European Journal of Applied Physiology

, Volume 115, Issue 10, pp 2107–2114 | Cite as

Sex differences in heart rate variability: a longitudinal study in international elite cross-country skiers

  • Daniela Schäfer
  • Gard Filip Gjerdalen
  • Erik Ekker Solberg
  • Maria Khokhlova
  • Victoria Badtieva
  • David Herzig
  • Lukas Daniel Trachsel
  • Patrik Noack
  • Laura Karavirta
  • Prisca Eser
  • Hugo Saner
  • Matthias WilhelmEmail author
Original Article



Exercise-related sudden cardiac deaths (SCD) occur with a striking male predominance. A higher sympathetic tone in men has been suggested as risk factor for SCD. Elite athletes have the highest risk for exercise-related SCD. We aimed to analyze the autonomic nervous system of elite cross-country skiers from Norway, Russia and Switzerland in supine position and after orthostatic challenge in various training periods (TP).


Measurements of heart rate variability (HRV) were performed on a weekly basis over 1 year using an orthostatic challenge test with controlled breathing. Main outcome parameters were the high-frequency power in supine position (HFsupine) as marker of cardiac parasympathetic activity and the low-frequency/high-frequency power ratio after orthostatic challenge (LF/HFstand) as marker of cardiac sympathetic activation. Training intensity and duration were recorded daily and expressed as training strain. The training year was divided into three TPs. An average of weekly HRV measurements was calculated for each TP.


Female (n = 19, VO2max 62.0 ± 4.6 ml kg−1 min−1, age 25.8 ± 4.3 years) and male (n = 16, VO2max 74.3 ± 6.3 ml kg−1 min−1, age 24.4 ± 4.2 years) athletes were included. Training strain was comparable between sexes (all p > 0.05) and changed between TPs (all p < 0.05) while no HRV parameters changed over time. There were no sex differences in HFsupine while the LF/HFstand was significantly higher in male athletes in all TPs.


For a comparable amount of training, male athletes showed constantly higher markers of sympathetic activity after a provocation maneuver. This may explain part of the male predominance in sports-related SCD.


Autonomic nervous system Heart rate variability Orthostatic test Athletes Endurance Training 



Analysis of variance


Autonomic nervous system


Competition period


High-frequency power


Heart rate variability


Low-frequency power


Low-frequency/high-frequency power ratio


Mean of the R–R intervals


Preparation period 1


Preparation period 2


The square root of the mean squared differences of successive R–R intervals


Rate of perceived exertion


Standard deviation of all R–R intervals


Sudden cardiac death


In supine position


Standing after orthostatic challenge


Training periods



We thank all study participants, their coaches and physicians for their contribution and Polar Electro Oy for providing us equipment and technical support.

Conflict of interest



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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Daniela Schäfer
    • 1
  • Gard Filip Gjerdalen
    • 2
  • Erik Ekker Solberg
    • 3
  • Maria Khokhlova
    • 4
  • Victoria Badtieva
    • 4
  • David Herzig
    • 1
  • Lukas Daniel Trachsel
    • 1
  • Patrik Noack
    • 5
  • Laura Karavirta
    • 6
  • Prisca Eser
    • 1
  • Hugo Saner
    • 1
  • Matthias Wilhelm
    • 1
    Email author
  1. 1.Division of Preventive Cardiology and Sports Medicine, University Clinic for CardiologyInselspital University Hospital and University of BernBernSwitzerland
  2. 2.Section of Vascular InvestigationsOslo University Hospital, Bjorknes CollegeOsloNorway
  3. 3.Diakonhjemmet SykehusOsloNorway
  4. 4.Moscow Department of Public HealthMoscow Research and Practical Center of Medical Rehabilitation, Restorative and Sports MedicineMoscowRussia
  5. 5.Swiss Olympic Medical BaseSt. GallenSwitzerland
  6. 6.Polar Electro OyKempeleFinland

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