Reaction of Cardiac Activity of Senior Pupils of Schools Providing Differentiated Education upon Examination Stress

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1 Unman Physiology. Vol. 29. No J. pp. / Translated from Fiziohgiya Cliclovcka. Vol. 29. No x pp Original Russian Text Copyright 2003 by Dayan, Ogannisyan. Cwvorkyan, Baklavadzhyan. Minasyan. Mkrtchyan. Reaction of Cardiac Activity of Senior Pupils of Schools Providing Differentiated Education upon Examination Stress A. V. Dayan, A. O. Ogannisyan, E. S. Gevorkyan, O. G. Baklavadzhyan 7, S. M. Minasyan, and R. M. Mkrtchyan Department of Human and Animal Physiology. Biological Faculty, Yerevan State University, ul. Aleka Manukyana 1, Yerevan, Armenia Received September Abstract Effects of examination stress on psychological characteristics and indices of the autonomic nervous system were studied in pupils of the eighth and tenth grades of high schools providing differential (test group, "Neuron" gymnasium) and general education (control group). General health state and levels of activity and mood (feeling, activity, mood; FAM) and neuroticism (according.to Eysenck) were determined in both groups. Main hemodynamic indices (heart rate and blood pressure) were measured, and mathematical analysis of the heart rate by was performed according to Baevskii. Comparative analysis of psychophysiological tests and heart rate changes in the control and test groups points to a high tension in the cardiac rhythm regulation mechanisms and strong anxiety in schoolchildren in the differential education school. The character and depth of preexamination stress depended on the type of autonomic control of cardiac activity. Schoolchildren with sympathicotonic cardiac rhythm regulation showed the strongest emotional tension. Schoolchildren with the normotonic type of regulation were the most calm. Revolution in science and technology has not only affected the character of adult labor but also led to intensification of the education process of children and adolescents. Although the plasticity of the functional systems of the body of an adolescent ensures his or her fast adaptation to a multitude of environmental factors, immaturity of physiological functions and regulatory mechanisms and rapid pubertal neuroendocrine changes frequently result in inadequate reactions to extreme situations. This problem is especially important in schools, lycees, and gymnasia with differential (intensified) education in the fields of physics and mathematics, chemistry and biology, or the humanities [1-3]. Examinations performed in the eighth to tenth grades of such schools during the education process revealed substantial tension of the physiological systems of students. The ever-increasing deficit of time required for perception, processing, and acquisition of an extremely large amount of information has an especially adverse effect on their health [2, 3]. The combined action of these factors frequently results in physiological disorders, maladaptation, and disease [4-6]. In this context, investigation of functional changes in schoolchildren undergoing differential education during examinations is urgent, because this period is associated with substantial psychoemotional tension and mental load [7, 8]. In this connection, in this work we examined the cardiac reactions of pupils of the eighth and ninth grades of schools with differential education ' Deceased. to examination stress. The cardiovascular system received primary attention, because it is a fine effector organ closely associated with regulatory mechanisms of cerebral cortex and subcortical structures and, at the same time, an efficient indicator of the potential level of adaptation of autonomic functions to psychoemotional stress. METHODS With the aim of studying the influence of examination stress on psychophysiological characteristics of schoolchildren, we undertook a complex examination of 42 pupils of the eighth and ninth grades of the "Neuron" gymnasium (13- to 16-year-old boys and girls) with differential (intensified) study of physics and mathematics or chemistry and biology (test group). The control group was formed from 66 pupils of a Yerevan school providing general education. Pupils of the control group were gender- and age-matched with the test group and had no deviations in the state of their health. Main indices of hemodynamics heart rate (HR) and blood pressure (BP) were measured in both groups. The functional state of the cardiac system was estimated by an ECG recorded by means of an EK 2T-02 dual-channel electrocardiograph in a standard right hand-left foot lead with the subject in a recumbent position. The ECG was analyzed by Baevskii's method of variance pulsometry [9]. For each subject, 100 cardiac cycles (RR intervals) were recorded. Values of RR intervals were fed into a computer and processed with /03/ $ MAIK "Nauka/Interperiodica"

