Work 57 (2017) 43–54 43

DOI:10.3233/WOR-172533
IOS Press

Analysis of air temperature changes

on blood pressure and heart rate
and performance of undergraduate students
Joseana C.F. Siqueiraa , Luiz Bueno da Silvaa,∗ , Antônio S. Coutinhoa and Rafaela M. Rodriguesb
a Department of Production Engineering, Federal University of Paraiba, João Pessoa, Paraiba, Brazil
b Department of Psychology, Federal University of Paraiba, João Pessoa, Paraiba, Brazil

Received 15 March 2016

Accepted 17 October 2016

Abstract.
BACKGROUND: The increase in air temperature has been associated with human deaths, some of which are related to
cardiovascular dysfunctions, and with the reduction of physical and cognitive performance in humans.
OBJECTIVE: To analyze the relationship between blood pressure (BP) and heart rate (HR) and the cognitive performance
of students who were submitted to temperature changes in classrooms.
METHODS: The university students answered a survey that was adapted from the Battery of Reasoning Tests over 3
consecutive days at different air temperatures while their thermal state and HR were measured. During those 3 days, BP and
HR were evaluated before and after the cognitive test.
RESULTS: The average and final HR increased at high temperatures; the tests execution time was reduced at high tempera-
tures; and the cognitive tests was related to Mean BP at the beginning of the test, the maximum HR during the test and the
air temperature.
CONCLUSIONS: The cognitive performance of undergraduate students in the field of engineering and technology will
increase while performing activities in a learning environment with an air temperature of approximately 23.3◦ C (according
to their thermal perception), if students have an initial MBP of 93.33 mmHg and a 60 bpm HRmax.

Keywords: Thermal comfort, thermoregulation, cognitive activity, productivity, cardiovascular system

1. Introduction the physical environment reduces the overload of

Concern about the effects of the environment
on humans has aroused the interest of several
researchers, resulting in a comprehensive literature
on the subject. Inadequacies in the environment
may lead to health disorders such as sick build-
ing syndrome (SBS) and productivity loss. This
fact underscores the notion that the adequacy of
∗ Address for correspondence: Luiz Bueno da Silva, Depart-
ment of Production Engineering, Federal University of Paraiba,
Cidade Universitária, s/n - Castelo Branco, João Pessoa -
PB, 58051-900, Brazil. Tel.: +55 83 991066287; E-mail:
bueno@ct.ufpb.br.
regulatory systems of the body and improves the
ability to participate in activities [1, 2]. This con-
cern has been influenced by climate change and by
content change within environments. According to
Spector [3], an intelligent environment refers to a
place that uses adaptive technologies or models that
include innovative resources to improve the under-
standing and performance of individuals. However,
according to the same author, few plans of sus-
tainable strategies have been designed to improve
the quality of those environments; consequently, no
attention has been given to empirical research in this
field.

