A Review of Biomarkers in Leadership Research

Institutionen fr Lrande, Informatik, Management och Etik (LIME) Frontiers in leadership research 5 pong Examensarbete Vrterminen 2007
A Review of Biomarkers in Leadership Research Can Heart Rate Variability be a Suitable Method?
Frfattare: Ingegrd E. Malmros
A Review of Biomarkers in Leadership Research Can Heart Rate Variability be a Suitable Method? Ingegrd E. Malmros, ingegard.malmros@telmedit.com, Karolinska Institutet, LIME
Content
Content ....................................................................................................................................... 2 Abstract ...................................................................................................................................... 3 Introduction ................................................................................................................................ 4 Purpose and questions to be answered ....................................................................................... 5 Methods...................................................................................................................................... 5 Results ........................................................................................................................................ 5 Leadership .............................................................................................................................. 6 Leadership history .............................................................................................................. 6 Gender aspects.................................................................................................................... 8 Leadership and stress ......................................................................................................... 8 Biomarkers ............................................................................................................................. 9 What is a biomarker?.......................................................................................................... 9 HRV, stress and sleep....................................................................................................... 10 HRV, Organizational changes and stress ......................................................................... 12 HRV and gender differences ............................................................................................ 12 Discussion ................................................................................................................................ 12 Conclusion........................................................................................................................ 13 References ................................................................................................................................ 13
Abstract
Leadership research is a very young discipline from the 20th century, with its background in the ancient history of Plato, Sun Tzu, Machiavelli and Pareto. The focus has changed from war strategies to individuals and organisations. The purpose of this report was to examine what has been written about leadership research and the use of biomarkers. The focus was laid on Heart Rate Variability (HRV) as HRV is an easy way to record the sympathetical parasympathetical balance which reflects the autonomous nervous system that is strongly influenced by psychological as well as physiological activities from the environment both outside and inside a person. HRV is considered to be the strongest predictor for cardiovascular diseases. No reports were found with the key words leadership and Heart Rate Variability but some were found when extending the searching to professionals who had to practise leadership in their professions. It is worth underlining the importance of correlation between leadership and management with stress, sleep disturbances and a negative impact on HRV which means disturbances in the heart power. There are gender differences in both interpretation of the female and male leadership among subordinates as between leaders themselves. There also are gender differences in HRV mean values among healthy subjects which has to be noticed when analyzing material. In many of the reports there is a demand for further investigations on HRV in different inventions and sleep. No studies on correlation between psychological and physiological datas are found expressing indications of unhealthy stress-levels within leadership research for sorting out the most efficient and cost-effective ways of predicting cardiovascular diseases and burnouts. The conclusion is that there is a need for biomarkers in leadership research and HRV is proposed as a suitable method.