2 REACTION OF CARDIAC ACTIVITY OF SENIOR PUPILS 161 the software program Cardio, developed at the Laboratory of Mathematical Simulation of the Nervous System, Orbeli Institute of Physiology, National Academy of Sciences of Armenia. Data processing and statistical analysis (Student's Mest) were performed using an IBM-486 computer. Mathematical analysis included the calculation of mode (Mo) and its amplitude (AMo), variance range (AX), and index of tension (IT), accepted as an indicator of the stress state: IT = АМо/2ДХМо. Additionally determined were Spielberger's level of state anxiety, the level of neuroticism according to Eysenck [10] and the general state of health (selfassessed feeling), activity, and mood measured by the FAM test (SAN [11]). Physiological and psychological indices were recorded in three situations: on an ordinary day of an academic year (a physiologically normal state), before an examination (a state of psychoemotional tension), and immediately after the examination. RESULTS AND DISCUSSION Analysis of histograms of the IT distribution (the integral index that reflects the degree of centralization of cardiac rhythm control) made it possible to differentiate the following gradations of the functional state: (I) IT < 60 arb. units, a decreased level of activation of the regulatory mechanisms; (II) 60 < IT < 150 arb. units, adaptive changes in regulation; (III) IT > 150 arb. units, regulation tension. Analysis of the IT by these gradations was performed in each of the adolescents in all three experimental situations. Three groups of schoolchildren were distinguished according to the IT gradations: with the heart rate regulation in the region of a decreased activation level (type I), in the region of adaptive changes (type II), and in the region of tensi5n (type III). The type of autonomic control was determined as normotonic if the IT was higher than 60 and lower than 150 arb. units, as sympathicotonic if the IT was higher than 150 arb. units, and as vagotonic if the IT was lower than 60 arb. units. Values of AX and AMo were also taken into account. On an ordinary school day, in control pupils of the eighth grade (32 subjects) the normotonic type of autonomic regulation of the cardiac rhythm was observed in 50% of schoolchildren (Type II). In the remaining 50% pupils the vagotonic and sympathicotonic types of regulation were observed in 31% (type I) and 19% (type III), respectively (Fig. 1). Among pupils of the tenth grade (34 subjects), 24% had an IT lower than 60 arb. units and the remaining 76% had type II autonomic regulation. In the test group of 22 pupils of the eighth grade, 37% had type I regulation, 54% had type II, and 9% had type III regulation. Pupils of the tenth grade (20 subjects) were distributed as follows: type I was found in, while the remaining 80% were normotonics (type II). Strong emotional reactions were characteristic of the state of pupils before examinations. The degree and duration of emotional excitation depended on objective factors and, mainly, psychological personality traits. This is consistent with data in the literature [12, 13]. Some authors relate autonomic shifts of different directions observed during positive and negative emotions to different factors: significance of an emotional stimulus, psychological assessment of a situation, individual psychological characteristics, age of a subject, previous experience in stressful situations, etc. Psychological testing of schoolchildren by means of Eysenck's questionnaire showed that almost all the schoolchildren were extraverts. Only five pupils were introverts. Pupils with high and low neuroticism levels were equally represented in the test group. According to the FAM questionnaire, on average, the general health state (self-estimate) of schoolchildren both of the control and test groups was good. However, the levels of activity and mood were different. The mean FAM scores in the control group normally were 5.24 ± 0.22, and scores on individual scales of this questionnaire were 5.44 ± 0.3 (SF), 5.55 ± 0.25 (A), and 4.75 ± 0.1 (M). In the preexamination period, the total FAM score decreased (to 5.10 ± 0.25) due to a decrease in self-estimates of general health state, activity, and mood (5.15 ± 0.25, 5.44 ± 0.2, and 4.71 ± 0.4, respectively). In the postexamination period, the FAM score displayed the same decreasing trend (4.99 ± 0.25) because of a decrease in the levels of self-estimates of health and activity (5.08 ± 0.2 and 4.88 ± 0.3, respectively). FAM scores in the test group were somewhat different. A greater responsibility for the results of examinations resulted in slightly lower levels of activity and mood in schoolchildren of this group in pre- and postexamination periods. According to the FAM questionnaire, in the test group scores of general health state, activity, and mood normally were 5.42 ± 0.27, 5.30 ± 0.19, and 4.55 ± 0.12, respectively (on average, 5.09 ± 0.19). In the preexamination period, the FAM score decreased to 4.85 ±0.17, mainly due to a decrease in the levels of activity and mood (4.95 ±0.12 and 4.25 ±0.18, respectively). In the postexamination period, the mean FAM score remained at its preexamination level (4.95 ± 0.29). However, there was a tendency for it to increase because of the levels of mood and general health state. Noticeably, the strongest fear (decrease in the level of mood) before the examination was experienced by pupils with the sympathicotonic type of cardiac rhythm regulation. Schoolchildren with the normotonic type of regulation were the most calm. Normally, in the control group, the mean score of state anxiety according to Spielberger was 37.6 ± 2.7 and 35.8 ± 2.7 in pupils of the eighth and tenth grades, respectively. This index increased before

