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Search Strategy and Screening issue until they agreed. Both authors (RBO, LS) developed a
The authors (RBO, LS) performed a three-step search strategy data extraction form, which was pilot tested before the data-
recommended by the JBI for all scoping reviews. 15,16 An initial base search and then revised after each reviewer appraised a
limited database search was conducted using the Cochrane Li- minimum of three articles. The final list of research data char-
brary, PubMed, and the DTIC for studies related to the topic, acteristics extracted and evaluated from all articles included
questions, and objectives of this scoping review. For the sec- (1) author(s) and year, (2) article type, (3) primary aim, (4)
ond database search, we used the index terms and keywords method, and (5) key outcomes.
from the articles we located for inclusion during the initial
search. Finally, we reviewed additional relevant reference lists
of the eligible full-text articles. Results
Figure 1 shows the scoping review flowchart for selecting
For our initial search in PubMed, we included the following sources. Articles were screened for eligibility, based on the es-
article types: books and documents, case reports, clinical stud- tablished inclusion criteria. Seventy-two articles were included
ies, evaluation studies, historical articles, introductory jour- for extensive review. Articles selected for inclusion consisted
nal articles, meta-analyses, observational studies, randomized of the following: primary research articles (n = 23), reviews
controlled trials, original reviews, systematic reviews, and De- (n = 25), DTIC reports (n = 3), observational studies (n = 1),
partment of Defense technical reports published between 31 perspective articles (n = 1), systematic reviews (n = 6), book
December 1993 to 31 December 2021. chapters (n = 2), dialogue articles (n = 2), meta-analyses (n
= 2), manuals (n = 1), consensus articles (n = 3), hypothesis/
The first search terms entered into PubMed pertinent to this theory articles (n = 1), abstracts (n = 1), white papers (n = 1),
scoping topic were “physiological, psychological, stress in and opinion articles (n = 1).
Special Forces,” which produced four articles; three were
retrieved for further analysis of the text words used in the FIGURE 1 Scoping review flowchart.
title and the index terms that described the articles. For the 36,032 potential articles
second search in PubMed, we entered “Performance, health, identified through the databases 142 duplicates excluded
recovery, Special Forces,” which generated 35 articles related 1) PubMed (n=714)
to the scoping topic; 4 were retrieved for further analysis of 2) Cochrane Library (n=22,108)
text terms and index terms. Our third search in PubMed was 3) DTIC (n=13,210)
related to the review question, which was entered as “Fac-
tors, health, physical, performance, Special Forces,” which
produced 21 articles related to the primary scoping question; 35,890 titles screened 35,675 records excluded
two were retrieved for further analysis of text words and index
terms. Our final search in PubMed was related to “interven-
tions” and “allostatic load.” For “interventions,” we entered
the search terms “performance, recovery, monitoring,” which 215 abstracts screened 123 records excluded
generated 363 articles; 13 were retrieved for further analysis.
Finally, the search term “allostatic load” produced 291 arti-
cles; 40 were retrieved for further analysis. 92 full-text articles 19 articles excluded based
assessed for eligibility on inclusion criteria
We performed an advanced title, abstract, and keyword search
in the Cochrane Library for articles published from 31 Decem-
ber 1993 to 31 December 2021. Search limits consisted of Co-
chrane Reviews, Cochrane protocols, Clinical Answers, and 72 articles included in review
after final analysis
Special Collections using the word variations (physiological
3 articles identified
OR psychological OR stress OR Special Forces) AND (per- through reference lists
formance OR health OR recovery OR Special Forces) AND of included articles
(factors OR health OR performance OR Special Forces) AND
(interventions OR performance OR recovery OR monitoring) DTIC, Defense Technical Information Center.
AND (allostatic load OR overload OR stress) which gener-
ated 22,108 potential articles. We followed a similar search Discussion
strategy sequence in the DTIC database under the Department Allostasis
of Defense Science and Technology reports icon and selected Allostasis occurs when the body, to counteract acute threats,
the Department of Defense technical report PDF documents, alters physiologic parameters via the output of stress hormones
which resulted in 13,210 technical reports. that allow the organism to achieve stability through change. 11,18
For example, the heart maintains its rate in a stressful environ-
Source Selection and Data Analysis ment at levels not typically held in a non-stressful environ-
The authors (RBO, LS) independently reviewed titles and ment. This response comes with an added energy cost through
abstracts that were included from the initial database search anticipation of the challenge/threat known as “brain-pull.”
against inclusion criteria, then searched and selected full-text Brain-pull is a condition in which the brain actively demands
articles meeting the inclusion criteria. Articles were then inde- energy from the body to meet the acute threat. When expo-
19
pendently appraised by both authors (RBO, LS) using the JBI sure to stress is chronic, the brain-pull response is prolonged.
Critical Appraisal Checklist for Systematic Reviews and Re- Repeated or prolonged activation of these brain-pull mecha-
search Syntheses. When there were disagreements regarding nisms during chronic stress may lead to the accumulation of
17
the overall appraisal process, both reviewers met to discuss the visceral fat (i.e., internal fat storage) and loss of subcutaneous
Physiological and Psychological Stressors | 141