % 49.19 (58.84) 39.02 (28.20) 29.80 (16.28) 26.15 (28.76) 0.001
Frequency domain parameters
VLF (0–0.4 hz), ms2 3952.50 (2783.25) 1311.63 (1244.50) 667.00 (344.50) 764.50 (594.81) <0.001
LF (0.04–0.15 hz), ms2 5878.00 (1924.25) 1529.30 (1080.00) 759.00 (508.50) 965.00 (561.44) <0.001
HF (0.15–0.4 hz), ms2 6143.50 (968.75) 2085.63 (1778.94) 772.00 (750.00) 1170.88 (896.13) <0.001
Total power, ms2 15846.00 (2917.50) 4982.56 (2608.75) 2225.00 (190.50) 2987.50 (440.81) <0.001
LF/HF ratio 0.91 (0.50) 0.67 (0.65) 1.16 (1.65) 0.90 (1.02) 0.365
LFnu 0.48 (0.13) 0.40 (0.21) 0.54 (0.39) 0.47 (0.28) 0.365
HFnu 0.52 (0.13) 0.60 (0.21) 0.46 (0.39) 0.53 (0.28) 0.365

SDNN, standard deviation of all NN intervals; RMSSD, square root of mean of the sum of the squares of differences between adjacent NN
intervals; NN50 count, number of pairs of adjacent NN intervals differing by more than 50 ms in entire recording; pNN50, percentage of NN50
counts, which is given by NN50 count divided by total number of all NN intervals; Total power, the variance of NN intervals over the temporal
segment; LF, Power in low frequency range (0.04–0.15 Hz); HF, Power in high frequency range (0.15–0.4 Hz); LFnu, LF power in normalized
units (LF/(TP-VLF)*100); HFnu, HF power in normalized units (HF/(TP-VLF)*100); LF/HF ratio, ratio LF (ms2)/HF (ms2). Comparison between the
group was done using the Kruskal-Wallis test.

Table 7: Post-hoc analysis using the Mann-Whitney U-test for the heart rate variability parameters among male subjects stratified based on
the somatotype category.

Parameters Central vs. Central vs. Central vs. Ectomorphy vs. Ectomorphy vs. Endomorphy vs.
ectomorphy endomorphy mesomorphy endomorphy mesomorphy mesomorphy

Time domain parameters

SDNN, ms <0.001 <0.001 <0.001 <0.001 <0.001 0.717
Mean HR 0.128 0.036 0.073 0.882 0.772 0.402
RMSSD, ms <0.001 <0.001 <0.001 <0.001 <0.001 0.760
NN50 (Count) 0.852 0.351 0.110 0.331 0.002 0.093
pNN50, % 0.128 0.014 0.004 0.085 0.001 0.223
Frequency domain parameters
VLF (0–0.4 hz), ms2 <0.001 <0.001 <0.001 <0.001 <0.001 0.219
LF (0.04–0.15 hz), ms2 <0.001 <0.001 <0.001 <0.001 <0.001 0.054
HF (0.15–0.4 hz), ms2 <0.001 <0.001 <0.001 <0.001 <0.001 0.041
Total power, ms2 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001
LF/HF ratio 0.257 0.521 0.879 0.160 0.296 0.457
LFnu 0.257 0.521 0.879 0.160 0.296 0.457
HFnu 0.257 0.521 0.879 0.160 0.296 0.457

SDNN, standard deviation of all NN intervals; RMSSD, square root of mean of the sum of the squares of differences between adjacent NN
intervals; NN50 count, number of pairs of adjacent NN intervals differing by more than 50 ms in entire recording; pNN50, percentage of NN50
counts, which is given by NN50 count divided by total number of all NN intervals; Total power, the variance of NN intervals over the temporal
segment; LF, power in low frequency range (0.04–0.15 Hz); HF, power in high frequency range (0.15–0.4 Hz); LFnu, LF power in normalized
units (LF/(TP-VLF)*100); HFnu, HF power in normalized units (HF/(TP-VLF)*100); LF/HF ratio, ratio LF (ms2)/ HF (ms2). Comparison between the
group was done using the Mann-Whitney U-test.

