Aerospace medicine and human performance最新文献

Introduction: Fighter pilots endure significant physical stress due to elevated gravitational forces, leading to a high prevalence of neck pain. The biomechanical loads and operational demands of high-gravitational maneuvers highlight the need for targeted interventions. Exercise training has been proposed to mitigate neck pain and enhance musculoskeletal resilience. This review examines the effectiveness of exercise interventions and identifies research gaps requiring further exploration.

Methods: A PRISMA-guided systematic review examined randomized controlled trials and longitudinal studies on fighter pilot neck pain exercise interventions. Databases searched included PubMed, Cochrane Library, Defense Technical Information Center, and Web of Science, with search terms such as "fighter pilot," "aircrew," "exercise," "neck pain," "cervical," "Gz," and "conditioning." Two independent reviewers selected studies based on population, intervention, outcomes, and design. There were 5 studies that met the inclusion criteria, involving 199 participants.

Results: The findings were mixed regarding the effectiveness of exercise interventions in reducing neck pain. Three studies reported significant pain reduction, while two found no significant changes. Programs incorporating deep cervical muscle training and supervised sessions demonstrated more consistent positive outcomes. Improvements in neck muscle strength and endurance were observed across all studies. Training compliance was higher in supervised (58-77%) than unsupervised (28-41%) programs.

Discussion: Exercise interventions, particularly strength and endurance training, show the potential to improve neck muscle function in fighter pilots. However, mixed results on pain reduction, small sample sizes, and varied methodologies limit generalizability. Future research should employ standardized definitions of flight-related neck pain and robust methods to develop tailored exercise protocols. Acevedo A, Zeigler Z. Exercise training and neck pain in fighter pilots. Aerosp Med Hum Perform. 2025; 96(5):425-430.

Introduction: The military aviation environment is inherently noisy, with occupational noise hazards from a variety of sources. At the same time, it demands good binaural auditory acuity and speech discrimination abilities for the safe and effective performance of flight duties. This study aimed to 1) examine the burden, characteristics, and severity of abnormal audiograms among military aircrew and ground-based aviation personnel in the Republic of Singapore Air Force; and 2) elicit the risk factors associated with abnormal audiograms.

Methods: In this cross-sectional study, anonymized data (sociodemographic information, pure tone audiometry thresholds, anthropometric and physiological measurements, and biochemical investigations) were extracted from all consecutive unique annual certification examinations performed between January 1 and December 31, 2022. Multivariable logistic regression was performed to identify statistically significant risk factors associated with abnormal audiograms.

Results: Of the 1817 audiograms, 83 (4.6%) were abnormal based on the modified World Health Organization criteria. Abnormal audiograms featured an early bilateral high-frequency hearing loss pattern characteristic of noise-induced effects. The multivariable model retained only age and four vocations [i.e., Communication Equipment Specialist, Air Force Engineer (Flight Engineer), Air Warfare Officer (Air Battle Manager), and Unmanned Aerial Vehicle Pilot] as significant risk factors. Neither aircraft platforms nor specific engine types were associated with higher odds of developing abnormal audiograms.

Discussion: This study suggests that the modified World Health Organization criteria are useful in identifying at-risk subgroups within the military aircrew population and could be considered for use as a more sensitive screening threshold for early noise-induced hearing loss. Seah BZQ, Ng WT, Gan WH, Low JW, See B. Abnormal audiogram risk factors in military aircrew and ground-based aviation personnel. Aerosp Med Hum Perform. 2025; 96(5):378-385.

Introduction: This study examines the health status of pilots above age 60 and its impact on the workforce, focusing on those not returning to work.

Methods: Pilots from a major Japanese airline reaching age 60 between 2008-2013 were studied for the subsequent 5 yr ("senior pilots"). Disqualifying diseases, application for Aviation Medical Review Board (AMRB), disposition, and grounding periods during the 5 yr were compared with those of a pilot cohort reaching age 55 during the same period ("non-senior pilots").