1051-9815/17/$35.00 © 2017 – IOS Press and the authors. All rights reserved
44 J.C.F. Siqueira et al. / Analysis of air temperature changes on BP and HR
When the adequacy or lack thereof of the physical
environment refers to a school environment, the envi-
ronment must be recognized as a key factor in an area
of human activity in which excellence is a goal [4].
The characteristics of the environment directly affect
student performance, particularly regarding crystal-
lized intelligence (Gc), the development of which
depends mainly on culture and formal education [5].
This intelligence refers to the type of knowledge and
skills there are acquired through the education pro-
cess and life experience [6].
Thus, issues regarding comfort derived from the
environment must be considered by educational insti-
tutions as promoters of scholastic skills. The concept
of comfort is related to the mental satisfaction over
the environment [7], including the functionality and
thermal, acoustic and lighting conditions of it [8].
Some authors, including Heath and Mendell [9], have
already highlighted that indoor physical environmen-
tal conditions directly affect student performance.
Also, according to Silva et al. [10], the character-
istics of the environment, such as thermal conditions,
could affect individuals’ heath, with great impact in
psychological and physiological factors.
Learning is considered one of the most important
part of the human’s life, however it could be very
sensitive to the environment characteristics such as
indoor air temperature, affecting not only the perfor-
mance but also the health of students and teachers
[11]. Besides, Pawar and Khedkar [12] had previ-
ously evidenced the need of more implementation of
ergonomics at schools.
Although many studies about air temperature, air
quality and other variables of the learning environ-
ment [13–15], recognize the importance of thermal
comfort on students’ performance, these same studies
do not use any measure of cognitive performance, nor
even relating it to the comfort and thermal sensation.
Yang et al. [16] conducted a study to investigate
how the environmental variables, such as temper-
ature, air quality and room layout, influence the
performance of students, according to a subjective
score answered by them. Although the temperature
has shown itself one of the most important attributes
in the classroom, it was not related with the students’
performance, according to their own perception.
In a critical review on how environmental con-
ditions affect performance and health, Mendell and
Heath [17] claim there is little consistent evidence
available, although they indicate that common condi-
tions found in education environments have adverse
effects on the health and academic performance of
students. Although cardiovascular parameters and
tasks that involve mental solving skills have displayed
an association, the relationship between these factors
and performance has been little explored, according
to Ickovics et al. [18].
Factors such as air temperature and quality, light-
ing and acoustics contribute to the quality of the
indoor environment. Furthermore, recent studies have
identified that human performance is largely depen-
dent on environmental quality [19]. Higgins et al. [20]
found that extreme temperatures, inadequate light-
ing and poor air quality have negative effects on the
cognitive development of students.
Parsons [21], Wargocki and Wyon [22] and Cui
et al. [19] advocate that air temperature affects moti-
vation, which, in turn, largely explains students’
performance at class. Accordingly, Primi et al. [5]
emphasize that the motivation, interest and dedication
of students are major predictors of the development
of intelligence.
According to Yang et al. [16], given the rapidly
increasing use of technologies during class (e.g. com-
puters, projectors) researchers have been motivated
to examine the effect of those equipment have both
on learning and on the perception of students in the
educational environment.
However, a consensus regarding their benefit or
harm to students has not been reached because some
authors advocate that the technology used in the class-
room is a positive factor whereas others claim that it
has a negative effect on learning [16]. Nevertheless,
according to Yang et al. [16], temperature is one of
the most significant factors affecting the perception
of students regarding comfort in the classroom.
Zhang et al. [23], using undergraduates in a cli-
mate chamber in China, noted that temperature
affects both psychological and physiological factors.
However, in regards to temperature change, psycho-
logical conditions are stabilized first, followed by
physiological conditions. These results suggest that
physiological conditions have more negative impact
of the temperature change, in comparison with psy-
chological conditions, evidencing the importance of
studies about both temperature and physiological
variables.
Cao et al. [24] emphasize that the discomfort
sensation felt by people is not caused by a single
factor. Instead, it is affected by several factors con-
comitantly. Thus, temperature does not operate alone
regarding the promotion of discomfort because it is
usually related to lighting and air quality, as shown
by Barrett et al. [25].
 J.C.F. Siqueira et al. / Analysis of air temperature changes on BP and HR
Lan et al. [26] argue that the effect of the environ-
ment on the cognitive performance of students may
be systematically measured by psychometric tests of
neurobehavioral functions. Thus, the Battery of Rea-
soning Tests 5 (BPR-5) was used in this study to
measure the cognitive performance of undergraduate
students under different temperature conditions.
The BPR-5 is an instrument that helps prepare psy-
cho diagnoses, selection and vocational guidance and
school evaluation; it also assesses general cognitive
functioning, according to Almeida and Primi [27].
This instrument consists of 5 subtests: the Abstract
Reasoning (AR) Test, the Verbal Reasoning (VR)
Test, the Numerical Reasoning (NR) Test, the Spatial
Reasoning (SR) Test and the Mechanical Reasoning
(MR) Test, which are all used to measure specific
skills [28].
Similar to performance, heart rate (HR) and blood
pressure (BP) are also affected by environmental con-
ditions depending on the type of activity performed
[29, 30]. The variation in HR is more sensitive to
demands of perception than of attention [31]. Whar-
ton et al. [32] found a positive relationship between
BP and the performance of visuospatial tasks. Lyn-
gdoh et al. [33] found an association between some
cognitive functions and BP; however, the associations
were gender specific or exclusively related to systolic
BP (SBP) or diastolic BP (DBP), thus precluding their
generalization.
The dependence of the activity performed may
be related to the cortical area activated while per-
forming the task and temperature control areas of the
human body. The negative effects observed in health
and performance when people are in thermally hot
environments may be caused by physiological mech-
anisms, according to Lan et al. [2].
It should be noted that cardiovascular param-
eters are affected by cognitive activity. However,
cognitive performance, in turn, may be affected by
these parameters. This fact was exemplified in the
study conducted by Lan et al. [2], who observed
that reduced oxygenation (SpO2 ) may reduce
cognitive functioning and consequently student
performance.
Some studies have only found a relationship
between performance and changes in HR and BP.
Bernardi et al. [34] found a reciprocal relationship
between mental activity and stress that was associ-
ated with sympathetic activation of the cardiovascular
system; this activation may be affected by the indi-
vidual’s breathing. Hjortskov et al. [35] noted that
mental stress suffered during computer work leads to
45
changes in HR variability and to a sustained increase
in BP, and these effects are reversed with rest.
Vuksanovic and Gal [36] observed that changes
in autonomic modulation are expressed in the high-
frequency (HF) spectral power and are responsible
for increasing HR under mental stress. Furthermore,
Schnell et al. [37] showed that thermal load levels,
which are measured using the physiological equiva-
lent temperature, are associated with low frequency
(LF) and HF levels.
Changes in an electrocardiogram (ECG) are asso-
ciated with environmental variations. These changes
do not have a linear trend when related to tempera-
ture and humidity and may have higher values at low
or high temperatures [23, 30, 38, 39]. Liu et al. [30]
identified that the LF/HF ratio was higher at a dis-
comfort level than at a comfort level when describing
the association of cardiac activity with the thermal
sensation of occupants. The increased LF/HF ratio
indicates that the activity of the sympathetic nervous
system (SNS) was high. The SNS stimulates auto-
matic actions that allow our body to react in stressful
situations by accelerating the heartbeat and increas-
ing BP, adrenaline, blood sugar concentration and
activation of the general metabolism of the body.
Although Akimoto et al. [40] failed to identify dif-
ferences in the perceived mental workload in office
workers, Lan et al. [2] demonstrated that the increase
in temperature produces an increase in perceived
mental workload.
The results from a study conducted by Taelman
et al. [41] confirmed that HR was higher and vagal
modulation was lower when assessing the relation-
ship of mental tasks with normal office physical
activity; that is, the effect of a mental workload
outweighs the cardiovascular effects of a physical