Keywords: Biomarkers, gender, Heart Rate Variability (HRV), leadership, sleep, stress.
Introduction
Can biomarkers be of interest in leadership research and if so, why? Leadership is a rather young research field and started to develop as a science during the 20th century (Grint, 1977; Yukl, 1989). Leadership often was connected to war strategies and it was not until the industrial revolution in the 19th century that the work environment with its different hierarchies and roles came into focus (Grint, 1997; Tyrstrup, 2005). One of the forerunners of management research is Taylor1 who examined the production time of the subordinates for increasing the productivity (Tyrstrup, 2005). The theory also made the role identification of leaders and subordinates more distinctive. Henry Ford was very impressed by the Tayloristic approach and wanted to produce cheap cars for the people using the assembly line principle where the subordinates were working like robots. It is said that he thought he got unnecessary problems as the subordinates turned out to be not only hands but whole persons (Tyrstrup, 2005). Fords leadership was surely firm, prosperous and visionary but was it good for the health of the subordinates? There are also studies reporting leadership impact on subordinates (Lewis, 2000; Mc Coll-Kennedy & Andersson, 2002; Newcombe & Aschkanasy, 2002; Pescosolido, 2002; Pirola-Merlo, Hrtel, Mann & Hirst, 2002; Nyberg, Bernin & Theorell, 2005; Sy, Cot & Saavedra, 2005). Many studies point out that psychosocial effort and work strain are risk factors for diseases, and then especially stressrelated diseases as cardiovascular ones (Theorell, 2001; Ekman & Arnetz, 2005; Jansson von Vulte, 2004, Vtijkotte, Doornen & de Geus, 2000; Lindholm, Savolainen, Ahlberg, Rantala, Savinen, Knnen & Nissinen, 2001; Ta-Chen, Lian-Yu, Wen-Tsan, Yuan-The, Chen-Fong & Jung, cited 2007; Westerholm, 2001). For predicting cardiovascular diseases the biological markers as electrocardiogram (ECG) and blood pressure often were used but today the strongest predictor is Heart Rate Variability (HRV) (Task Force of the European Society of Cardiology and The North American Society of Pacing and Electrophysiology, 1996). HRV is said to reflect the autonomous sympathetical parasympathetical balance indicating a persons stress-level (Organisation of the Nervous System, Kimballs Biology pages, 2007). Human beings have an inherited circadian rhythm with an impact on the hormonal balanced mood as well as physiological changes where the cortson level is low just before it raises in the morning when it is time to wake up (Ekman & Arnetz, 2005; Sderstrm, 2007). Stress and sleep has a close negative relationship ( Ekman & Arnetz, 2005). To compare biological markers during daytime and sleep gain new information on psychophysiological background data without influencing the subject with questionaires or interviews. The intervention with blood samples might be stressing for some subjects which will be avoided with the use of devices for Heart Rate Variability. These devices are now available as small, wireless online sensors easy to wear almost anywhere (during work and sleep,sporting activites etc) without any intervention. Most studies in leadership research are performed by psychologists or professionals closely related to that scientific field where interviews, questionnaires and behavioural research are in focus. The emotions, feelings and mood are examined with a qualitative methodology which is subjective and gives a lot of information that is very useful for understanding what is going on from a psychological point of view. But on which stress-level is the body working? Is there a balance between anabolic and katabolic prosesses? Long-lasting catabolic processes as during stress will usually cause illnesses. So what have been done and what doulc be done?
Theory of Scientific Management
Purpose and questions to be answered