Results: There were 263 senior and 202 non-senior pilots. For AMRB cases, cardiovascular diseases were significantly more common in senior pilots compared with non-senior pilots (10.3 vs. 4.0%, respectively). Senior pilots were less likely to apply for AMRB (9.9 vs. 3.5%) or return to work, i.e., the sum of those who were denied by and who did not apply for AMRB (12.2 vs. 5.0%) and also had a higher incidence of cardiovascular diseases (4.6 vs. 1.0%). The grounding period of those not returning to work within the 5-yr study period was significantly longer than the temporary grounding period in both groups of pilots (senior: 22.3 ± 15.7 vs. 6.3 ± 4.7 mo; non-senior: 24.2 ± 17.2 vs. 7.5 ± 8.6 mo, as mean ± SD, respectively).

Discussion: Medical disqualification in senior pilots is more frequent than with younger pilots and may have a greater impact on crew availability. Looking at ways of increasing the number of older pilots returning to work would benefit crew availability as would a focus on the prevention of cardiovascular diseases. Takazoe K, Gomi H. The health status of pilots over age 60 at a Japanese airline. Aerosp Med Hum Perform. 2025; 96(5):392-398.

Introduction: Expeditions in remote locations are becoming increasingly commonplace. As the composition of teams change, understanding team dynamics is important to inform subsequent expeditions in challenging environments.

Methods: Eight individuals (five men, three women; five military, three civilians) completed a ski expedition from the Ronne Ice Shelf to the South Pole over 47 d. A mixed methods observational cohort study was undertaken, involving completing pre-expedition Multidimensional Personality Questionnaires and Portrait Values Questionnaires. During the expedition individuals completed the Isolated and Confined Environments Questionnaire and the Positive and Negative Affect Scale at 7-d intervals. Subsequent semistructured interviews using a topic guide informed by Goffman's "total institution" were conducted and analyzed using reflexive thematic analysis.

Results: Multidimensional Personality Questionnaire and Portrait Values Questionnaire responses were similar between participants. The Isolated and Confined Environments Questionnaire results showed significant variation with no clear trend. Statistical significance was seen in social and emotional domains between sex and occupations. Positive and Negative Affect Scale scoring demonstrated higher positive affect (mean ± SD; 38.9 ± 1.5) to negative (13.1 ± 1.3). Subgroup analysis demonstrated significance for negative affect between sexes (one result skewed the data). The interviews highlighted that individuals found the routine and lack of personal space challenging. Interpersonal relationships were a source of support but also friction.

Discussion: Despite similar initial questionnaires and experiences during the expedition, subjects used a diverse range of coping strategies. Interpersonal factors remain the most important aspect in ensuring a successful team and pre-expeditionary work should be carried out focusing on this. Harper P, Albertsen N, Koivula F, Greenfield S, Thomas N. Psychological adaptation in a mixed sex and ability team during a ski expedition to the South Pole. Aerosp Med Hum Perform. 2025; 96(5):399-406.

Introduction: Real-time monitoring of pilots through physiological responses may provide a means of identifying onset of degraded states. This could potentially be used to introduce methods of preventing negative impacts to performance. However, few studies to date have examined whether quantitative physiological data can successfully be recorded in actual flight, with even fewer during extreme maneuvering.

Methods: An observational study was completed where physiological data was collected from three Army aviators while they completed an upset prevention and recovery training. The training was through a private company not affiliated with the Department of Defense. Subjects completed multiple flights within a small, acrobatic fixed-wing aircraft. Physiological data [electroencephalography (EEG) and electrocardiography] were recorded continuously in flight.

Results: The physiological data were evaluated for signal loss and signal quality. The electrocardiography signals were determined as excellent quality based on the metrics proposed previously, with minimal signal loss. Similarly, the EEG recordings had near zero loss of data, except for one of the participant's flights. The EEG quality was determined to be acceptable.