3 162 DAYAN et al. (а) 50% 31% 19% 56% II 13% 31% 50% III 12% 38% type I type II type III (b) 58% 12% 82% 64% 27% (с) 37% 73% (d) 80% 40% 60% 60% Fig. 1. Changes in the proportion (%) of the three types of autonomic regulation cardiac rhythm (type I. vagotonic (white sectors); type II, normotonic (gray sectors): type III. sympathicotonic (black sectors)) in pupils of the eighth and tenth grades of the control ((a) and (b), respectively) and in the eighth and tenth grades of the test groups ((c) and (d), respectively) on an ordinary school day (/), before an examination (II). and after an examination (III). the examination and reached, on average, 47.3 ±3.1 (p <0.01) and 44.9 ± 3.5 (). In the test group, this index grew from 39.4 ± 3.9 in the normal state to 54.2 ± 2.9 before the examination (p < 0.01) in pupils of the eighth grade and from 38.1 ± 3.2 to 50.2 ± 3.4 (p < 0.01) in pupils of the tenth grade. These data testify to a comparatively high level of situation anxiety in schoolchildren of the test group. Substantial reorganization of the regulation of cardiac activity was also revealed. In the preexamination period, the mean values of the statistical characteristics of the IT changed qualitatively in the same direction in pupils of the control and test groups. The observed increases in the IT and AMo were accompanied by a decrease in the Mo and AX, which testified to an increase in centralization of regulation of the cardiac rhythm. The IT value increased by 39% and 89% in the control and test groups, respectively, and approached the upper limit of adaptive changes (Table 1). In the test group, the IT increased to a greater extent than in the control group. The strongest IT changes were observed in the pupils of the eighth grade of the test group, i.e., in the first year of the intensified education process. In the eighth graders, the IT increased before an examination, on average, by 83% in the test group and by 39% in the control group. The blood pressure and heart rate also significantly increased before the examination (Table 2). Because the individual reaction to examination stress is the main factor that determines the type of autonomic control of cardiac activity, the assessment was for the most part made by the individual data grouped by qualitative gradations. The distribution of schoolchildren with respect to the IT index substantially changed in a preexamination period (Fig. 1). Among the test pupils of the eighth grade, the number of schoolchildren with a decreased level of activation of the cardiac system reduced (to 13%) and the number of children classified as having types II and III of regulation grew (to 56 and 31%, respectively). The distribution of the control pupils of the tenth grade according to the IT gradations mentioned above was as follows: in the preexamination period, 6% schoolchildren were classified as having type I regulation (against 24% on an ordinary day of the academic year), type III was represented by 35% of children (against 0% on an ordinary day), and 59% of schoolchildren had type II. Distribution of the pupils of the test group according to the gradations mentioned showed that the number of eighth-graders with types II and III of regulation increased (to 64 and 27%, respectively) because of a decrease in the number of schoolchildren with decreased activation of cardiac activity (Fig. 1). As in the control group, similar changes were more pronounced in the tenth-graders. Among these pupils, the

4 REACTION OF CARDIAC ACTIVITY OF SENIOR PUPILS 163 Table 1. Mean statistical characteristics of the heart rate in schoolchildren in an examination period (M±m) Ordinary school day Before an examination Grades HR, beats per min IT, arb. units AMo, % Mo, s Ax, s HR, beats per min IT, arb. units AMo, % Mo, s Ax, s Control group VIII ± ± ± ± ± ± p < 0.01 /><0.01 p < 0.01 /><0.01 X ± ± ± ± ± ± ± Test group p< 0.01 p< /><0.01 VIII ± ± ± ± ± ± ± ± p <0.001 /><0.01 <0.01 /><0.001 X ± ± ± ± ± ± ± p< p <0.001 p < 0.02 p < After an examination HR, beats per min IT, arb. units AMo, % Mo, s Ajc, S Control group VIII ± ± ± ± <0.05 X 76.2 ± ± ± ± ± 0.04 /><0.01 /><0.01 P <0.05 Test group VIII ± ± ± ± <0.05 X ± ± ± ± <0.02 p < 0.01 number of sympathicotonics (type III) reached 60% and vagotonics (type I) were absent. In addition to gradations of the IT changes, the types of reactions to examination stress were analyzed for estimation of the functional state of the schoolchildren. To this end, changes in the indices of the heart rate (both absolute and as a percentage of the initial values) were