The purpose of this review is to search out information on what is done in leadership research dealing with psychophysiological reactions among leaders, registered with biomakers that might give interesting objective datas about the physiological well-being within a person. As mentioined above leadership and stress are closely connected and heart diseases are very much stress-related. Leadership therefore ought to be examined not only from a psychological point of view but also from a medical one as the impact of health is of great concern both for the individual (quality of life) as well as for the society (great economical costs). Questions to be ansewered: Are there any reports on biomarkers in leadership research? Which biomarkers are then examined? Have Heart Rate Variability (HRV) been used for predicting heart diseases among stressed leaders and subordinates? Have distincion been made between daytime and sleep? Definitions: Heart Rate Variability (HRV): A method for recording electrical activity within the heart indicating shifts in the sympathical parasympathical balance and thus telling the stress-level within a person. Very early signs of diminished power in the heart predicting heart disease is also registered. Biomarkers: According to MedTerms in MedicineNet.com http://www.medterms.com a biomarker is a biochemical feature of facet that can be used to measure the progress of disease or the effects of treatment.
Methods
The methodology is mainly a literature review. Databases used: PubMed, MedLine, Wikipedia, Google, Mednet, MedicineNet.com, Liber.se, Biblioteket.se. Key words used: Biomarkers, gender, Heart Rate Variability (HRV), leadership, sleep, stress. Inclusion criteria: Literature edited 1982-2007. Leadership: No distinction is made between different kinds of theories on leadership, leaders, managers or chief executive officers. Reports are included dealing with work environments and jobb stress where professionals are acting as leaders in their practise.
Results
Leadership research from a psychophysiological point of view is a multidisciplinary and challenging field. For being able to understand basics of leadership philosophy and terminology it is necessary also for biomarker researchers to be acquainted with some of the leadership history which succesively lead into leadership research. For psychologists it might be useful to know something more about the pontential usefulness of different kinds of biomarkers (biological markers). In this literature research hardly any reports dealing exactly with leadership and biomarkers were found, but some reports that are closely related, as many professional act as leaders even if the key words might be different, for example physicians, coachers among others.
Leadership
Leadership history
How to define leadership? Leadership as a science is a rather young discipline but has its roots in the ancient history more than 2000 years ago. A review of Leadership Classical, Contemporary, and Critical Approaches (Grint, 1997) gives an interesting introduction of leadership in a historical perspective. Leadership has always existed even if the terminology and interest in it has changed over the decades. The Classical Leadership emanates from Plato, Sun Tzu, Machiavelli and Pareto. Plato in Greece proclaims that only the leader has the necessary economic and occupational knowledge to lead like a captain on the boat and leaves a very anti-democratic image of a leader. Women only act as service providers to the leaders and citizens of Ancient Athens but some women anyway could get a higher rank. It is interesting though that Plato argued that the citizens were their own experts in moral knowledge. Almost in the same period between the fifth and the third centuries BC, Sun Tzu in China wrote The Art of War which became classic as the oldest known written military text. It is dealing about strategies to avoid the war or to end it as fast as possible. The way of peace is always sought in preference to violence but if you have to fight you shall execute the violence with the minimum of effort and maximum effect. The heritage of this philosophy you still can find in the Kung Fu movies and also in martial art. The famous martial artist connected to Sun Tzu called Li Chuan brought the art into the Shaolin Temple where it is still practised today! This philosophy also have a connection between conflict and medicine which can be seen in Tai Chi. The underlying philosophy generates a hierarchy of strategies both in combat and in medicine. Avoidance is always the first strategy and face-to-face contact the last one. Sun Tzu like Plato had the opinion that only one leader was in charge and political leaders had no right to interfere with the military strategists as the responsibility for a martial host of a million lies in one man. He is the trigger of its spirit. The Warring States period of ancient China was the background for Sun Tzus war strategy work. Sun Tzu stated that if you can not eliminate the enemy completely you should provide a golden bridge for giving them a possibility to escape and lower their wish for revenge. Machiavelli and Sun Tzu both had experiences of war but totally different approaches to it. Bertrand Russel called Machiavellis book The Prince written in 1513 a handbook for gangsters while Napoleon called it the only book worth reading. Machiavellis background was the civil war. For him there was no reason to act morally in such an immoral world as such an action was considered inefficient. At the same time he did not celebrate the tyranny but had no hope that the pacifist or goodness could save the world. The book is a polemic review of the world. For Machiavelli the approach to leadership is not just concerning the leader himself but he the politic body: leading the corporate body of the state not the body of the corporate leader. He also argues for alliances for getting strength and the usage of technology. Machiavelli introduced the dual strategies of the lion and the fox which means that the prince in the book (the leader) has to be like a centaur; a half-beast and a half-man. Pareto (1848-1923) incorporated Machiavellis distinction between the lion and the fox in his elite theory where the lites, not the people, were ruling the society which meant that necessarily all organizations had to be non-democratic. According to Pareto lites always rule and the way individuals get to leaders are up to the people. As soon as the leader is chosen the opponents start to plan for their downfall. Referring to Yukl (1989) scientific research did not begin until the twentieth century. First the focus laid on determinants of leadership, later on traits, abilities and behaviours that will determine the possibility for a leader to be able to influence his/hers followers and accomplish group activities. Leadership effectiveness was in focus. An on-going discussion also deals 6