Frequency domain parameters
A comparison of frequency domain parameters among
boys across the somatotype category shows statistically
significant difference in VLF, LF, HF and total power. VLF,
LF, HF and total power are significantly higher in central
somatotype as compared to the ectomorphy, endomorphy
and mesomorphy. Ectomorphy has significantly higher
VLF, LF, HF and total power as compared to endomor-
phy and mesomorphy. The mesomorphy somatotype

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 Subramanian et al.: Somatotype and Heart rate variability 7

category has significantly higher HF and TP as compared Discussion

to endomorphy.
Comparison of heart rate variability
between boys and girls of the same
somatotype
Table 8 shows a comparison between boys and girls for
each somatotype category. The data for comparison is
given in Tables 4 and 6.
Time domain parameters
In central somatotype and endomorphy category genders
are comparable. Ectomorphy girls have higher SDNN and
NN50 than ectomorphy boys. SDNN and RMSSD are sig-
nificantly higher in mesomorphy girls compared to meso-
morphy boys.
Frequency domain parameters
Ectomorphy girls have higher LF, HF and TP values com-
pared to ectomorphy boys. VLF, HF and TP are signifi-
cantly higher in endomorphy girls than in endomorphy
boys. Mesomorphy girls have higher LF, HF and TP than
mesomorphy boys.
Based on the time domain and frequency domain param-
eters, parasympathetic activity was highest in the central
category followed by ectomorphy and mesomorphy and
endomorphy with the lowest. Meanwhile, sympathetic
activity is lowest in the central category followed by
ectomorphy and mesomorphy and endomorphy with the
highest values in both boys and girls. Girls have higher
parasympathetic activity and lesser sympathetic activity
than boys in ectomorphy and mesomorphy. In the central
somatotype and endomorphy categories, the genders are
comparable.
Endomorphy represents relative adiposity and the
ANS derangement observed could be due to the pro-
duction of adipocytokines from the fat depots [34]. The
finding is in line with the previous studies, which have
shown increased sympathetic activity [35] and decreased
parasympathetic activity [36] in the obese individual as
defined by BMI or BF%.
Skeletal muscle is a metabolically active tissue, and
skeletal muscle metabolic dysfunction has been attrib-
uted to obesity and metabolic syndrome [37]. Previous
studies have shown that subjects with decreased BF% [38]
or normal BMI [39] or higher FFM [40] had higher para-
sympathetic activity and decreased sympathetic activ-
ity. Similarly, we observed that mesomorphy autonomic
profile is better in terms of higher parasympathetic activ-
ity and decreased sympathetic activity than endomorphy.

Table 8: Comparison of the heart rate variability between the male and female subjects with same somatotype category.

Parameters Central Ectomorphy Endomorphy Mesomorphy

Time domain parameters

SDNN, ms 0.699 0.018 0.379 0.006
Mean HR 0.092 <0.001 0.003 0.443
RMSSD, ms 0.773 0.010 0.067 0.010
NN50 (count) 0.335 0.004 0.818 0.064
pNN50, % 0.630 0.790 0.729 0.191
Frequency domain parameters
VLF (0–0.4 hz), ms2 0.809 0.132 0.032 0.176
LF (0.04–0.15 hz), ms2 0.123 0.002 0.067 0.002
HF (0.15–0.4 hz), ms2 0.083 <0.001 0.009 0.030
Total power, ms2 0.773 <0.001 <0.001 0.001
LF/HF ratio 0.123 0.184 0.210 0.652
LFnu 0.123 0.184 0.210 0.652
HFnu 0.123 0.184 0.210 0.652

