Page 148 - JSOM Summer 2022

response to repeated acute stressors, lack of adequate recovery a yearly follow-up,” and “there is a need for regular standard-
between stress exposures, and their reaction to the perception ized check-ups” on an individual basis. 6
of these stressors may lead to NFO/OTS. 44
Multidimensional Recovery Tracking
Our second postulate as to the biological mechanisms for We propose the concept of multidimensional recovery tracking
NFO/OTS is explained by the basic principle of homeostasis, (MDRT) to address NFO/OTS. Based on our findings, both
which is an organism’s ability to maintain nearly constant in- objective (quantitative) and subjective (qualitative) monitor-
ternal conditions in response to external stimuli through self- ing should be considered in evaluating an individual’s adap-
regulatory processes. Hence, any biological factor (e.g., HR, tation to acute and chronic physiological and psychological
blood pressure level, core temperature, blood glucose level) stressors. 1,6,40 For example, collecting objective measures using
will continually oscillate around an organism’s minimum and wearable physiological monitoring devices and biomarkers,
maximum normal homeostatic range. 44,48 Homeostasis is not and qualitative measures such as validated and reliable short
constant; rather, it continually expands in response to internal response questionnaires, allow one to assess the whole person’s
or external agitation, extending its normal homeostatic range. response to both acute and chronic stimuli. MDRT should in-
Thus, the normal adaptive homeostatic range expands into a clude the following dimensions: (1) performance physiology,
positive or negative adaptive range. Adaptive homeostasis is (2) psychological function assessment, (3) biological markers,
“the transient expansion or contraction of the homeostatic and (4) functional movement assessment.
range for any given physiological parameter (e.g., heart rate,
blood pressure, core temperature) in response to exposure to Numerous researchers 49-53 have reported that the diagnostic
sub-toxic, non-damaging, signaling molecules or events, or assessments and types of wearable devices chosen for tracking
48
the removal or cessation of such molecules or events.” Thus, physiological measures should offer some degree of validity
adaptive homeostasis infers that there is no constant homeo- and reliability, provide telling data, and be easy to administer.
static set point but rather continual fluxes in an organism’s However, further exploration of the domains of MDRT is es-
response to internal and external stimuli. Therefore, based on sential to understand the unique conditions and challenges of
the adaptive homeostatic theory, we postulate that the exces- the SO community.
sive and repetitive exposures to stimuli (stressors) encountered
by SOs throughout their careers may result in chronic overac- The Performance Physiology Dimension
tivation of these positive and negative adaptive homeostatic Measuring performance capability is an ecologically valid
pathways, leading to limited or reduced capacity of the SO to measure of recovery but is not always practical. Decrements
6
regulate their transient adaptive responses to stimuli. in physical performance measures are considered the primary
marker for diagnosing OTS in athletes. However, investiga-
For example, according to Pomatto and Davies, “an aged tors highlight the difficulty in supporting and administering
48
organism, which has faced a lifetime of chronic or excessively performance tests in sports, especially in large groups of ath-
30
repetitive adaptive stimuli, relies upon constant activation of letes. Nonetheless, sports and exercise medicine practitioners
stress responses, with little or no ability to modulate adaptive can leverage the real-time data provided by wearable devices
48
homeostasis.” Therefore, we extend this theory to describe to tailor treatment and recovery to SOs individually. Further-
how NFO/OTS may develop in SOs. Simply put, continual more, and perhaps more importantly, by sharing this phys-
overactivation by SOs of these adaptive pathways may limit iological data with the SO, they will be able to directly see
their ability to extend their functional adaptive homeostatic the performance-enhancing effects of recovery technology and
range, ultimately leading to severely compressed adaptive other treatments provided, which provides a strong incentive
ranges, resulting in chronic low-grade stress. Finally, lack of for adopting recovery techniques. We have seen this “buy-in”
recovery between repeated acute stress exposures over time phenomenon happen in Special Operations Performance and
may manifest into chronic, long-term impairment in SO health Recovery, a performance enhancement and recovery program
and performance. at the Center for the Intrepid, when such data are shared with
54
SO participants. It is hypothesized that such knowledge will
Recovery Monitoring facilitate adoption by the SO of essential self-management
Individualized recovery strategies and commercial technolo- tools as well as help create a cultural shift toward recognizing
gies for objective monitoring may be the first step in addressing the importance of recovery and treatment in the SO commu-
the recurring problem of chronic stress burden, overtraining, nity. Nonetheless, published research on the early detection
and under-recovery in the SO community. 1,2,6,9 Considering the and amelioration of NFO and URS/OTS is presently lacking
biological uniqueness of each individuals’ NFO/OTS, recov- in the SO community; therefore, this area of research warrants
ery monitoring should begin in the early phases of the initial extensive exploration. 6
training of SOs. The baseline measures used for comparison
are essential for detecting early signs of overtraining to pre- Commercially available wearable devices can track important,
serve the performance and health of SOs. The importance of measurable factors affected by the training and operational
establishing standardized testing, combined with structured demands to which SOs are exposed. For example, heart rate
data aggregation in the SO community, is also essential. For variability (HRV) is an essential physiological variable that
example, according to Vrijkotte et al., elite military person- can indicate how an athlete responds to training stressors
6
nel, such as SOs, experience high operational turnover, and and subsequent recovery strategies over time. 55,56 HRV is the
the recovery component of performance is often abandoned variation in the time between heartbeats and measures ANS
to tactical training priorities. Therefore, they conclude, “to be health, which refers to the balance between the sympathetic
able to determine whether a Soldier is at risk to develop NFO/ (fight/flight) nervous system and parasympathetic (rest/digest)
OTS, health and performance status of military personnel con- branches. 56,57 The noninvasive measure of HRV using a wear-
cerning NFO/OTS should be checked at entry into service with able device is considered a valuable tool to effectively monitor

144 | JSOM Volume 22, Edition 2 / Summer 2022