with leadership versus management and there is no sharp distinction between them. A person can be a manager without leading people and some managers do not even have any subordinates (especially in the financial business). Some has the opinion that managers are oriented towards stability and leaders are oriented towards innovation which means that managers get people to work more effectively whereas leaders works for getting people to agree about what should be done. Yukl is discussing leadership as a specialised role and a social influence process. Major research approaches: Trait approach, behavioural approach, power-influence approach, situational approach and integrative approaches. The situational approach emphasizes the importance of contextual factors such as the nature of the work and the external environment and the characteristics of followers. Managerial behaviour is here treated as a dependent variable where the researchers try to discover how this behaviour is influenced by aspects of the situation such as the type of organisation or managerial position. The research investigates how managers cope with demands and constraints for subordinates as well as from superiors. The primary research method is a comparative study of two or more situations in which managerial activities or behaviours are measured with leader description questionnaires, job description, questionnaires or direct observation. Effectiveness depends on how well a manager resolves role conflicts, copes with demands, recognizes opportunities and overcomes constraints. Cross-cultural leadership is a part of this. The other group of research in this situational approach is focusing on identifying aspects of situations that moderate the relationship of leaders behaviours (or traits) to leadership effectiveness and much knowledge about that is found in the contingency theories. Also the Integrative approaches point out interesting research ideas trying to explain why followers of some leaders are willing to exert exceptional effort and make personal sacrifices to accomplish the group objective or mission. The effectiveness of a leader is explained in terms of influence on the way followers view themselves and interpret events. Effective leaders influence followers to have more optimism, self-confidence and commitment to the objectives or missions of the organization. Most theories of charismatic and transformational leadership identify behaviours and traits that facilitate the leaders effectiveness. The same behaviour by one special leader may have a different effect on followers depending on the situation, the history of interaction between the leader and followers and the way the behaviour is interpreted by the followers (Grint, 19979. Contemporary leadership styles are traditional, modern, mythical and alternative according to Grint (1997) but will not be summarized here. These styles are important as they are the background for the modern leadership styles. Developmental leadership (Larsson & Kallenberg, 2003) and Improvising leadership (Tyrstrup, 2006) styles are modern examples of leadership that are focused on the individual on a high ethical level grounded on trust between the leader and the subordinate respective having the managerial power to improvise. Bolman (1997) discussed the problem with the terminology of leadership and chief executive officer in his book Reframing Organization, Artistry, Choice and Leadership. He states that leadership seems to be something that is highly evaluated and something people look for and still there is no strict definition of what it really stands for. Bolman (1997) and Tyrstrup (2005) refers to authors like Gardner2 and Bennis & Nanus3 who claim that the attributes of leadership is separated from the ones of a chief executive officer and propose a distinction which means that chief executives are doing the right things and leaders are doing it in the right manner. Still Gardener at the same time argues against the idea of separating these talents totally from each other as one person may have both.
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in 1989 in his book On Leadership 1985, in their book Leaders: Strategies for Taking Charge.
Gender aspects
Gender aspects will not be focused in this report but is of importance in all studies. There are different gender theories. In the biological theory there are both psychological and biological differences according to biological and physiological reasons (Dahlstrm, 2007). For those who are belonging to the socialconstructionistic theory the assumption is that human beings themselves are creating, building and constructing the male and female norms and what to call feministic or masculine (Wahl, Holgersson, Hk & Linghag, 2000). Reports have started to drop in dealing with male and female leaders and in one of them When leaders display emotion: how followers respond to negative emotional expression of male and female leaders (Lewis, 2000) a significant interaction between leader, gender and emotion was found. Female leaders received lower effective rating when expressing either sadness or anger while male leaders received lower ratings when expressing sadness compared to neutrality. Eagly and Carli (2003) was checking leadership styles and concluded that a female style ought to be more effective under contemporary conditions but prejudices, especially in organizations with a masculine context made that style to an disadvantage.
Leadership and stress