workload, suggesting an additional effect in the com-
bination of multiple tasks.
However, regarding environmental effects on
health, it is noteworthy that no mono-causal relation-
ship between temperature and health exists according
to Hübler et al. [42]. Different risk factors, including
age (children and the elderly), physical conditions
(pre-existing conditions) and low fitness exacer-
bate the thermal load effects. Indeed, Luque-Casado
et al. [31] observed that fitness is a key factor to
improve cardiac autonomic control and cognitive per-
formance.
Health-promoting strategies may also improve
learning in addition to fulfilling their original pur-
pose, according to Ickovics et al. [18]. The authors
suggest that the management of chronic health condi-
46 J.C.F. Siqueira et al. / Analysis of air temperature changes on BP and HR
Table 1
Study variables and indicators
Variables
Comfort Parameters Personal
Environmental
Subjective Parameters Thermal sensation
Thermal assessment
Performance Reasoning
tions increases physical activity and proper nutrition
promotion among the strategies, which results in
healthy school environments that improve emotional
and behavioral health.
Based on the above information, the present study
sought to answer the following research question:
“Could blood pressure and heart rate influence the
cognitive performance of students under different
air temperatures in learning environments?” The
aim of this study was to analyze the relationship
between heart rate, blood pressure and cognitive
performance of students who were subjected to
air temperature variations in learning environments
with devices called news ICT (Information, Com-
munication and Technology) that include systems as
computers, projectors, air conditioners, wireless sig-
nals, audio-visual systems, etc.
2. Experimental methods
This study was approved by the Ethics Committee
of the Federal University of Paraı́ba (Universidade
Federal da Paraı́ba; CAAE: 31037614.0.0000.5188).
The study was conducted in learning environments
with news ICT, specifically in computer labs of pub-
lic and private higher education institutions in the
field of exact sciences. All students were invited
to participate after explaining the objectives and
methods of the study. The students who showed
interest in participating signed an informed consent
form and moved on to the initial data collection
step.
Twenty-eight volunteers were selected based on
the following inclusion criteria: 1) aged 17 to 30
years and 2) good self-reported general health sta-
Indicators
Activity performed, M, (W/m2 );
Thermal insulation of garments, Icl , (clo); Height (m); weight (kg); age
(years); gender; HR (bpm); BP (mmHg)
Air temperature (◦ C);
Average radiant temperature, trm , (◦ C);
Air velocity, va , (m/s);
Partial pressure of water vapor in ambient air, pa , (kPa)
Seven-point scale of perceptions and preferences of the International
Organization for Standardization (ISO) standards 10551/1995
Hit rate and time spent in the Verbal Reasoning (RV);
Hit rate and time spent in the Abstract Reasoning (AR);
Hit rate and time spent in the Mechanical Reasoning (MR);
Hit rate and time spent in the Spatial Reasoning (SR);
Hit rate and time spent in the Numeric Reasoning (NR);
Hit rate and time spent in the Overall Score (BPR)
tus. The others interested were excluded based on
the exclusion criteria: 1) self-reported cardiovascu-
lar and metabolic diseases; 2) calculated body mass
index (BMI) greater than 30; and 3) failure to attend
the 3 study days.
The study environments were computer laborato-
ries with 35 to 40 computers. Each computer had
a case placed below the workstation and a cath-
ode ray tube (CRT) monitor, keyboard and mouse
placed above the workstation. Each bench had 3 to
4 terminals placed side by side. The rooms were
air-conditioned with split air conditioning, artificial
lighting distributed on the ceiling, and audiovisual
resources and wireless technologies.
The variables of interest that are shown in Table 1,
and their respective indicators were analyzed in the
present study. The method used for data collection is
explained below.
2.1. Comfort parameters
2.1.1. Personal characteristics
Data on height, weight, HR and BP were col-
lected from all of the students who volunteered for
this study. Weight was measured using a digital scale
with a 150-kg capacity and a 100-gram variation. The
height of the subjects was measured using astadiome-
ter. This measurement was manually recorded on the
data spreadsheet by the same researcher to avoid any
disparities. Based on these data, the Excel’s spread-
sheet was used to calculate the body mass index
(BMI) of each participant, and this parameter was
classified as low weight (<18,5), normal weight (18,5
< BMI < 24,9), overweight (25 < BMI < 29,9) and
obese (>30).
 J.C.F. Siqueira et al. / Analysis of air temperature changes on BP and HR
The BP and HR were assessed in the experimen-
tal days before and after the cognitive performance
tests using the automatic arm blood pressure monitor
model HEM-7220by OMRON, which was validated
according to the international protocol of the Euro-
pean Society of Hypertension. The procedures for
the measurements were in accordance with the rec-
ommendations of the VI Brazilian Hypertension
Guideline [43].
The mean and maximum HRs were recorded dur-
ing the test using the POLAR FT07 heart rate monitor.
The thermal resistance of the students’ garments was
also calculated according to the self-report of the
students in the questionnaire regarding the clothing
items used. The metabolism of the students was set
at 70 W/m2 because this was a sitting activity with-
out a significant physical effort. The maximum HR
for age (HRmax = 220 − age) and the mean BP for
each individual were calculated after tabulating these
data in Excel’s spreadsheet.
2.1.2. Environment
The measurements of environmental variables,
including air temperature (ta), wet-bulb temperature
(wbt), globe temperature (tg) and air velocity, were
performed using the TGD300 heat stress meter and
the microclimatic station BABUC A, which records
data by creating a local file and transferring the data
to a computer, where in the data may be processed
through specialized applications or by using spread-
sheets. The devices met the demands of the ISO-DIS
7726/1998 [44] and were calibrated by accredited
institutions of reference.
The meter was installed in the center of the
classroom, at the height of the torso of the seated
participants, according to the recommendations of
the ISO Standard 7726 [44]. For each day and
classroom, these measurements were calculated indi-
vidually using the mean of the data recorded during
the testing period. The devices were programmed to
record measurements every minute, beginning from
the entry of the participants into the classroom. The
devices were placed in the classroom 30 minutes
before data collection for stabilization.
2.2. Subjective parameters
Subjective parameters, including thermal sensa-
tion and thermal preference of the respondents,
were determined by administering a questionnaire on
perception, evaluation and thermal preference of stu-
dents; this questionnaire was based on the 7-point
47
scale of perceptions and preferences of the ISO Stan-
dard 10551/1995 [45]. These questions were included
at the end of the reasoning test.
2.3. Performance evaluation
Based on the study conducted by Vasconcelos [46],
the BPR-5 was broken down and reorganized into 3
brief tests with questions of the same level of dif-
ficulty, with each test being applied on a different
experimental day, to allow for a comparison of the
performance and comfort parameters of the students
at all temperature ranges at the end of the experi-
ment. A survey was prepared for this purpose on the
website Qualtrics.com that applied the questions and
measured the answering time for each question. Thus,
the number of hits and the time spent to answer the
questions were also measured. Each test consisted of
4 questions on each type of reasoning.
To divide the questions and prepare each of the
3 tests, the items were categorized according to
Campos [47] into the following: grammatical class
and type of relationship between words for the Ver-
bal Reasoning (VR) Test; size of the numerical
sequence, mathematical operations used, number of
logical sequences used and complexity of the logi-
cal sequences for the Numeric Reasoning (NR) Test;
types of modification rules and number of types of
modification rules for the Abstract Reasoning (AR)
Test; number of rotational axes, rotation directions,
visible faces of cubes and presence of visual stimuli
on the edges of the faces of cubes for the Spatial Rea-
soning (SR) Test; and types of physics knowledge
for the Mechanical Reasoning (MR) Test. Similar
items were distributed randomly between the tests
based on this classification and categorization. The
tests were randomly distributed to ensure that each
student would answer one test each day and would
answer all 3 by the end of the experimental period.
The BPR-5 is divided into 2 parts, A and B; the
first part is intended for elementary school students,
and the second part is intended for students attending
secondary school or higher [28].
2.4. Statistical analysis
After data collection, the data were tabulated in
Excel’s spreadsheet and prepared for use in SPSS
software. The Excel’s spreadsheet was used to tab-
ulate, transform and calculate the data. The SPSS
was adopted to correlation analyses between the
variables. Descriptive statistics were initially per-
48 J.C.F. Siqueira et al. / Analysis of air temperature changes on BP and HR