SDNN, standard deviation of all NN intervals; RMSSD, square root of mean of the sum of the squares of differences between adjacent NN
intervals; NN50 count, number of pairs of adjacent NN intervals differing by more than 50 ms in entire recording; pNN50, percentage of
NN50 counts, which is given by NN50 count divided by total number of all NN intervals; Total power, the variance of NN intervals over the
temporal segment; LF, power in low frequency range (0.04–0.15 Hz); HF, power in high frequency range (0.15–0.4 Hz); LF norm, LF power
in normalized units (LF/(TP-VLF)*100); HF norm, HF power in normalized units (HF/(TP-VLF)*100); LF/HF ratio, ratio LF (ms2)/HF (ms2).
Comparison between the group was done using the Kruskal-Wallis test.

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8 Subramanian et al.: Somatotype and Heart rate variability

However, the autonomic profiles of ectomorphy and function test battery and body composition measure-
central somatotype are better than mesomorphy. ments to screen the future CV risk occurrence in the ado-
A higher sympathetic activity is known to reduce bone lescent population.
mass [41]. We hypothesize that higher bone mass in ecto-
morphic individuals might be due to lesser sympathetic
Strengths and limitations
activity or vice versa due to less BF% [38] or due to the
rheostatic role of bone tissue in the energy metabolism [6].
To the best of our knowledge, our study is the first to assess
The FFM is recognized as an independent factor for the
the HRV for the major somatotype categories. However,
development of metabolic syndrome [42] or development
we have not done the entire battery of autonomic func-
of the brain regions involved in the autonomic regulation
tion tests, and we have not studied the entire somatotype
[43]. However, whether such effects are due to the bone
categories due to the lack of sample size in each category.
mass component or muscle mass component of fat-free
A smaller sample size in mesomorphy in girls would com-
mass requires further exploration.
promise the interpretation. However, we observed that
Out of all the somatotypes, we observed higher HRV
there are fewer girls with muscular phenotype in that age
(total power) with vagal dominance and reduced sym-
group and in the general population and this is reflected
pathetic tone in central somatotype irrespective of their
in our study population too.
gender. However, how a balanced body composition with
fat mass, muscle mass and linearity (bone density) leads
to a positive autonomic profile is yet to be studied.
Future recommendations
Girls have higher parasympathetic activity and
decreased sympathetic activity than boys in ectomorphy
Additional studies are required to study the HRV in all the
and mesomorphy, which could be attributed to the posi-
somatotype categories for various populations in order to
tive effect of estrogen and the negative effect of testoster-
achieve the early identification of CV risks.
one on ANS in girls and boys, respectively [44, 45], which is
in accordance with our previous study where we reported
Acknowledgments: We thank all the teachers from the
vagal dominance in girls compared with boys during rest
JNV School, Kalapet, Puducherry for their support during
[29]. Girls and boys are comparable in the endomorphy
the study period.
and central somatotype categories. Studies have shown
Author contributions: All the authors have accepted
that increased fat deposits in women reduce the protective
responsibility for the entire content of this submitted
effect of estrogen and their CV risk resembles that of men
manuscript and approved its submission.
[46]. This might be the cause of comparable HRV param-
Research funding: None declared.
eters in endomorphy. However, we are not able to explain
Employment or leadership: None declared.
the same in central somatotype.
Honorarium: None declared.
Previous studies have assessed the relationship
Competing interests: The funding organization(s) played
between somatotype categories and disease prevalence
no role in the study design; in the collection, analysis and
[27, 47]. Endomorphy and mesomorphy somatotypes have
interpretation of data; in the writing of the report; nor in
been reported to show a higher risk for arterial hyperten-
the decision to submit the report for publication.
sion [26] and CV risk [48] than ectomorphy. Sympathetic
overactivity and decreased parasympathetic activity are
associated with the development of hypertension [49] and
CV risk [50]. In our study, we observed that both endomor- References
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