analyzed in each subject during pre- and postexamination periods. Two types of reactions were distinguished: a significant increase in IT before examinations and either maintenance of the increased or recovery of the initial IT levels during the postexamination period (I) or a significant decrease in the IT before and after the examinations (II). Analysis of the distribution of pupils by types of reaction showed that, in the eight graders of the control group, type I reactions were observed in 63% of children. Type II was observed in the remaining 37%. The tenth graders exhibited mainly the type I reaction to stress. In the test group, the type I reaction was characteristic of 65% eighth graders and 82% of tenth graders; type II was observed in 35 and 18% of these students, respectively. The "functional portraits" of the representatives of these groups are presented in Fig. 2. Changes in the heart rate parameters in subjects with type I reactions (Fig. 2a) point to increasing tension of the regulatory mechanisms. An increase in the IT and AMo with a decrease in AX testify to the predominance of the tone of the sympathetic part of the autonomic system both prior to examination and in the postexamination period. This can be indicative of the development of emotional overstrain in schoolchildren with type I autonomic regulation. Therefore, this type of reaction can be considered as less favorable upon emotional stress. In schoolchildren with type II autonomic regulation of cardiac rhythm (Fig. 2b), the IT decreased before the examination and continued

5 164 DAY AN et al. Table 2. Changes in the heart rate and blood pressure in schoolchildren in an examination period (M ± m) Groups Grades Heart rate, beats per min Systolic pressure, mm Hg Diastolic pressure, mm Hg I 2 3 Control VIII ± ± ± ± ± ± ± ± 1.96 p <0.01 p< p<0.01 p <0.01 X ± ± ± ± ± ± ± ± ± 1.58 p < 0.01 p <0.01 p< Test VIII ± ± ± ± ± ± ± ± ±2.7 p< /><0.001 X ± ± ± ± ± ± ± ± ± 1.84 p <0.001 p< Note: 1, an ordinary school day; 2, before examination; 3, after an examination. decreasing in the postexamination period. According to theoretical concepts (presented in [9]), when the IT and AMo decrease and AX increases (as was observed by us in schoolchildren with type II autonomic regulation), the autonomic circuit of regulation of the cardiac rhythm "copes" with the current load, which provokes functional tension but does not lead to strong fatigue. The obtained evidence (a decrease in IT and AMo and an an increase in AX) suggests an attenuation of the sympathetic tone in these pupils and increase in the influence of the parasympathetic part of the autonomic nervous system on the heart [14]. Taking into account the primary importance of the sympathetic system in the development of psychoemotional tension in this situation, we can consider that the activation of the parasympathetic part is probably of regulatory character and is directed at preventing excessive effects of the sympathetic system. The high variability of RR intervals in this group of subjects points to relatively weak centralization of control of the cardiac rhythm and the dominance of the autonomic regulation circuit. Thus, this type of reaction may be considered more favorable in examination stress. CONCLUSIONS The data obtained suggest that an examination period is a strong psychoemotional stress factor that affects the psychological and autonomic indices of senior schoolchildren. The time course of changes in the IT parameters in the examination period testifies to tension in the state of the control mechanisms of the cardiac rhythm. Comparative analysis of changes in the heart rate parameters of the control and test groups of subjects points to an increasing tension of the control mechanisms of the cardiac rhythm in pupils of a school with differentiated education, characterized by a higher sympathetic activation in the preexamination period. Learning at a gymnasium requires the acquisition of a great body of information during the examination period. This process is characterized by a high "physiological price," i.e., the tension and overstrain of the CNS and systems of autonomic control. This is verified by the increase in the number of sympathicotonics among the schoolchildren. It is known that the higher the activity of the sympathetic part of the autonomic nervous system, the higher the excitability of the hypothalamus-hypophysis-adrenal cortex system, which ensures the general adaptive reaction of the body [1]. However, changes in the autonomic indices observed by us in senior schoolchildren both in the school providing general education and, to a greater extent, in the specialized school fell outside the scope of acceptable adaptive reactions. The results obtained by us showed that the character and depth of examination stress depended on the type of autonomic control of cardiac activity. Schoolchildren with the sympathicotonic type of control experienced greater emotional tension, reflected in a significant rise in the tension of the regu-

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