Page 144 - JSOM Summer 2022

is not uncommon for an SO with ten years or more of opera- lifestyle (e.g., poor nutrition) stressors it can lead to a state
tional experience to have had up to fifteen combat deployments, of allostatic overload where an SOs’ performance and mis-
including hundreds of individual direct-action missions. 1-3,9 In sion readiness is degraded over time. Allostatic overload often
fact, SOs may be in direct action every night for days, not re- manifests as chronic health problems that significantly impede
12
turning to the Forward Operating Base for weeks. SOs are SOs’ ability to sustain peak performance. 5-9
also exposed to an array of other mission- related stressors to
include 1) extended patrols while wearing heavy gear, 2) rou- While some levels of anxiety may be considered good for max-
tinely lifting and pulling heavy equipment, 3) working in awk- imizing performance, an unmanageable level of chronic anxi-
ward positions for hours, 4) convoy operations that require ety may worsen performance in SOs over time. High allostatic
sitting for prolonged durations while wearing heavy combat load may lead to over activation of the sympathetic nervous
gear, and 5) exposure to extreme conditions for prolonged pe- system, which constantly oscillates until the stressful situation
10
riods that must be endured until the job is completed. 1-3,6 abates. When the stress persists and becomes chronic, neu-
ronal excitability becomes variable or elevated and catabolic
To mimic the allostatic load of modern warfare, SOs train un- hormones are released into the blood. Chronic stress may also
4
der very stressful conditions. Nindl et al. studied the physio- lead to unhealthy lifestyle behavioral changes such as poor nu-
logical consequences of Ranger School on strength, power, and trition/diet, decreased physical activity, tobacco and alcohol
body composition. He found that Ranger School students sleep use, disruptions in circadian rhythm, and insufficient sleep du-
an average of only 3.6 hrs/day, experience acute caloric deficits, ration and quality. 11
and chronically expend more energy than consumed (e.g., net
4
caloric loss) for the majority of the 8-week course. This type of The acute effects of training and deployment on SOs are well
2-9
training and the physiological consequences of such activity are described in the literature. However, there is a lack of re-
analogous across all special operations commands. 1,4 views describing the long-term effects of stressors on SOs and
the types of performance recovery monitoring that may elu-
The combined training and constant deployment demand cidate the harmful effects of these stressors. Thus, this scop-
on SOs throughout their career result in a chronically high ing review focuses on factors that affect performance, health,
burden of physical and psychological stress. 9, 14 SOs may also and recovery in SOs. It provides postulates as to the biological
experience continual overexposure to internal and external mechanisms for OTS and allostatic overload in the SO popula-
stressors, leading to significant degradations in performance tion and insights on a multidimensional performance recovery
and health. Stress is a “threat, real, or implied to an individ- tracking (MDRT) model.
ual’s psychological or physiological integrity.” 13[p.2094] The au-
tonomic nervous system (ANS) and adrenocortical system are The primary objectives of this review were (1) to identify
the regulators of the stress reaction to which all other systems and expound the various types of physiological and cognitive
in the body may react. Both serve as protectors of bodily func- stressors affecting SO performance and health, and (2) to in-
tions in the short term but can hasten the disease process in the vestigate the potential benefits of a MDRT model, including
long term if not managed appropriately. 10, 13 performance physiology, psychological function, biomarkers,
and functional movement.
There are essential differences in how acute versus chronic
stress can manifest into stress-related diseases. Understand- Our primary question for this scoping review was (1) what
ing these differences is necessary when attempting to lessen types of physiological and psychological stressors affect long-
the impact of stressors on SOs. Stress should be viewed as a term performance and health in SOs? In addition, a sub-
conceptual and methodological basis for describing the phys- question was (2) what recovery tracking approaches deserve
iological and behavioral factors and mechanisms which lead further exploration in ameliorating chronic physical and cog-
to the disruption of standard biological systems, structures, nitive overload in SOs?
routines, and functions. These factors consist of genotypical,
intrinsic traits, or environmental, extrinsic factors, such as life
experiences, living and working environments, exercise, inter- Methods
15
personal relationships, sleep habits, diet, education, and other This scoping review fulfilled the PRISMA-ScR. For this scop-
lifestyle factors. 9 ing review, we followed the JBI guidance for the conduct of
scoping reviews published in the JBI Manual for Evidence
16
The normal physiological and cognitive load of an SO ap- Synthesis. This review is not registered in the JBI database
proaches, and often extends beyond, physiological limits, for reviews and implementation. However, this review can be
depending on the environment, type and duration of the acquired on request from the corresponding author. 1
mission. 1,4-6 This may lead to an allostatic imbalance known
as overtraining syndrome (OTS) that begins to emerge over Inclusion Criteria
weeks, months, or years. OTS is a chronic imbalance between Primary, secondary, and tertiary articles were eligible for inclu-
recovery and allostatic load, and without adequate periods sion and had to be written in English. Peer-reviewed and non–
of respite can manifest into long-term impairments in physi- peer-reviewed articles were eligible for inclusion and had to
ological and psychological functionality. Over time, OTS may address the scoping review’s primary and secondary questions
manifest in SOs who have deployed many times and engaged and objectives. Articles that focused on “interventions,” such
in rigorous training but did not receive adequate periods of as performance and recovery monitoring, and “phenomena of
respite following such intense events. interest” as to the biochemical mechanism of OTS, were eli-
gible for inclusion. Finally, articles that adequately described
When the body experiences an unmanageable level of chronic OTS and allostatic load in athletes or US Military Special
internal (e.g., anxiety), external (e.g., austere conditions), and Forces were eligible for analysis.

140 | JSOM Volume 22, Edition 2 / Summer 2022