Cardiovascular reactions to exam situations

Different investigations have shown the stressfulness of exam periods and exam situations, manifested in increase of anxiety, depressiveness and negative emotional states as the exam approaches (Ellis & Fox, 2004; Gruzelier, Smith, Nagy, & Henderson, 2001; Laidlaw, Naito, Dwivedi, Enzor, & Brincat, 2003; Oaten & Chang, 2005; Ogden & Mtandabari, 1997; Vivian, Koh, & Chia, 2003). Apart from these reactions, it has been shown that immunological and some other physiological functions become impaired during exam periods (Al-Kubati, Fišer, & Siegelova, 1997; Glaser, Pearl, Kiecolt-Glaser, & Malarkey, 1997; Lewis, Nikolova, Chang, & Weekes, 2008; Marsall, Agarwal, Cohen, Henninger, & Morris, 1998). The effects of this impairment were high incidences of respiratory infections (Deinzer & Schuller, 1998) and abdominal pains (Harris & Martin, 1994). Students who reported higher stress before the exam also had higher cortisol level and lower examination scores (Vivian et al., 2003). Some investigations included continuous follow up of changes in psychophysiological variables which are known indicators of stress level (Huwe, Henning, & Netter, 1998). The results showed an increase in bad mood, lack of energy, bodily discomfort, somatic strain and restlessness during the pre-exam period, with the peak immediately before the exam. The cortisol level and heart rate, which were monitored immediately before and after exams, showed a significant increase after the exam in comparison with the pre exam levels (Huwe et al., 1998). There is a paucity of studies, however, with recordings of physiological reactions during the exam itself. Two such studies with heart rate monitoring showed that oral exams were more stressful than written exams (Spangler, 1997), and first year medical students having higher heart rates during oral exams than their colleagues in the second year (Carreras & Fernandez-Castro, 1998). These differences in heart rates between the two groups were interpreted as a better adaptation to the exam stress of the second year students. In this study, authors did not control the exam difficulty. Some studies have related changes in heart rate to emotional reactions or emotional component of stress (Lipman, Grossman, Bridges, Hamner, & Taylor, 2002; Šimić, 2006). Heart rate itself, however, does not clearly reflect changes in mental load, which is one of the major components of stress during exams. Although heart rate is a good indicator of overall stress, which includes reactions to the task difficulty (physical and mental components), as well as emotional reactions, for finer analyses so called sinus arrhythmia changes seem more suitable. Sinus arrhythmia changes are easy to monitor via changes in cardiac R-R intervals, i.e. the time Cardiovascular reactions to exam situations