Discussion: This study demonstrates an important step in real-time monitoring. It was demonstrated that qualitative physiological data can successfully be recorded in flight during extreme maneuvering. Further research is needed to determine the utility of such data in relation to pilot state and performance. Demonstration that this type of data can be successfully collected in flight while pilots undergo extreme maneuvers provides promise for using these types of measures across a variety of flight scenarios where a pilot's cognitive states may become degraded. Yue X, Andres K, Duffy MJ, Rodriguez R, Aura CJ, Feltman KA. Measuring pilot physiology during in-flight training and implications for real-time monitoring. Aerosp Med Hum Perform. 2025; 96(5):447-452.

Introduction: Operators of rotary wing aircraft and high-performance jet aircraft often face musculoskeletal pain and cervical spine injury risks due to flight-related factors, including heavy vibrational and g-loading, abrupt head maneuvering, and a large number of flight hours. This study explores the use of a portable lightweight resistance band exercise device (PLED) to strengthen and stretch neck musculature, potentially mitigating these risks.

Methods: A multi-aircraft study building on an initial pilot study of 10 high-performance jet aircraft aviators involved both active-duty aviators and civilians. Over 6 wk, subjects engaged in targeted PLED-based exercises. Baseline and endpoint measurements were obtained. Quantitative measurements assessed range of motion (ROM) and endurance, while Visual Analog Scale reports tracked pain. A total of 47 subjects consented, with 26 completing the protocol. There were 21 subjects who were either lost to follow-up or withdrew due to scheduling conflicts.

Results: Analysis of this interventional study showed significant ROM improvement, increased muscular endurance, and reductions in pain magnitude. Subjects reported improvements in flexibility, strength, stiffness, and pain relief. Active-duty aviators noted improved ROM, quicker postflight recovery, and reduced in-flight pain.

Discussion: This collaborative Department of Defense-academia-Department of Veterans Affairs research highlights the effectiveness of regular PLED-based cervical musculature exercises in enhancing ROM and endurance. While promising, further research with larger datasets is needed to support definitive recommendations. Moreover, the study's findings may benefit a broad population engaging in activities that stress the cervical spine and surrounding musculature. Keller RJ, Rosenthal R, Dalal S, O'Conor D, Ramachandran V, Vandeven S, Butler N, Shivers B, Shender B, Jones JA. Exercise regimen for mitigation of neck pain in military aircrew and support personnel. Aerosp Med Hum Perform. 2025; 96(4):314-321.

Introduction: Facial hair is prohibited for most airline pilots because of the widespread belief that the seal on oxygen masks might be rendered ineffective, preventing aircrew from performing their duties during emergencies.

Methods: Continuous oximetry recordings were made every second from 24 volunteers wearing a standard commercial airline mask in 1 of 3 beard conditions: no beards, short beards (<10 mm in length), and long beards (>10 mm in length) in a normobaric hypoxia chamber at 30,000 ft (10,000 m). Masks were worn in the chamber for about 10 min before being removed for about 2 min to experience hypoxia. Once returned to normoxia, volunteers were exposed to smelling salts held directly under the chin.

Results: None of the beard conditions differed in the time to don the masks. There were no differences in the arterial saturation percent of oxygen (Spo2) between beard conditions for either mask-on or mask-off segments in the chamber. There were significant differences in Spo2 between the mask-on segment and the mask-off segment, indicating that hypoxemic conditions would have been detected had the masks been ineffective.

Discussion: Using a current on-demand airline oxygen mask, Spo2 levels were never compromised by any of the beard conditions. Because the highly volatile smelling salts were imperceptible through the masks, smoke and other noxious irritants would not be perceived. These results support the contention that airline pilots with beards of any length would not be impaired by hypoxia or smoke while dealing with an in-flight emergency. French J, Wagner SD. Beard length and the efficacy of an aviator oxygen mask. Aerosp Med Hum Perform. 2025; 96(4):322-326.

Introduction: This study systematically explores the effects of self-administered physical exercise training on alleviating flight-associated neck pain and improving functional outcomes in military pilots.

Methods: PubMed, Cochrane Library, Web of Science, Embase, Scopus, China National Knowledge Infrastructure, and the Chinese biomedical literature service system (SinoMed) were searched from inception to September 18, 2024. Standardized mean differences (SMD) or mean differences (MD) and 95% confidence intervals (95% CI) were calculated and data pooled using fixed or random effects models.

