Aim to assess the importance of managerial support from superior, colleagues, external, employees and private life and its importance for managers’ health- related sustainability Background. Managers and leadership can have a great importance for employees’ health related sustainability. Few published studies, have investigate what kind of support managers need to sustain in their position with preserved health. Design. A prospective cohort study with data collection 2009 and 2011. Methods. All first and second line managers for public health care in seven Swedish municipalities were included (n=344). Managers’ health related sustainability and support resources were measured with Gothenburg Manager Stress Inventory. Analysis with structured equation modeling with a crossed-lagged panel design. Results. All of the studied sources of support were cross-sectional associated with sustainable health, but only support from private life predicted health related sustainability across time. Stratified analyses revealed further prospective associations. First, among less experienced managers, all of the studied sources of support predicted at least some aspect of health-related sustainability. Second, among managers with a large span of control (>30 subordinates), external support and support through good cooperation with subordinates predicted health-related sustainability. Conclusion. It is important to provide health care mangers with adequate support, but only support through private life predicted health-related sustainability. Socializing as well as organisational support was strongly predicting sustainable health among managers new in their role and managers with a large span of control.