Table 2 Table 3
Student characteristics Indoor thermal data of the study environment
Variable Values Day Humidity Air Globe Wet Bulb Air
Age (mean) 21 ± 2.89 years temperature temperature temperature velocity
Weight (mean) 72.88 ± 14.75kg 1 49.33 22.60 23.11 17.41 0.17
Height (mean) 1.76 ± 0.09 m 2 48.65 23.24 23.76 18.14 0.17
BMI (mean) 23.32 ± 3.55 3 50.44 27.95 27.50 25.71 0.05
Tobacco smoker (rate) 4%
Alcohol drinker (rate) 71.4%
Sedentary lifestyle (rate) 14.3% Table 4
Mean PMV and PPD for each experimental day
DIA PMV PPD
formed to assess the characteristics of the sample Mean SD Mean SD
data, including the central tendencies, dispersion and 1 0.3074 0.5994 14.1489 12.1986
distribution of collected variables. Histograms were 2 0.3424 0.4121 10.8768 7.3270
designed in this step to assess the distribution of the 3 1.0806 0.2019 30.2877 9.1285
blood pressure, heart rate and performance parameter.
When the data were not continuous, the Kruskal-
air conditioner settings. The air temperature and black
Wallis and Wilcoxon nonparametric tests were
globe temperature were similar to one another. This
subsequently used to test the hypothesis that the dis-
similarity shows that thermal radiation was not sig-
tributions of the parameters analyzed were similar in
nificant in these environments. Air velocity was also
all experimental days.
lower on day 3, when the room was under natural
ventilation, than on days 1 and 2.
Additionally, Table 4 shows the data regarding the
3. Results predicted mean vote (PMV) of the environment and
the percentage of people dissatisfied with the envi-
3.1. Student characteristics ronment (PPD).
The indoor environments on days 1 and 2 were
A total of 23 men and 5 women who were similar according to the PMV, with the mean values
undergraduate students in the field of exact sciences within the interval considered thermally acceptable;
participated in this study, including 13 students who however, this value was higher than 0.5 on day 3,
studied in a private university and 15 students who indicating that it was outside the acceptability inter-
studied in a public university. Table 2 outlines the val. In addition, the PPD was also much higher on
characteristics of these participants. the last experimental day when the average tempera-
In addition to biometric data, it is important to ana- ture was 27.95◦ C. The indoor environment that was
lyze the environment to which these individuals are studied is a category B environment according to ISO
subjected to understand the changes that occur in their 7730/2005; that is, it is considered thermally accept-
bodies. able with a PMV ranging from –0.5 to 0.5, and a
PPD lower than 10% of the participants is expected.
3.2. Environmental characteristics The analysis of Table 4 shows that the PMV val-
ues on the 3rd day were greater than the acceptable
On the first day, the temperature was adjusted to limits. Although days 1 and 2 showed PMV values
20◦ C, and the measured temperature ranged from within acceptable limits, they had PPD values above
20.3◦ C to 23.35◦ C. On the second day, air con- the admissible level of 10%; however, it should be
ditioner was adjusted to 24◦ C, but it fluctuated noted that the standard deviation was also high.
between 21.88◦ C and 23.45◦ C. On the last day, the In addition to the predicted values of people dissat-
air-conditioner was turned off and the range of fluc- isfied with the environment as assessed by the PPD,
tuation was between 21.96◦ C and 29.15◦ C. Table 3 the actual votes of these students regarding thermal
shows the average indoor environmental conditions comfort were also assessed. The analysis of Table 5
of the laboratories during the data collection process. shows that the percentage of people comfortable with
The analysis of Table 3 shows that the humid- the environment was much lower on the 3rd day and
ity was consistent during the 3 experimental days, was similar on days 1 and 2 of the experiment, which
whereas the air temperature varied according to the corroborated the expected values (in Table 4).
 J.C.F. Siqueira et al. / Analysis of air temperature changes on BP and HR 49

