Does heart rate and degree of self-perceived physiological stress pre- and post-exam predict testing performance?

Physiological stress, such as that associated with taking university exams, takes many forms and that stress may be associated with changes in heart rate or the self-perception of stress. It was hypothesized that heart rate and self-reported level of stress pre- and post-exam could be measures of stress that are predictive of university exam scores. In this study, pre-health science student volunteers (n=30) completed three anatomy exams as part of their normal curriculum. Immediately before (pre-exam) and after (post-exam) heart rate was determined with a pulse oximeter. Students also completed a pre- and post-exam survey with questions pertaining to self-reported levels of stress that included ranking the following parameters from 1 (not at all) to 10 (quite a bit): preparedness, anxiousness, alertness, physiological symptoms, and cognitive state. Statistical significance was analyzed using repeated measures mixed effects models which included a random subject effect. Tukey’s HSD test was used for investigating pairwise comparisons with p<0.05 considered significant. While all subjects completed the same anatomy exams at the same time at three different times over a 2 month period, differences were observed in exam score with exam #1 (43.6±5.9) and exam #3 (41.7±6.7) slightly but significantly more difficult than exam #2 (45.8±5.2). The stress of the exam was associated with a predictably significant decrease in heart rate from 103.3 ± 17.1 pre-exam to a post-exam value of 96.4 ± 15.7 (beats/minute). Pre-exam perceptions of preparedness just before exam 1, 2 and 3 were 7.5 ± 1.46, 7.7 ± 1.46, and 6.9 ± 1.29, with only test 2 and 3 being statistically different from each other. Post-exam perceptions of preparedness just after exam 1, 2 and 3 were 7.8 ± 1.13, 7.6 ± 1.47, and 6.9 ± 1.49, with exam 1 and 2 being statistically different from exam 3. It was surprising that exam scores were not significantly correlated either pre- or post-exam values for anxiousness, alertness, physiological symptoms, and cognitive state. Given that university exams are generally perceived by university students as being stressful, and it was not surprising that heart rate decreased after exam completion, however it was surprising that self-predictive indicators of stress that were correlated with exam performance could not be validated. Winona State University Foundation This abstract was presented at the American Physiology Summit 2025 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.