To act as a leader or a manager is many times an activity on a very high stress level. In On the Brink of Failure (Tyrstrup, 2006) the stressful situation is pointed out. while discussing the improvising leadership as a working environment issue due to the uncertainties and confusion around what actually happens. Tyrstrup was interested in the physical as well as the psychological strain and stress in that context. He focused on adrenalin and cortisol which temporarily can increase a persons stress level, which is good, but the same agents nevertheless can cause illness it they are on a sustained high level and cause cardiovascular diseases and burnout syndroms. Tyrstrup made contact with researchers closely related to the health care for employees at Ericssons who hade performed a study on cortison in saliva which is very easy to handle (Tyrstrup, 2006, LOOP, 2006). Their report on a simple saliva test for preventing bournouts (Loop, 2006) tells how a test with a follow-up talk with suggestions on lifestyle changes can prevent unnecessary suffering and lower the high costs for sick-listings. In a stressed person the cortisol level do not fall which is the normal situation during the sleep and this also causes sleep disturbances as the cortisol speeds up the metabolism (Ekman & Arnetz, 2005; LOOP, 2006; Sderstrm, 2007). Several different analyzes of leaders and managers from a therapeutic point of view are made from different perspectives according to which psychological approaches the therapists belong to. At the Grubb Institutes approach to Organizational Role Analysis (ORA) (Newton, Long & Sievers, 2006) the analyze is focused on how leaders and managers shall be able to find, make and take up their organizational roles more effectively within their organizational settings. To take a role eliminates much of the stress related to a personal approach as role-taking is related to ones professional role, not to ones person. For most leaders loss of prestige is a nightmare and causes a very high stress-level which also was the cause of this ORA methodology development (Newton, Long & Sievers, 2006). There are many reports on leadership impact of subordinates and groups related to their mood (Sy & Cot, 2005) and psychological well-being (Gilbreath & Benson, 2004). In Emergent leaders as managers of group emotion (Pescosolido, 2002) and The role of affect and affective congruence in perceptions of leaders (Newcombe & Ashkanasy, 2002) the emotional leader member exchanges are focused. In Impact of leadership style and emotions on subordinate performance (McColl-Kennedy & Andersson, 2002) the positive effect of transformational leadership style is discussed and pointed out as significant but indirect. Pirola-Merlo, Hrtel, Mann & Hirst (2002) highlights the emotional dimensions of 8
teamwork and knowledge work with particular attention to the role of team leadership in How leaders influence the impact of affective events on team climate and performance in R&D teams. There are reports on leadership and health, but most frequently on the subjective evaluation from a psychological perspective as The impact of leadership on the health of subordinates (Nyberg, Bernin & Theorell, 2005) which is a literature research including a wide range of different studies. Burnout stressors that are mentioned are job strain, lack of social support, low control, conflict at work and that the job is threatened. In Leadership Burnouts (2007) business coaching and chief executive officer leadership burnout is discussed as employee engagement and long-term improvements in corporate performance cant be accomplished with a burned out, low energy and low confidence leadership team.
Biomarkers
What is a biomarker?
The definition of a biomarker according to MedTerm, the Medical Dictionary of MedicineNet.com, states that a biomarker is a biochemical feature or facet that can be used to measure the progress of disease or the effects of treatment. Theorell ( 2001) stated in his paper Introduction: Biological Markers of Long-Term Effects of Naturally Occuring Stress that it has become evident that no distinction can be made between psyche and body. accordingly all life situations that arouse the body are reflected to some extent in biological changes. Biomarkers often used are blood pressure, electrocardiogram (ECG), pulse, saliva and urine tests (Theorell, 2001). Stress and cardiovascular diseases are related and for predicting cardiovascular diseases Heart Rate Variability (HRV) is the most suitable biomarker, as there is a signifikant relationship between the autonomic nervous system and cardiovascular mortality including sudden cardiac death (Task Force of the European Society of Cardiology and The North American Society of Pacing and Electrophysiology, 1996). The autonomic nervous system consists of both the symphatethic and the parasympathetic system and this is an involuntatry system which has to be in balance for keeping up the health. The sympathetical parasympathetical balance is like the accelerator and the brake pedal for a driver, where the sympathetical drive increases heart beats and blood pressure with the instinct for fight or flight and the parasympathetical drive relaxes a person and activates the rebuilding of the body (The Task Force, 1996). The sympathetical drive is causing a stress situation within a person and if a person is staying on this level for a longer period deseases can emerge not only in the cardiovascular system but also in many other organ systems, for example the digestive system (Ekman & Arnetz, 2005). Humans are continuously reacting on stimuli from the environments outside as well as inside a person for keeping the total psychophysiological balance for being able to survive. The physiological biofeedback system which regulates the internal environment in an subject is called homeostasis (Organisation of the Nervous System, cited 2007). It is possible to registrate the autonomous nervous system in many different ways and in this report the focus is laid on HRV. Health informatics combines health care, medicine and information sciences (digital devices, information- and communication systems) and gives new opportunities for research in reell and virtual environments. Today HRV can easily be registered in almost any environement in a mobile online mode with a small device allowing ordinary work which
offers new possibilities for leadership research and research of subordinates. Not only daytime registration is of interest, but also the sleep registration.
HRV, stress and sleep

