Page 68 - JSOM Winter 2022

“athletes,” “sleep,” “physical functional performance,” “pain,” current narrative review focused on understanding whether
“humans,” “exercise,” and “athletic performance.” Addition- there is evidence to support the use of FR to enhance physio-
ally, reference lists of the retrieved articles were assessed for logical and psychological performance parameters in the SO
potential inclusion. population and to provide postulations as to the mechanisms
of action of FR therapy.
Study Selection and Data Extraction
The inclusion criteria for selecting articles were limited to The operational tempo for SOs has increased, resulting in
16
those published in English and to studies that used FR as an in- more frequent combat deployments and missions. To meet
tervention to improve well-being and performance in healthy the operational environment’s unique physical, emotional,
and unhealthy adults and athletes. We combined the initial key and environmental demands, SOs train rigorously and con-
terms with “flotation REST.” We performed a final search us- tinuously. However, this can lead to interconnected health
ing the following central search terms for all databases: “flota- problems and degradations in performance. 16,17 For instance,
17
tion REST adults,” “flotation REST athletes,” “flotation REST Freuh et al. reported that prolonged exposure to extreme
sleep,” “flotation REST physical functional performance,” environmental conditions and training creates situations in
“flotation REST pain,” “flotation REST humans,” “flotation which traditional medical models of healthcare are often inef-
REST exercise,” and “flotation REST athletic performance.” fective in treating the interrelated health disorders frequently
The first two authors (RO, LS) independently searched pri- reported in SOs. Comorbid conditions include traumatic brain
mary and secondary sources, screened titles and abstracts, and injury, endocrine dysfunction, sleep disturbance, sleep apnea,
evaluated the full text of published articles potentially relevant depression, suicide, anger, stress reactivity, chronic joint/back
to the narrative topic and aims. pain, orthopedic issues, worry, rumination, hypervigilance,
decrements in memory and concentration, and headaches.
17
Without precisely timed restoration and recovery periods, the
Results
overall performance degradations of SOs will likely progress
The online database searches produced 39 primary and sec- to injury and other health-related issues. 16,17
ondary articles in PubMed and 55 in the Cochrane Library.
We included 34 in the narrative review (Figure 1). 13-15 The in- Traditional Recovery Interventions
cluded articles consisted of conference abstracts (n = 2), a phe- Elite athletes utilize many postexercise strategies to lessen the
nomenological study (n = 1), a meta-analysis (n = 1), original physical and mental stress typically incurred from high train-
research studies (n = 18), literature reviews (n = 9), system- ing loads. Recovery strategies include consuming carbohy-
atic reviews (n = 2), and an advanced-level independent thesis drates and protein, stretching, massage therapy, hydrotherapy,
(n = 1). use of compression garments, cryotherapy, and neuromuscular
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stimulation. 18-20 DuPoy et al. published a meta-analysis com-
FIGURE 1 Flow chart of literature selection. paring the effects of a single session of varying recovery strat-
egies (e.g., active recovery, stretching, compression garments,
Records identified from the Additional records identified
electronic databases through other sources cryotherapy) and their effects on perceived muscle soreness,
(n = 94) (n = 4) perceived fatigue, and biological markers of muscle damage
and inflammation in healthy adults 19 to 64 years old. Mas-
sage therapy was cited as the most effective recovery strategy
for ameliorating delayed-onset muscle soreness and perception
Records after duplicates removed
(n = 98) of muscle fatigue, regardless of the participant’s status (e.g.,
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athletic, sedentary). As reported by Morgan et al., several
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of these recovery interventions have been systematically re-
searched and are associated with enhanced postexercise recov-
Records screened Records excluded ery. However, these forms of recovery pose limitations, such
(n = 98) (n = 6) as the risk of further tissue damage with massage, extreme
discomfort from cryotherapy, and the expense of specialized
compression garments. Collectively, the recovery interventions
Articles reviewed for Articles excluded are reported to have a small effect size. 20,21
potential inclusion (n = 58)
(n = 92) Reasons: Impact of FR on Relaxation Response
Not directly related
to flotation-REST, Effective recovery modalities elicit a relaxation response (RR).
mechanisms, population, For example, Bood et al. reported that two conditions must oc-
6
or performance
Total articles included (n = 58) cur to initiate the RR: (1) reduction of all external stimuli and
(n = 34) (2) limited bodily movement. These conditions subsequently
elicit activation of the parasympathetic nervous system, result-
ing in reduced heart rate response, the diminished release of
Discussion
hormones epinephrine and cortisol, and reductions in resting
7
Although studies have evaluated the use of FR to address blood pressure. Although there are a variety of effective re-
physiological and psychological conditions and improve ath- covery/relaxation strategies, such as diaphragmatic breathing,
letic recovery and performance, there is a paucity of published mindfulness, and yoga, some participants report difficulty ini-
scientific studies on the potential short- and long-term phys- tiating the RR through the use of these active interventions,
6
ical and performance benefits of FR on specialized military which require learning a skill. However, this difficulty can be
populations. Nevertheless, evidence suggests that FR can pro- ameliorated through FR, which has been reported to passively
duce a wide range of benefits across a broad time scale. The induce the RR in these types of individuals. 6

66 | JSOM Volume 22, Edition 4 / Winter 2022