Results: Included were 7 studies involving 366 patients having neck pain. Military pilots who underwent self-administered physical exercise training showed a significant reduction in their Visual Analog Scale scores (SMD = -0.25, 95% CI: -0.47 to -0.03). The maximum voluntary contraction (MVC) of neck extension and flexion in military pilots did not increase significantly after self-administered physical exercise training (extension MVC, MD = 3.00, 95% CI: -1.33 to 7.33; flexion MVC, MD = 1.12, 95% CI: -2.12 to 4.36).

Discussion: Self-administered physical exercise training is an effective method for alleviating flight-associated neck pain in military pilots. However, its effectiveness in improving neck function among military pilots remains uncertain. Chen H, Wang M, Li J, Wang X, Fu Y, Gao B. Self-administered physical exercise training and flight-associated neck pain in military pilots. Aerosp Med Hum Perform. 2025; 96(4):339-349.

Introduction: New computerized color vision tests are gaining popularity in the aviation community. These tests determine color vision status by measuring chromatic sensitivity and they can effectively classify color vision as normal vs. abnormal. However, little information is available regarding their repeatability. We evaluated the repeatability of two such tests: the Operational Based Visual Assessment Cone Contrast Test (OCCT) and the Rabin Cone Contrast Test (RCCT).

Methods: A total of 56 subjects with normal color vision and 63 subjects with defective color vision completed both tests twice over 2 sessions. We determined the repeatability for a normal/abnormal result, between-eye differences in thresholds within a session, and between-session results for each eye.

Results: Both tests had excellent repeatability for normal vs. abnormal color vision (i.e., using a cutoff score of 75 Rabin Color Contrast Sensitivity Units). The OCCT also had excellent repeatability for acceptable vs. unacceptable color discrimination (i.e., a cutoff score of 55), whereas the RCCT repeatability was lower. The RCCT's lower repeatability was because the between-eye and between-session Limits of Agreement for the color-defective subjects were approximately ±40 relative sensitivity units. In contrast, the Limits of Agreement for the OCCT ranged from ±10 to ±15.

Discussion: These results reinforce the advantage of using a finer stimulus change when estimating cone thresholds in the clinical setting. Hovis JK, Almustanyir A, Glaholt M. Repeatability of cone contrast color vision tests. Aerosp Med Hum Perform. 2025; 96(4):287-295.

Introduction: The present study aimed to investigate changes in risky behavior in a sample of 36 healthy men during a 90-d head-down bed rest (HDBR) experiment and examined whether psychological factors-general self-efficacy, stress, and recovery-could influence these changes.

Methods: Subjects completed the Balloon Analog Risk Task (BART) and two psychological scales once during the acclimation period, six times during the HDBR period, and twice during the recovery period. During the HDBR period, subjects were required to maintain a -6° head-down position for most daily activities and only permitted to change positions around the longitudinal axis of their bodies.

Results: The results demonstrated that subjects' risk-taking behaviors were significantly affected by bed rest, with an increased propensity to engage in risky activities during the head-down stage. In addition, BART scores did not return to baseline when subjects entered the recovery stage. In terms of psychological variables, the results indicated that scores of general self-efficacy and recovery were negatively correlated with BART indicators, while stress levels were positively correlated with risky behaviors. Compared to other psychological variables, the perceived physical stress, including fatigue, somatic complaints, and sleep quality, exhibited the strongest correlations with BART indicators.

Discussion: The findings of this study implied that prolonged exposure to a simulated microgravity environment and confined isolation conditions may have a sustained impact on risk-taking tendencies, with changes in risky behaviors in the head-down state more closely associated with physiological symptoms. He X, Lei Y, Xu Z, Li K, Nicolas M, Wu R, Li Y. Changes in risky behavior in long-term head-down bed rest and relation to psychological status. Aerosp Med Hum Perform. 2025; 96(4):304-313.