In a journal ( The Independent, 2006) a report A Cure for Stress? is decribing a methodology with hi-tech relaxation technique for burnt-out executives that is now used by sportsmen on top levels as well as schoolchildren and ordinary people. It is a combination of a small sensor on the fingertip for recording Heart Rate Variability with breathing deeply slowly and rhythmically while trying to refresh ones memory of periods with happiness and love with biofeedback instantly. The subject is reinforced in healthy breathing and thinking while checking the curves of HRV indicated by smoother waves on the computer display as well as the a higher variability of the heart power when the subject is turning from the sympathetical stress-drive into the healthier relaxing parasympathetical drive. The goal is very similar to ordinary relaxation and mediation. The executives noted a brighter mind during stressful situation as did the pupils, which is explained by breaking and changing the harmful signals between the heart and the brain. Deep and rhythmic breathing brings the parasymphathetic system back to its baselevel where relaxation and rebuilding takes place and where the mind is open and visions take place (A Cure for Stress, The Independent, 2006). Jobb stress can kill your heart was on WebMD Medical News (2002) and the study was performed in Finland. In the same report Greenland who leads the department of preventive medicine at Chicagos Northwestern University says that still the most risky lifestyle is to smoke,have high blood pressure and high cholesterol, more important than to reduce the work-strain. Stress markers in Relation to Job Strain in Human Service Organizations (Ohlson, Sderfeldt, Sderfeldt, Jones & Theorell, 2001) is a report analyzing six different parameters4 along with a questionnaire specially designed to measure emotional demands. The conclusion was that emotional strain during work may cause psychological stress indicated by slightly increased levels of cortisol. Also the sleep is often disturbed by a stressful work situations which is written about in Smn and Stress (Ekman & Arnetz, 2005; Sderstrm, 2007). Some reports indicate that work stress might disturb the sleep in a serious way and in the end contribute to burn out syndromes (Ekman & Arnetz, 2005; Biologisk frklaring till utmattningsdepression, Dagens Medicin, 2006; Sderstrm, 2007)). Lifestyle factors do also have a great impact of the health (Psykosocial belastning och riskfaktorer fr hjrt-krlsjukdom, 2001). Does Work Affect Sleep or Does Sleep Affect Work? was the question in 2005 on www.ergoweb.com written by the reporter Jeanie Croasman who made a review of Medical News Today. The reason was that Senior Researcher Mikko Harma of the Finnish Institute of Occupational Health, who had studied sleeping disorders for more than 30 years, had found that these problems were increasing. He saw a relation between sleeping problems, occupational stress and abnormal working hours. He therefore wanted to have some sort of educational programs about the importance of sleep and recovery compared with those for smoking and alcohol. There is a report in 2006 (Hynynen, Uusitalo, Konttinen &Rusko) on Heart Rate Varaibility during Night Sleep and after Awakening in Overtrained Athletes with the purpose to check the autonomic balance while also testing the nocturnal urine stress hormones. No differences were found in HRV or stress hormones during the sleep and they were the same as for the control group but after awakening there was a slight difference in the
4
cortisol, prolactin, thyroid-stimulating hormone (TSH), testosterone, IgA and IgG.
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parasymphatetic cardiac modulation on a somewhat lower level which indicates stress signs. The researchers asks for further investigations concentrating on autonomic responses to different challenges, such as awakening. A study on call-on-duty physicians (Malmberg, Persson, Jnsson, Carlsson, Karlsson & rbank, 2005) for catabole processes compared with recovery only showed slight changes in the Heart Rate Variability indicating stress, but only skilled persons were studied and further studies are asked for. No changes were found in saliva cortisol. TSH (thyroid stimulating hormone) was dicreased after call-on-duty during recovery period but the reason was unclear and the study ought to be reproduced in a larger group according to the researchers. It might be stress-induced. Psychosocial strain and risk factors for cardiovascular diseases have been examined in the so called WOLF-project in Sweden, presented in 2001 (Westerholm). Risk factors analyzed are hypertension, hypercholesterolemia, low HDL5 cholesterol and a high amount of plasma fibrinogen and physical activity. The beneficial effect of physical activity was confirmed. Jobstrain and low control had negative effects on many parameters. ECG and HRV were not recorded. One Chapter in the WOLF-study is dealing with sleep disturbances as disturbed sleep can affect the precision at work, and the jobstrain can affect the sleep. It is also noted that there is amazingly few studies made on the relation between stress and other work environmental variables at the one hand and disturbances of the sleep, alertness and sleepiness at the other hand. On the 4th ICOH Conference on Work Environment and Cardiovascular Diseases with Tres Therorell as key note speaker in 2005, an interesting report was presented from the National Taiwan University about Elevated Blood Pressure, Decreased Heart Rate Variability and Delayed Recovery after Working on a 12-hour Night Shift (Ta-Chen, Lian-Yu, Wen-Tsan, Yuan-The, Chen-Fong & Jung-Der). They referred to the American Journal of Cardiology (1966;77:681), Circulation (1966;94:2850) and American Journal of Epidemiology (1997,145:696) where HRV was stated as a predictor of Cardiovascular Disease (CVD). They also noted that decreased HRV have been associated with higher work stress and shift work as noted in the journals Hypertension (200;35:880) and Hypertension Research (2001;24:25)6. The purpose of their own study was the observation that shift work has been associated with increased risk for CVD, which they also could confirm. Acute stress affects HRV during sleep says a research team at University of Pittsburg (2004). Their conclusion was that changes in HRV associated with acute stress may represent one pathway to disturbed sleep. Stress and anxiety are risk factors for cardiovascular disease according to another report (Brosschot, Van Dijk, Thayer, 2007) and Daily worry is related to low HRV during waking and the subsequent nocturnal sleep period. In 2004 Jansson von Vulte defended her doctoral thesis on management development programs targeting female physicians. The female physicians were compared with male physicians for checking gender and manager-reported differences on individual and organizational well-being. The female physicians reported a clearer organizational structure, influence and professionalism but no improvement in well-being, health or career development.
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High Density Lipoproteins A decrease in HRV is a pathological sign..
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HRV, Organizational changes and stress

