SynthesisBMC public health2021
Monitoring stress and allostatic load in first responders and tactical operators using heart rate variability: a systematic review.
Synthesis in BMC public health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
20 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Mapping smart technologies and nutritional strategies for monitoring cognitive resilience in military personnel under extreme operational conditions: a scoping review.Frontiers in nutrition · 2026Pooled it
- Occupation-Induced Fatigue and Impacts on Emergency First Responders: A Systematic Review.International journal of environmental research and public health · 2023Pooled it
- Does heart rate variability predict and improve performance in pediatric CPR?-a simulation study.BMC emergency medicine · 2025Trial
- Analysis of stress responses in medical students during simulated pericardiocentesis training using virtual reality and 3D-printed mannequin.Scientific reports · 2025Trial
- Work stress, dietary patterns and metabolic syndrome among military personnel in Ghana: a cross-sectional study.BMJ open · 2026Article
- Environmental conditions and cardiac autonomic function during an Antarctic summer expedition at James Ross Island.Scientific reports · 2026Article
- Human limits in next-generation fighter aviation: psychophysiological stressors, readiness, health, performance, and countermeasures.Frontiers in physiology · 2026Review
- Observational study of the effects of maximal oxygen uptake on cognitive function and performance during prolonged military exercise.BMJ military health · 2025Observational
- Review
- Changes in haemoglobin and ferritin levels during basic combat training: relevance for attrition and injury frequency.BMJ military health · 2025Article
- Intelligent Eye Tracker Integrated with Cylindrical Capacitive Sensors for Chronic Fatigue Assessment.Advanced sensor research · 2025Article
- Heart rate variability: a multidimensional perspective from physiological marker to brain-heart axis disorders prediction.Frontiers in cardiovascular medicine · 2025Review
- Ultra-short-term versus short-term measures of heart rate variability in specialist police units: A pilot reliability study.Physiological reports · 2025Article
- Heart rate variability is more sensitive to stress than heart rate in specialist police undergoing selection.PloS one · 2025Article
- Advancing the allostatic load model in military training research: from theory to application.Frontiers in physiology · 2025Review
- Psychophysiological insights and user perspectives: enhancing police de-escalation skills through full-body VR training.Frontiers in psychology · 2024Article
- Heart Rate Variability Assessment of Land Navigation and Load Carriage Activities in Specialist Police Selection.Healthcare (Basel, Switzerland) · 2023Article
- Higher Stress in Oncology Patients is Associated With Cognitive and Evening Physical Fatigue Severity.Journal of pain and symptom management · 2023Article
- Assessing Electroencephalography as a Stress Indicator: A VR High-Altitude Scenario Monitored through EEG and ECG.Sensors (Basel, Switzerland) · 2022Article
- Passive Heat Stress Affects Decision-Making, but not Situational Awareness and Executive Functioning in Virtual Simulations in Military Personnel.Chronic stress (Thousand Oaks, Calif.)Article
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAwareness of the cumulative stress placed on first responders and tactical operators is required to manage acute fatigue, which can impair occupational performance, and may precipitate negative chronic health outcomes. The aim of this review was to investigate the utility of heart rate variability (HRV) to monitor stress and allostatic load among these populations.
methodsA systematic search of Academic Search Complete, MEDLINE complete, PsycINFO, SPORTDiscus and Scopus databases was conducted. Eligibility criteria: original peer reviewed research articles, written in English, published between 1985 and 2020, using human participants employed as a first responder or tactical operator, free from any psychological disorder.
resultsOf the 360 articles screened, 60 met the inclusion criteria and were included for full text assessment. Articles were classified based on single or repeated stressor exposure and the time of HRV assessment (baseline, during stressor, post stressor). Singular stressful events elicited a reduction in HRV from baseline to during the event. Stressors of greater magnitude reduced HRV for extended durations post stressor. Lower resting HRV was associated with lower situational awareness and impaired decision-making performance in marksmanship and navigation tasks. There were insufficient studies to evaluate the utility of HRV to assess allostatic load in repeated stressor contexts.
conclusionA reduction in HRV occurred in response to acute physical and cognitive occupational stressors. A slower rate of recovery of HRV after the completion of acute occupational stressors appears to occur in response to stressors of greater magnitude. The association between lower HRV and lower decision-making performance poses as a useful tool but further investigations on within subject changes between these factors and their relationship is required. More research is required to investigate the suitability of HRV as a measure of allostatic load in repeated stress exposures for fatigue management in first responder and tactical operators.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.