Table 5 reduced satisfaction with the environment from 60%

Percentage of comfort and discomfort votes of the students on to 4%.
each experimental day (ISO 10551/95)
In addition to thermal comfort, temperature gen-
Day Comfortable Slightly Uncomfortable Very
erates a thermal load that requires adaptations of
uncomfortable uncomfortable
the thermoregulatory system. Therefore, the relation-
1 50% 39% 7% 4%
2 53% 39% 4% 4% ship between thermal comfort and blood pressure and
3 11% 50% 32% 7% heart rate must be assessed.

Table 6 3.3. Cardiovascular characteristics

Thermal sensation votes of the participants on each experimental
day (ISO 10551/95)
Day Hot Warm Slightly Indifference Slightly Cool Cold
warm cool
1 0% 0% 7% 57% 29% 7%
2 0% 4% 7% 60% 25% 4%
3 11% 67% 18% 4% 0% 0%
Furthermore the predicted data (Table 4), Table 6
shows that most participants voted that the environ-
ment was indifferent, that is, neither hot nor cold (i.e.
comfortable), on days 1 and 2, and the complaint of
discomfort was more associated with the cold. Con-
versely, 86% voted for some level of heat on the 3rd
day. That is, the discomfort on day 3 was associated
with heat, when temperature was over 29 degrees.
The average air temperature of 27.95◦ C on the
3rd day (Table 3) was less thermally accepted
(Table 5); it is interesting to note how far this temper-
ature was from the optimal temperature. Therefore,
a linear regression model was built based on the
thermal sensation vote of the students (dependent
variable) and the air temperatures to which they
were submitted (independent variable), enabling
the calculation of the neutral temperature for this
sample.
This procedure was performed in rising the vari-
able thermal sensation (TS) as a function of air
temperature (Ta). The model (1) showed reliability:
F: 121,3; p = 2.2–16 < 0.05, R∼ =0.8, R2 ∼
=0.6, adjusted
∼
R =0.6. The model is expressed in Equation 1.
2
TS = −7.937 + 0.341ta.
The term TS was set to 0 (value equivalent to
the thermal sensation of comfort) to identify the air
temperature that was associated with neutral ther-
mal sensation, and the temperature considered neutral
by the students was thus obtained, with a value of
approximately 23.3◦ C.
This result indicates that the average temperature
of 27.95◦ C on the 3rd day was 4.65◦ C greater than
the temperature considered neutral. This increase
The cardiovascular system of the participants was
evaluated on each experimental day to analyze the
relationship between thermal conditions and body
0% responses. The mean values of SBP, DBP and HR
0%
0%
measured on the 3 experimental days are shown in
Table 7. In addition, the value of MBP calculated
according Equation 2 was also presented.
[(2 × DBP) + SBP]
MBP = (2)
3
The analysis of the results in Table 7 shows that the
initial values of days 1 and 2 were similar. However,
they differed from those on the 3rd day, during which
HR was increasing and BP values were decreasing.
The final values varied between the 3 experimental
days, albeit maintaining the initial trend of BP val-
ues decreasing and HR values increasing over the
course of the experiment. In regards to the variation,
the highest absolute values were observed for SBP,
that is, in BP during contraction of the heart, par-
ticularly on the 2nd day, when the students reported
a greater acceptability of the thermal environment.
These variation values are negative, indicating that
the initial values were higher than the values follow-
ing the cognitive activity.
In addition, the MBP was normal, according to
the Brazilian Society of Cardiology (below 130 × 80
mmHg). Some students showed values of SBP and
DBP that were indicative of stage-1 hypertension.
(1) However, these students were not excluded because
a one-time measurement cannot be used to diagnose
high BP.
The thermal conditions of the environment (TCE)
are factors that may affect cardiovascular parame-
ters. The Kruskal-Wallis test was performed with
␣ = 0.05 to assess the effect of the thermal condi-
tions of the environment on each experimental day
and whether the distributions of the values of cardio-
vascular parameters were similar over the 3 days. The
results are shown in Table 8.
50 J.C.F. Siqueira et al. / Analysis of air temperature changes on BP and HR

