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Non-Modifiable Risk Factors for Stress Fractures in Military Personnel Undergoing Training: A Systematic Review.

ABSTRACT: A fracture, being an acquired rupture or break of the bone, is a significant and debilitating injury commonly seen among athletes and military personnel. Stress fractures, which have a repetitive stress aetiology, are highly prevalent among military populations, especially those undergoing training. The primary aim of this review is to identify non-modifiable risk factors for stress fractures in military personnel undergoing training. A systematic search was conducted of three major databases to identify studies that explored risk factors for stress fractures in military trainees. Critical appraisal, data extraction, and a narrative synthesis were conducted. Sixteen articles met the eligibility criteria for the study. Key non-modifiable risk factors identified were prior stress fracture and menstrual dysfunction, while advancing age and race other than black race may be a risk factor. To reduce the incidence of stress fractures in military trainees, mitigating modifiable risk factors among individuals with non-modifiable risk factors (e.g., optimising conditioning for older trainees) or better accommodating non-modifiable factors (for example, extending training periods and reducing intensity to facilitate recovery and adaptation) are suggested, with focus on groups at increased risk identified in this review.

SUBMITTER: Lennox GM

PROVIDER: S-EPMC8744653 | biostudies-literature | 2021 Dec

REPOSITORIES: biostudies-literature

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Non-Modifiable Risk Factors for Stress Fractures in Military Personnel Undergoing Training: A Systematic Review.

Lennox Grace M GM Wood Patrick M PM Schram Ben B Canetti Elisa F D EFD Simas Vini V Pope Rodney R Orr Robin R

International journal of environmental research and public health 20211231 1

A fracture, being an acquired rupture or break of the bone, is a significant and debilitating injury commonly seen among athletes and military personnel. Stress fractures, which have a repetitive stress aetiology, are highly prevalent among military populations, especially those undergoing training. The primary aim of this review is to identify non-modifiable risk factors for stress fractures in military personnel undergoing training. A systematic search was conducted of three major databases to ...[more]

PMID: 35010681

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Project description:IntroductionMilitary personnel are required to undertake rigorous physical training to meet the unique demands of combat, often leading to high levels of physiological stress. Inappropriate recovery periods with these high levels of physical stress may result in sub-optimal training and increased risk of injury in military personnel. However, no reviews have attempted to examine the magnitude of training-induced stress following military training activities. The aim of this systematic review was to assess the magnitude of physiological stress (physical, hormonal, and immunological) following task-specific training activities in military personnel.MethodsAn extensive literature search was conducted within CINAHL, PubMed, Scopus, SportDiscus, and Web of Science databases with 7,220 records extracted and a total of 14 studies eligible for inclusion and evaluation. Study appraisal was conducted using the Kmet scale. Meta-analysis was conducted via forest plots, with standard mean difference (SMD, effect size) and inter-trial heterogeneity (I2) calculated between before (preactivity) and after (12-96 hours postactivity) military-specific activities for biomarkers of physiological stress (muscle damage, inflammation, and hormonal) and physical performance (muscular strength and power).ResultsMilitary training activities resulted in significant levels of muscle damage (SMD = -1.28; P = .003) and significant impairments in strength and power (SMD = 0.91; P = .008) and testosterone levels (SMD = 1.48; P = .05) up to 96 hours postactivity. There were no significant differences in inflammation (SMD = -0.70; P = .11), cortisol (SMD = -0.18; P = .81), or insulin-like growth factor 1 (SMD = 0.65; P = .07) when compared to preactivity measures.ConclusionsThese findings indicate that assessments of muscle damage, anabolic hormones like testosterone, strength, and power are effective for determining the level of acute stress following military-specific activities. With regular monitoring of these measures, appropriate recovery periods may be implemented to optimize training adaptations and occupational performance, with minimal adverse training responses in military personnel.

Project description:Military personnel are often exposed to high levels of both physical and psychological challenges in their work environment and therefore it is important to be trained on how to handle stressful situations. The primary aim of this study was to examine whether military-specific virtual battle space (VBS) scenarios could elicit a physiological and subjective stress response in healthy military personnel, as compared to that of a virtual reality height exposure (VR-HE) stress task that has shown to reliably increase stress levels. Twenty participants engaged in two VBS scenarios and the VR-HE during separate sessions, while measurements of heart rate (HR), heart rate variability (HRV), respiration rate, and subjective stress levels were collected. Contrary to our initial expectations, analysis revealed that neither of the VBS scenarios induced a significant stress response, as indicated by stable HR, HRV, and low subjective stress levels. However, the VR-HE task did elicit a significant physiological stress response, evidenced by increased HR and HRV changes, aligning with previous research findings. Moreover, no discernible alterations were detected in cognitive performance subsequent to these stressors. These results suggest that the current VBS scenarios, despite their potential, may not be effective for stress-related training activities within military settings. The absence of a significant stress response in the VBS conditions points to the need for more immersive and engaging scenarios. By integrating interactive and demanding elements, as well as physical feedback systems and real-time communication, VBS training might better mimic real-world stressors and improve stress resilience in military personnel. The findings of this study have broader implications for stress research and training, suggesting the need for scenario design improvements in virtual training environments to effectively induce stress and improve stress management across various high-stress professions.

Project description:BackgroundPosttraumatic stress disorder (PTSD) is associated with sexual difficulties but the nuances of this relationship remain elusive. Research has increased in recent years, most notably following publication of several reviews in 2015.AimThis systematic review examines the relationship between PTSD and sexual difficulties in veterans/military personnel.MethodsA systematic review was conducted using PRISMA guidelines in PsycINFO and PubMed databases for studies examining a diagnosis of PTSD or PTSD severity in relation to a range of sexual difficulties. Forty-three studies were identified that met inclusion and exclusion criteria for this review.ResultsPTSD was associated with increased risk of experiencing at least one sexual difficulty. PTSD was most clearly associated with overall sexual function, sexual desire, sexual satisfaction, and sexual distress. Results were mixed for sexual arousal, orgasm function, erectile dysfunction, premature ejaculation, sexual pain, and frequency of sexual activity. PTSD symptom clusters of avoidance and negative alterations in cognition/mood were most commonly associated sexual difficulties. Few studies compared results by gender and trauma type.Clinical implicationsClinicians should inquire about sexual health in relation to PTSD symptoms and target avoidance and negative mood symptoms by incorporating sexual exposure assignments and sexual activation exercises when appropriate.Strengths & limitationsThis systematic review synthesizes an extensive literature that has grown substantially in the past 5 years and includes studies with low to moderate risk of bias. Limitations of the existing literature include challenges differentiating between PTSD and depression, inconsistent measurement of PTSD and trauma histories, inconsistent operationalization and measurement of sexual outcomes, and largely cross-sectional study designs.ConclusionPTSD is linked to a range of sexual outcomes. The current literature suggests that PTSD is associated with sexual difficulties related to both the sexual response cycle (ie, sexual desire) and one's emotional relationship to sexual activity (eg, sexual distress). More research is needed to increase confidence in findings. Bird ER, Piccirillo M, Garcia N, et al. Relationship Between Posttraumatic Stress Disorder and Sexual Difficulties: A Systematic Review of Veterans and Military Personnel. J Sex Med 2021;18:1398-1426.

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Non-Modifiable Risk Factors for Stress Fractures in Military Personnel Undergoing Training: A Systematic Review.

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Non-Modifiable Risk Factors for Stress Fractures in Military Personnel Undergoing Training: A Systematic Review.

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