Organizational changes are stressful for the executives as well as for the subordinates (Bolman, 1998; Tyrstrup, 2006; Yukl, 1989). A study is made on Work stress and autonomic nervous system function in workers of different age groups during organisational changes by Lindholm, Ahlberg, Rantal, Suvinen, Knnen & Nissinen (2001). The aim of the study was to evaluate the autonomic control of the circulatory system in three different age groups in a large company during organizational changes (1999-2001). The parameters of ECG, blood pressure and HRV were recorded. The subjective feelings of stress were increasing during these years. The result shows that the autonomic nervous system (analyzed via HRV), contributes in the physiological adaptive process during this period. There is also a difference between the age groups where increasing age attenuates the regulatory capacity. The aging group (50 years) had the most prominent changes in neurocardiological control parameters and this imbalance in the autonomic nervous system gives a loss of functional reserves that augments the decrease in work ability. These factors predispose for intolerance to changes in the work, delayed recovery after stress situations, increased risk for cardiovascular morbidity and problems with the health. Here the research team point out the new possibility for occupational health professionals to use non-invasive techniques that may serve as physiological indicators of stress adaptation, both in the evaluation of stress reactions in personnel and in improvement of stress management. In the report on Effects of Work Stress on Ambulatory Blood Pressure, Heart Rate, and Heart Rate Variability (Vrijkotte, Doornen, de Geus, 2000) the result showed that a stress-ful day also affects the sleeping period where the effects of work stress are mediated by increased heart rate reactivity, an increase in systolic blood pressure level and lower vagal tone.
HRV and gender differences