Table 7
Mean values of the cardiovascular parameters measured
Day 1 Day 2 Day 3
Start End Variation Start End Variation Start End Variation
SBP 127.46 124.36 –3.11 127.45 120.96 –6.48 121.16 120.18 –0.98
DBP 75.04 74.05 –0.98 73.89 72.34 –1.55 72.27 71.39 –0.87
MBP 92.51 90.82 –1.69 91.74 88.55 –3.20 88.57 87.65 –0.91
HR 76.14 73.27 –2.87 76.30 75.91 –0.39 81.04 81.59 0.55

Table 8 Table 10
P-values of the Kruskal-Wallis test Mean measured values of maximum and mean HR
p-value Day 1 Day 2 Day 3 p-value
Start End Variation HR mean 80.86 81.79 87.36 0.04
SBP 0.118 0.458 0.140 HRmax 105.86 104.25 103.39 0.880
DBP 0.230 0.483 0.892
MBP 0.368 0.565 0.565
HR 0.162 0.007 0.052
Table 11
Values obtained in the distribution-free confidence intervals test
for the mean HR
Table 9
Distribution-free confidence intervals for the comparison of Days p-value Maximum Minimum Estimates
final HR differences differences differences
1 and 2 0.5934
Days p-value Maximum Minimum Expected 1 and 3 0.01835 –1.999948 –11.499993 –7.327381
differences differences difference 2 and 3 7.006e–05 –4.000049 –8.500020 –6.499983
1 and 2 0.0634
1 and 3 0.00132 –4.250031 –13.249964 –8.250048
2 and 3 9.318e–5 –3.250044 –7.999986 –5.500029
were performing the activities. The non-parametric
Kruskal-Wallis H Test for independent samples was
The analysis of these results showed that the dis- applied again (␣ = 0.05) to determine whether the dis-
tribution of the (systolic, diastolic and mean) BP tributions of HR mean and HRmax were the same
levels of the participants was similar between the over the 3 days. Data regarding the mean and maxi-
3 experimental days (p-value >0.05). No significant mum HR are shown in Table 10.
difference in HR occurred initially, although the vari- These results show that the maximum HR was sim-
ation of HR before and after the activity was close to ilar between the 3 experimental days, whereas the
the level of significance, which should be considered mean HR showed a significant difference between the
in future studies. Conversely, the HR of the students 3 days. Thus, distribution-free confidence intervals
at the end of the cognitive activity was the only were estimated based on the Wilcoxon signed-rank
value with a significant difference between the days test to confirm the identified difference (Table 11).
[p-value = 0.007 (<0.05)]. Thus, as observed for the final HR, the results out-
Thus, it was important to determine which day dif- lined in Table 11 indicate that the mean HR was
fered in terms of the HR of the students. Therefore, significantly higher on the 3rd day than on days 1
distribution-free confidence intervals were estimated and 2. This finding suggests that both the final and
based on the Wilcoxon signed-rank test to identify mean HR of individuals increase throughout a period
any differences between days. The results are shown of exposure to high temperatures.
in Table 9.
These results show that no significant difference 3.4. Performance
occurred between the values for days 1 and 2. How-
ever, the values for day 3 were significantly higher A total of 84 questionnaires were analyzed (28 for
(p-value >0.05) than those of days 1 and 2. That is, each of the 3 experimental days); the analysis related
HR increased significantly at the end of the cognitive the thermal perception of the environment (based on
activity at an average air temperature of 27.95◦ C. the ISO standard 10551/1995) and the answers to
HR was also monitored while performing the activ- questions from the BPR-5. This test, as described
ity, allowing us to determine the maximum and above, consisted of 5 subtests, and the overall score
mean HR of the students for each day when they ranged from 0 to 20 hits.
 J.C.F. Siqueira et al. / Analysis of air temperature changes on BP and HR 51

Table 12
Mean number of hits and time spent (in seconds)to perform
the tests
Day 1 2 3
Mean SD Mean SD Mean SD
BPR 14 3.22 13.54 2.502 14.54 3.26
BPRT 838.2441 181.4175 725.3536 197.8429 659.4104 147.8613

