{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T18:16:31Z","timestamp":1772561791630,"version":"3.50.1"},"reference-count":101,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2021,8,20]],"date-time":"2021-08-20T00:00:00Z","timestamp":1629417600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001871","name":"Funda\u00e7\u00e3o para a Ci\u00eancia e a Tecnologia","doi-asserted-by":"publisher","award":["SFRH\/BD\/143608\/2019"],"award-info":[{"award-number":["SFRH\/BD\/143608\/2019"]}],"id":[{"id":"10.13039\/501100001871","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001871","name":"Funda\u00e7\u00e3o para a Ci\u00eancia e a Tecnologia","doi-asserted-by":"publisher","award":["UIDB\/50022\/2020"],"award-info":[{"award-number":["UIDB\/50022\/2020"]}],"id":[{"id":"10.13039\/501100001871","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>During operational activities, military personnel face extremely demanding circumstances, which when combined lead to severe fatigue, influencing both their well-being and performance. Physical exertion is the main condition leading to fatigue, and its continuous tracking would help prevent its effects. This review aimed to investigate the up-to-date progress on non-invasive physiological monitoring to evaluate situations of physical exertion as a pre-condition to fatigue in military populations, and determine the potential associations between physiological responses and fatigue, which can later result in decision-making indicators to prevent health-related consequences. Adhering to the PRISMA Statement, four databases (Scopus, Science Direct, Web of Science and PubMed) were used for a literature search based on combinations of keywords. The eligibility criteria focused on studies monitoring physiological variables through non-invasive objective measurements, with these measurements being developed in military field, combat, or training conditions. The review process led to the inclusion of 20 studies. The findings established the importance of multivariable assessments in a real-life context to accurately characterise the effects of military practices. A tendency for examining heart rate variables, thermal responses, and actigraphy measurements was also identified. The objectives and experimental protocols were diverse, but the effectiveness of non-invasive measurements in identifying the most fatigue-inducing periods was demonstrated. Nevertheless, no assessment system for standardised application was presented. Future work may include the development of assessment methods to translate physiological recordings into actionable information in real-time and mitigate the effects of fatigue on soldiers\u2019 performance accurately.<\/jats:p>","DOI":"10.3390\/ijerph18168815","type":"journal-article","created":{"date-parts":[[2021,8,22]],"date-time":"2021-08-22T21:47:52Z","timestamp":1629668872000},"page":"8815","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["Non-Invasive Physiological Monitoring for Physical Exertion and Fatigue Assessment in Military Personnel: A Systematic Review"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4942-7625","authenticated-orcid":false,"given":"Denisse","family":"Bustos","sequence":"first","affiliation":[{"name":"Associated Laboratory for Energy, Transports and Aeronautics, (LAETA\/PROA), Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2367-2187","authenticated-orcid":false,"given":"Joana C.","family":"Guedes","sequence":"additional","affiliation":[{"name":"Associated Laboratory for Energy, Transports and Aeronautics, (LAETA\/PROA), Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal"}]},{"given":"M\u00e1rio P.","family":"Vaz","sequence":"additional","affiliation":[{"name":"Associated Laboratory for Energy, Transports and Aeronautics, (LAETA\/PROA), Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal"},{"name":"Porto Biomechanics Laboratory, University of Porto, 4200-450 Porto, Portugal"}]},{"given":"Eduardo","family":"Pombo","sequence":"additional","affiliation":[{"name":"Commando Regiment, Portuguese Army, Serra da Carregueira, 2605-045 Sintra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5811-0443","authenticated-orcid":false,"given":"Ricardo J.","family":"Fernandes","sequence":"additional","affiliation":[{"name":"Porto Biomechanics Laboratory, University of Porto, 4200-450 Porto, Portugal"},{"name":"Center of Research, Education, Innovation and Intervention in Sport, Faculty of Sport, University of Porto, 4200-450 Porto, Portugal"}]},{"given":"Jos\u00e9 Torres","family":"Costa","sequence":"additional","affiliation":[{"name":"Associated Laboratory for