Are there any gender differences in HRV? The answer is yes, and there are several reports confirming this statement and one will be mentioned here by Ramaekers, Ector, Aubert, Rubens and Van de Werf (1998). The report on Heart rate variabilility and heart rate in healthy volunteers is a study of 276 subject (135 women, 141 men). The result is that HRV cardiac autonomic modulation as determined by HRV is significantly lower in healthy women compared to healthy men. The researchers hypothesize that the results might be explained by lower sympathetic activity which may then provide protection agains heart diseases as these diseases have been lower for women compared to men. Their subtitle of the report is therefore Is the female autonomic nervous system cardioprotective?
Discussion
When looking for frontiers in leadership research, biomarkers seem to be of highest interest. As psychologists were the first researchers who realized the importance of leadership research as a science it naturally has been a focus on the qualitative methodology. As the leadership research is a very young discipline from the 20th century it probably will still take some time before the physicians and alike will hook on and make quantitative studies. No reports were found on pure leadership and HRV as key search words but when professionals were included who probably had to act as leaders or managers, there were some reports of interest. Heart rate, blood pressure and cortisol in saliva seems to be the most used biomarkers until now but HRV seems to take over more and more because of its great predicting power for identifying very early signs of cardiovascular diseases. Until now HRV has not been used for pure leadership research.
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Many reports confirm that leadership and stress are related as are stress and cardiovascular diseases. There are also many studies showing that leaders have impact on their subordinates and also that there is an interchange of emotions. As emotions give responses in the autonomous nervous system, which is an involuntary system, it means that the leader probably has an impact also on the health of the subordinates. As the autonomous system has an impact on the Heart Rate Variability reflecting the well-being of the heart it seems to be ot interest to try to make recordings in working environments for analyzing both leaders and their subordinates with HRV. At the same time sleeping recordings ought to be done as the work stress negatively influences the sleep where negative changes are visible in HRV recordings according to some studies. Distinction between HRV-recording during daytime and sleep has been asked for from some researchers. The technology for recording and analyzing physiological activities within the body without intervention in a mobile and often even online manner, changes the possibilities for adding new research methods to the older ones. As there is hardly any research made on HRVbiomarker in leadership research it would be a challenge to use this tiny easy wearable online HRV device in work environment and sleeping interventions. Probably it would be visible HRV-changes reflecting the sympathetical parasympathetical balance. If a sustained high stress-level will show up it means that the heart power will be lowered, which is a bad sign and can predict cardiovascular disease. Reports on gender in this review tells that there are significant biological differences between men and women in the HRV analyses. It is interesting that the gender discussion is very inflamed and there are political correct opinions and not much depending on which country you are living in. It seems impossible to deny the biological importance but it is possible to discuss when and why the changes between the sexes occur. In this review the changes occur already in healthy women.
Conclusion
There is a need for adding biomarkers to the leadership research. HRV is proposed as a method with its tiny mobile (online) tool with the potential to predict cardiovascular diseases in a very early stage for stressed leaders and subordinates in their work environment and during sleep. There is a demand for further investigations in many of the reports reviewed. A question not discussed here is what correlation could be found between psychological and physiological datas expressing indications of unhealthy stress-levels within leadership research for sorting out the most efficient and cost-effective ways of predicting cardiovascular diseases and burnouts.
References
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A Review of Biomarkers in Leadership Research

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A Review of Biomarkers in Leadership Research

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Institutionen fr Lrande, Informatik, Management och Etik (LIME) Frontiers in leadership research 5 pong Examensarbete Vrterminen 2007

Theory of Scientific Management

Purpose and questions to be answered

Leadership and stress

HRV, stress and sleep

cortisol, prolactin, thyroid-stimulating hormone (TSH), testosterone, IgA and IgG.

High Density Lipoproteins A decrease in HRV is a pathological sign..

HRV, Organizational changes and stress

HRV and gender differences

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