In addition to the number of hits (BPR), the time Table 13

spent in seconds (BPRT) to perform the test was also
analyzed. The means and standard deviations of these
data are shown in Table 12.
Most of the students had scores higher than 10 hits
(50% of the total number of hits) on all days. The
range of scores was lower on the 2nd day, with an
interval ranging from 9 to 18 hits, whereas the scores
on the 1st and 3rd days ranged from 5 to 19 hits.
Furthermore, the average score also differed on each
day, with 15 hits on the 1st day, 14 hits on the 2nd
day and 16 hits on the 3rd day. However, despite these
visual differences, the result from the Kruskal-Wallis
test for independent samples (␣ = 0.05) showed that
the distribution of hits was similar over the 3 days,
with a p = 0.237 > 0.05.
To corroborate the descriptive analyses, the
Kruskal-Wallis test (␣ = 0.05) was performed to
determine whether the distribution of time spent to
answer the questions was similar in the 3 experimen-
tal days. The results from this test showed that the
distribution of time spent was significantly different,
with a p-value = 0.001461 < 0.05.
The identification of this difference made it nec-
essary to estimate the distribution-free confidence
intervals to determine which days differed. The
results for the total time spent for each day are out-
lined in Table 13. It shows a significant decrease in the
time spent throughout the experimental period; the
students took longer to answer the questions on the
1st day, whereas the cognitive performance test was
completed more quickly on the 3rd day. Students
reported a warm or hot thermal sensation on the days
when the time spent was the shortest. However, the
test took longer when the students reported a thermal
sensation between slightly cold or cold.
4. Discussion
This study aimed to fill the gaps in the litera-
ture, identified in the literature review section, and
answer the question: could blood pressure and heart
rate influence the cognitive performance of students
Distribution-free confidence intervals comparing the total time
spent on each day
Days p-value Maximum Minimum Expected
Differences Difference Difference
1 and 2 0.01911 221.345 16.085 110.5775
1 and 3 0.0004729 277.010 77.985 179.6625
2 and 3 0.01911 115.86 8.88 60.72
under different air temperatures in learning environ-
ments? Studies associating the cognitive performance
of undergraduate students separately, either with
environmental conditions or with the cardiovascu-
lar system, were identified, but there were not found
articles that evaluate these three variables together.
The most studies that relate performance and thermal
comfort are carry out in chamber or offices. The main
contribution of this current paper is that the experi-
ment was carried out in the usual class rooms, which
the students were already adapted.
4.1. Comfort and thermal sensation
The rate of students who reported dissatisfaction
with the environment on the 3rd experimental day,
during which the mean air temperature was approx-
imately 27.95◦ C, was greater than the 10% that is
considered acceptable for this type of environment,
according to the ISO 7730/2005 [48]. Furthermore,
the students showed a reduced acceptability of that
temperature.
Based on the above results, it is important to deter-
mine how much theme a temperature of 27.95◦ C
differs from the optimal temperature that is consid-
ered acceptable. In addition, the possible implications
should be considered of the thermal discomfort of
students that causes an overload to the body when
maintaining the internal temperature.
The air temperature has implications for phys-
iological responses because the thermoregulatory
system must adapt to the environment [49, 50]. Thus,
there was also a need to examine the relationship
between thermal comfort and cardiovascular param-
eters, including BP and HR.
52 J.C.F. Siqueira et al. / Analysis of air temperature changes on BP and HR
According to the thermal sensation votes, the tem-
perature considered neutral by the sample of students
was 23.3◦ C; this study showed that adjusting the tem-
perature to the optimum value reduced the error rate
and improved performance.
The main practical objective of this study was to
provide an understanding of the implications of dif-
ferent temperatures on cognitive and cardiovascular
responses of a body of undergraduate students in
intelligent learning environments. Currently, there is
no standardization specific to this type of environ-
ment and population in Brazil; therefore, there is no
optimization of the teaching-learning process.
4.2. Blood pressure and heart rate
The final and mean HR were significantly higher
on the 3rd experimental day because this day was the
hottest day. The thermal satisfaction of students on the
same day consisted of approximately 89% of thermal
discomfort votes, 96% of which were associated with
some degree of heat. These findings corroborate the
hypothesis that high temperatures, which cause ther-
mal discomfort, also cause increased HR throughout
the exposure period of the subject [51].
BP values lower than 120 × 80 mmHg are con-
sidered optimal according to the Brazilian Society of
Cardiology [43]. Thus, the optimal MBP is lower than
93 mmHg. Conversely, values lower than 90 × 60
mmHg are considered hypotensive. Therefore, the
MBP should be higher than 70 mmHg.
The predicted HRmax of this sample ranged from
190 to 203bpm, depending on age. The rate of 50 to
75% of predicted HRmax is reached in moderately
intense physical activities, as established in guide-
lines and handbooks of the American College of
Sports Medicine [52]. The HR should not exceed
50% of the predicted rate during cognitive activity.
That is, the HRmax of this sample should be lower
than 85 to 101.5bpm, depending on age. However, the
HRmax should be higher than 60bpm because values
below this limit may hinder proper body circulation
(bradycardia) and oxygenation of the CNS and nega-
tively affect performance [53]. Thus, the HR should
be above this limit.
The relationship between cognitive performance
and HRmax that was obtained during the tests
showed that performance improves with a decrease
in HRmax. However, the lowest HRmax reached in
the sample was 77bpm (which exceeded the limit
of 60bpm), resulting in a considerable range that
may be used to assess the effects on performance.
Compared to the predicted value for age, theme a
value for HRmax was 53% of the predicted HRmax.
This value is very far from posing a risk to the
individual. However, HRmax reached 92% in one
observation, surpassing the safety zone of 85 to 90%
(anaerobic threshold zone), according to Lumingu
and Dessureault [54].
This study showed that temperatures common in
several Brazilian regions are considered uncomfort-
able by students and can affect HR. This finding
reveals a little explored subject: the risk of increased
HR.
Awareness campaigns usually focus on the risks
and consequences of increased BP. However, there is
little research on the risks of increased HR. Thus,
these effects must be further studied because this
study demonstrated that keeping students in environ-
ments without proper air conditioning might increase
the risk of cardiovascular diseases secondary to
tachycardia.
4.3. Cognitive performance
Temperature affects both the thermoregulatory
system and the academic performance of students,
according to Schellen et al. [55]. Thus, the BPR-5
was used to measure the cognitive performance of
students because of its validity and accuracy [56].
There was a reduction in time spent to perform
the battery of tests in the BPR-5 throughout the
experimental period. Therefore, the time spent was
the longest in the hot test temperature period. Con-
versely, the longest time spent occurred on days when
the air temperature and thermal sensation were the
lowest.
This phenomenon may have occurred because the
reduction in total time spent may have been associ-
ated with the learning effect of questions in general.
However, given the high level of discomfort (89%) of
the participants on the 3rd experimental day, it is pos-
sible that behavioral acclimation contributed to the
reduction in time spent; that is, there was a conscious
adjustment to situations of thermal discomfort [21,
57]. Thus, the students reduced the execution time of
activities with the goal of leaving the uncomfortable
environment faster.
When thermal variation causes discomfort to stu-
dents, thermal variation may render students unable
to adequately develop cognitive skills, thus hindering
concentration and learning. Although, it is important
to remember that to maintain proper cognitive per-
formance even in uncomfortable environments, the
 J.C.F. Siqueira et al. / Analysis of air temperature changes on BP and HR
execution speed is more commitment than the accu-
racy of the activity performed [58, 59]. This can be the
reason of the differences between the running times
but not in the number of hits each subtest.
Studies must reach a better understanding of the
role of cardiac variables in cognitive performance,
particularly through monitoring the same parameters
that were adopted in this study but with more thor-
ough cardiac tests (including ECG and ambulatory
BP monitoring).
Furthermore, studies that use samples without age
limits should be conducted to determine whether age,
together with cardiovascular and thermal variables,
may affect cognitive performance.
5. Conclusion
The increase in air temperature occurring in Brazil
as a result of climate change should be a focus
of research. In addition to that increase, the com-
puter laboratories in which this study was conducted
contain audiovisual resources, wireless technologies,
computers and air conditioning system, resulting in
an environment with various heat sources as well
as heat derived from the students themselves. The
sum of the above factors, the data collection per-
formed in these laboratories, and the development of
a generalized linear mathematical model of cognitive
performance as a function of thermal and cardio-
vascular variables enabled the following conclusion:
student performance will likely increase while per-
forming activities in a learning environment with an
air temperature of approximately 23.3◦ C (according
to their thermal perception), if students have an IMBP