Energy, Transports and Aeronautics, (LAETA\/PROA), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8524-5503","authenticated-orcid":false,"given":"Jo\u00e3o Santos","family":"Baptista","sequence":"additional","affiliation":[{"name":"Associated Laboratory for Energy, Transports and Aeronautics, (LAETA\/PROA), Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal"},{"name":"Porto Biomechanics Laboratory, University of Porto, 4200-450 Porto, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2021,8,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1007\/s40279-014-0253-z","article-title":"Monitoring training load to understand fatigue in athletes","volume":"44","author":"Halson","year":"2014","journal-title":"Sports Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1016\/0020-7489(96)00004-1","article-title":"Fatigue: A concept analysis","volume":"33","author":"Ream","year":"1996","journal-title":"Int. J. Nurs. Stud."},{"key":"ref_3","first-page":"18","article-title":"Worker Fatigue: Managing Concerns in Rapid Renewal Highway Construction Projects","volume":"55","author":"Hallowell","year":"2010","journal-title":"Prof. Saf."},{"key":"ref_4","unstructured":"ISO, and IOFS (2004). ISO 6385: 2016 Ergonomic Principles in the Design of Work Systems, ISO."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1016\/j.jsams.2018.06.004","article-title":"Military applications of soldier physiological monitoring","volume":"21","author":"Friedl","year":"2018","journal-title":"J. Sci. Med. Sport"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Belenky, G., Lamp, A., Hemp, A., and Zaslona, J.L. (2014). Fatigue in the Workplace, in Sleep Deprivation and Disease, Springer.","DOI":"10.1007\/978-1-4614-9087-6_18"},{"key":"ref_7","unstructured":"Friedl, K.E., and Santee, W.R. (2012). Predicting Human Limits: The Special Relationship between Physiology Research and the Army Mission. Military Quantitative Physiology: Problems and Concepts in Military Operational Medicine, Office of The Surgeon General United States Army. Available online: https:\/\/www.worldcat.org\/title\/military-quantitative-physiology-problems-and-concepts-in-military-operational-medicine\/oclc\/1001883316."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1177\/0018720813489148","article-title":"Force-on-Force Handgun Practice: An Intra-Individual Exploration of Stress Effects, Biomarker Regulation, and Behavioral Changes","volume":"56","author":"Taverniers","year":"2013","journal-title":"Hum. Factors"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1136\/jramc-2017-000765","article-title":"Health and well-being management in the military: A systematic review of genetic studies","volume":"164","author":"Parnell","year":"2018","journal-title":"J. R. Army Med. Corps"},{"key":"ref_10","unstructured":"Jones, T.E., Hoyt, R.W., Baker, C.J., Hintlian, C.B., and Walczak, P.S. (1990). Voluntary Consumption of a Liquid Carbohydrate Supplement by Special Operations Forces during a High Altitude Cold Weather Field Training Exercise, Army Research Institute of Environmental Medicine."},{"key":"ref_11","first-page":"37","article-title":"Influence of a Carbohydrate Drink on Nutritional Status, Body Composition and Mood during Desert Training","volume":"71","author":"Cline","year":"2000","journal-title":"Aviat. Space Environ. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"972","DOI":"10.7205\/MILMED.172.9.972","article-title":"Dehydration in extreme temperatures while conducting stability and support operations in a combat zone","volume":"172","author":"Manning","year":"2007","journal-title":"Mil. Med."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Booth, C., Coad, R., Forbes-Ewan, C., Thomson, G., and Niro, P. (2001). The Effect of Consumption of Australian Combat Rations on Military Personnel after a Medium-Term Field Exercise, Defence Science and Technology Organisation Victoria (Australia) Aeronautical and Maritime Research Lab., Fishermens Bend.","DOI":"10.1037\/e447292006-001"},{"key":"ref_14","first-page":"239","article-title":"Evaluation of an Australian Combat Ration Pack as a Sole Nutrition Source during 23 Days of Military Adventurous Training in the Tropics","volume":"60","author":"Booth","year":"2003","journal-title":"Nutr. Diet."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Edwards, J.S., Roberts, D.E., Mutter, S.H., and Moore, R.J. (1990). A Comparison of the Meal, Ready-To-Eat VIII with Supplemental Pack and the Ration, Cold Weather Consumed in an Arctic Environment, Army Research Institute of Environmental Medicine.","DOI":"10.21236\/ADA229412"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.apergo.2015.07.003","article-title":"Predicting physiological capacity of human load carriage\u2014A review","volume":"52","author":"Drain","year":"2016","journal-title":"Appl. Ergon."