of 93.33 mmHg (120 × 80 mmHgBP) and a 60bpm
HRmax, which are values considered normal by the
Brazilian Society of Cardiology (SBC, 2010).
Acknowledgments
The National Council of Scientific and Techno-
logical Development of Brazil (Conselho Nacional
de Desenvolvimento Cientı́fico e Tecnológico -
CNPQ) financially supported this project (No
404034/2013-6). The authors would like to thank the
following partner institutions: theTechnology Center
of Maurı́cio de Nassau University and the Institute
of Mathematical Sciences and Computing (Instituto
de Ciências Matemáticas e de Computação - ICMC)
of Sao Paulo University (Universidade de São Paulo
- USP). The authors would also like to thank the
53
subjects who participated in the experiments and the
members of CESET research group.
Conflict of interest
The authors have no conflict of interest to report.
References
[1] Fang L, Wyon D, Clausen G, et al. Impact of indoor air
temperature and humidity in an office on perceived air qual-
ity, SBS symptoms and performance. Indoor Air 2004;14:
74-81.
[2] Lan L, Wargocki P, Wyon DP, et al. Effects of thermal dis-
comfort in an office on perceived air quality, SBS symptoms,
physiological responses, and human performance. Indoor
Air 2011;21:376-90.
[3] Spector JM. Conceptualizing the emerging field of smart
learning environments. Smart Learn Environ 2014;1:2.
[4] Almeida RMSF, Freitas VP de. Indoor environmental qual-
ity of classrooms in Southern European climate. Energy
Build 2014;81:127-40.
[5] Primi R, Couto G, Almeida LS, et al. Intelligence, age and
schooling: Data from the Battery of Reasoning Tests (BRT-
5). Psicol Reflexão e Crı́tica 2012;25:79-88.
[6] Thorsen C, Gustafsson J-E, Cliffordson C. The influence
of fluid and crystallized intelligence on the development of
knowledge and skills. Br J Educ Psychol 2014;84:556-70.
[7] Ritter VM. Avaliação das condições de conforto térmico,
lumı́nico e acústico no ambiente escolar, no perı́odo de
inverno. Universidade Federal de Pelotas, 2014.
[8] Bernardi N. Environmental comfort in school buildings: A
case study of awareness and participation of users. Environ
Behav 2006;38:155-72.
[9] Heath GA, Mendell MJ. Do indoor environments in schools
influence student performance? a review of the literature.
Ernest Orlando Lawrence Berkeley Natl Lab 2002;7.
[10] Da Silva LB, Coutinho AS, Da Costa Eulálio EJ, et al.
School furniture and work surface lighting impacts on the
body posture of Paraı́ba’s public school students. Work
2012;42:579-87.
[11] Gilavand A. The impact of educational furniture of schools
on learning and academic achievement of students at ele-
mentary level. Int J Med Res Heal Sci 2016;5:343-8.
[12] Pawar PY, Khedkar EB. Review of Ergonomics practices in
difference Sectors. Int Res J Multidiscip Stud 2016;2:1-4.
[13] Hwang R-L, Lin T-P, Kuo N-J. Field experiments on ther-
mal comfort in campus classrooms in Taiwan. Energy Build
2006;38:53-62.
[14] Corgnati SP, Filippi M, Viazzo S. Perception of the ther-
mal environment in high school and university classrooms:
Subjective preferences and thermal comfort. Build Environ
2007;42:951-9.
[15] Lee MCC, Mui KWW, Wong LTT, et al. Student learn-
ing performance and indoor environmental quality (IEQ)
in air-conditioned university teaching rooms. Build Environ
2012;49:238-44.
[16] Yang Z, Becerik-Gerber B, Mino L. A study on student
perceptions of higher education classrooms: Impact of class-
room attributes on student satisfaction and performance.
Build Environ 2013;70:171-88.
54 J.C.F. Siqueira et al. / Analysis of air temperature changes on BP and HR
[17] Mendell MJ, Heath GA. Do indoor pollutants and ther-
mal conditions in schools influence student performance? A
critical review of the literature. Indoor Air 2005;15:27-52.
[18] Ickovics JR, Carroll-Scott A, Peters SM, et al. Health and
academic achievement: Standardized test scores among
Urban youth in the United States. J Sch Health 2014;
84:40-8.
[19] Cui W, Cao G, Park JH, et al. Influence of indoor air
temperature on human thermal comfort, motivation and per-
formance. Build Environ 2013;68:114-22.
[20] Higgins S, Wall K, Mccaughey C. The Impact of School
Environments: Produced for the Design Council. Des
Counc.
[21] Parsons KC. Maintaining health, comfort and productivity
in heat waves. Glob Health Action 2009;2:1-7.
[22] Wargocki P, Wyon DP. Providing better thermal and air
quality conditions in school classrooms would be cost-
effective. Build Environ 2013;59:581-9.
[23] Zhang Y, Zhang J, Chen H, et al. Effects of step changes of
temperature and humidity on human responses of people in
hot-humid area of China. Build Environ 2014;80:174-83.
[24] Cao B, Ouyang Q, Zhu Y, et al. Development of a multi-
variate regression model for overall satisfaction in public
buildings based on field studies in Beijing and Shanghai.
Build Environ 2012;47:394-9.
[25] Barrett P, Zhang Y, Moffat J, et al. A holistic, multi-level
analysis identifying the impact of classroom design on
pupils’ learning. Build Environ 2013;59:678-89.
[26] Lan L, Wargocki P, Lian Z. Quantitative measurement of
productivity loss due to thermal discomfort. Energy Build
2011;43:1057-62.
[27] Almeida LS, Primi R. Perfis de capacidades cognitivas na
bateria de provas de raciocı́nio (BPR-5): Capacidades cog-
nitivas e BPR-5. Psicol Esc e Educ 2004;8:135-44.
[28] Primi R, Almeida LS. Estudo de validação da bateria de
provas de raciocı́nio (BPR-5). Psicol Teor e Pesqui; 16.
Epub ahead of print August 2000. doi: 10.1590/S0102-
37722000000200009
[29] Burov O, Tsarik O. Educational workload and its psy-
chophysiological impact on student organism. Work
2012;41(Suppl 1):896-9.
[30] Liu W, Lian Z, Liu Y. Heart rate variability at different
thermal comfort levels. Eur J Appl Physiol 2008;103:361-6.
[31] Luque-Casado A, Zabala M, Morales E, et al. Cognitive per-
formance and heart rate variability: The influence of fitness
level. PLoS One 2013;8:e56935.
[32] Wharton W, Hirshman E, Merritt P, et al. Lower blood
pressure correlates with poorer performance on visuospa-
tial attention tasks in younger individuals. Biol Psychol
2006;73:227-34.
[33] Lyngdoh T, Viswanathan B, Kobrosly R, et al. Blood pres-
sure and cognitive function: A prospective analysis among
adolescents in Seychelles. J Hypertens 2013;31:1175-82.
[34] Bernardi L, Wdowczyk-Szulc J, Valenti C, et al. Effects of
controlled breathing, mental activity and mental stress with
or without verbalization on heart rate variability. J Am Coll
Cardiol 2000;35:1462-9.
[35] Hjortskov N, Rissén D, Blangsted AK, et al. The effect of
mental stress on heart rate variability and blood pressure
during computer work. Eur J Appl Physiol 2004;92:84-9.
[36] Vuksanović V, Gal V. Heart rate variability in mental stress
aloud. Med Eng Phys 2007;29:344-9.
[37] Schnell I, Potchter O, Epstein Y, et al. The effects of expo-
sure to environmental factors on Heart Rate Variability: An
ecological perspective. Environ Pollut 2013;183:7-13.
[38] Yao Y, Lian Z, Liu W, et al. Experimental study on phys-
iological responses and thermal comfort under various
ambient temperatures. Physiol Behav 2008;93:310-21.
[39] Yao Y, Lian Z, Liu W, et al. Heart rate variation and elec-
troencephalograph - the potential physiological factors for
thermal comfort study. Indoor Air 2009;19:93-101.
[40] Akimoto T, Tanabe S, Yanai T, et al. Thermal comfort and
productivity - Evaluation of workplace environment in a
task conditioned office. Build Environ 2010;45:45-50.
[41] Taelman J, Vandeput S, Vlemincx E, et al. Instantaneous
changes in heart rate regulation due to mental load in simu-
lated office work. Eur J Appl Physiol 2011;111:1497-505.
[42] Hübler M, Klepper G, Peterson S. Costs of climate change:
The effects of rising temperatures on health and productivity
in Germany. Ecol Econ 2008;68:381-93.
[43] SBC SB de C, SBH SB de H, SBN SB de N. VI
diretizes brasileiras de hipertensão arterial. Arq Bras Cardiol
2010;95:1-51.
[44] ISO 7726. Ergonomics of the thermal environment - Instru-
ments for measuring physical quantities. 1998.
[45] ISO 10551. Ergonomics of the thermal environment -
Assessment of the influence of the thermal environment
using subjective judgement scales. 1995.
[46] Vasconcelos PE de M. Estudo da relação entre variáveis
térmicas e o desempenho de estudantes da academia
de polı́cia militar do estado da paraı́ba. Dissertação de
Mestrado em Engenharia de Produção da Universidade Fed-
eral da Paraı́ba, 2013.
[47] Campos HR. Análise de Conteúdo e sua Relação com a
Dificuldade dos Itens da Bateria de Provas de Raciocı́nio
(BPR-5). Dissertação de Mestrado em Psicologia da Uni-
versidade São Francisco, 2005.
[48] ISO7730. Ergonomics of the thermal environment – Ana-
lytical determination and interpretation of thermal comfort
using calculation of the PMV and PPD indices and local
thermal comfort criteria. 2005.
[49] Tham KW, Willem HC. Room air temperature affects occu-
pants’ physiology, perceptions and mental alertness. Build
Environ 2010;45:40-4.
[50] Mishra AK, Ramgopal M. Field studies on human thermal
comfort: An overview. Build Environ 2013;64:94-106.
[51] Siqueira JCF, Neves AIA, Silva LB da, et al. Influence of air
temperature in cardiovascular parameters of undergraduate
students. CESET J 2015;21:1-12.
[52] ACSM. American College of Sports Medicine.
[53] SOBRAC SB de AC. BRADIARRITMIA.
[54] Lumingu HMM, Dessureault P. Physiological responses to
heat strain: A study on personal monitoring for young work-
ers. J Therm Biol 2009;34:299-305.
[55] Schellen L, Loomans MGLC, Kingma BRM, et al. The use
of a thermophysiological model in the built environment to
predict thermal sensation. Build Environ 2013;59:10-22.
[56] Rodrigues RM, Celiza JSF, Souza EL. Using bpr- 5 test to
analyze university students’ cognitive performance. CESET
J 2015;21:95-103.
[57] Bradshaw V. Human comfort and health requirements. In:
The Building Environment: Active and Passive Control Sys-
tems. New Jersey: John Wiley and sons Inc., 2006, pp. 3-38.
[58] Lan L, Wargocki P, Lian Z. Thermal effects on human per-
formance in office environment measured by integrating
task speed and accuracy. Appl Ergon 2014;45:490-5.
[59] Vimalanathan K, Babu TR. The effect of indoor office envi-
ronment on the work performance, health and well-being of
office workers. J Environ Heal Sci Eng 2014;12:113.
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