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1016\/j.apergo.2018.07.010","article-title":"Cardiorespiratory responses to heavy military load carriage over complex terrain","volume":"73","author":"Looney","year":"2018","journal-title":"Appl. Ergon."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1111\/jsr.12431","article-title":"The effect of sleep deprivation on leadership behaviour in military officers: An experimental study","volume":"25","author":"Olsen","year":"2016","journal-title":"J. Sleep Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1017\/S0007114517000630","article-title":"Body weight and body composition changes during military training and deployment involving the use of combat rations: A systematic literature review","volume":"117","author":"Tassone","year":"2017","journal-title":"Br. J. Nutr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"991","DOI":"10.7205\/MILMED-D-11-00053","article-title":"Physiological decrements during sustained military operational stress","volume":"176","author":"Henning","year":"2011","journal-title":"Mil. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"103079","DOI":"10.1016\/j.autcon.2020.103079","article-title":"Physical exertion modeling for construction tasks using combined cardiorespiratory and thermoregulatory measures","volume":"112","author":"Umer","year":"2020","journal-title":"Autom. Constr."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Brewer, B.W., Schwartz, L.O., Cornelius, A.E., Van Raalte, J.L., Urbina, E.L., and Stubbs, J.S. (2019). It\u2019s about time: Effects of physical exertion on duration estimates. J. Funct. Morphol. Kinesiol., 4.","DOI":"10.3390\/jfmk4010006"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1016\/j.cjca.2015.12.026","article-title":"Aerobic Fitness and Risk of Ventricular Arrhythmia Following Physical Exertion","volume":"32","author":"Chahal","year":"2016","journal-title":"Can. J. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1089\/neu.2015.3989","article-title":"Persisting Effects of Concussion on Heart Rate Variability during Physical Exertion","volume":"33","author":"Abaji","year":"2015","journal-title":"J. Neurotrauma"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.autcon.2019.04.016","article-title":"Jerk as an indicator of physical exertion and fatigue","volume":"104","author":"Zhang","year":"2019","journal-title":"Autom. Constr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2540","DOI":"10.1249\/MSS.0000000000002085","article-title":"Load Carriage and Physical Exertion Influence Cognitive Control in Military Scenarios","volume":"51","author":"Giles","year":"2019","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1016\/j.mjafi.2017.09.017","article-title":"\u2018Health, Environment and Training\u2019: Guidance on conduct of physical exertion in hot and humid climates","volume":"74","author":"Cariappa","year":"2018","journal-title":"Med. J. Armed. Forces India"},{"key":"ref_28","first-page":"B224","article-title":"Neurophysiologic methods to measure stress during survival, evasion, resistance, and escape training","volume":"78","author":"Taylor","year":"2007","journal-title":"Aviat. Space Environ. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/j.apergo.2016.12.004","article-title":"The sensitivity of a military-based occupational fitness test of muscular strength","volume":"60","author":"Middleton","year":"2017","journal-title":"Appl. Ergon."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.ergon.2015.08.010","article-title":"Physiological and biochemical responses during incremental uphill load carriage","volume":"50","author":"Paul","year":"2015","journal-title":"Int. J. Ind. Ergon."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.ergon.2017.11.003","article-title":"Influence of military workload and footwear on static and dynamic balance performance","volume":"64","author":"DeBusk","year":"2018","journal-title":"Int. J. Ind. Ergon."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1177\/0018720816671604","article-title":"The Effect of Soldier Marching, Rucksack Load, and Heart Rate on Marksmanship","volume":"59","author":"Tenan","year":"2016","journal-title":"Hum. Factors"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1136\/jramc-2017-000851","article-title":"Physiological Monitoring for Healthy Military Personnel","volume":"164","author":"Stacey","year":"2018","journal-title":"J. R. Army Med. Corps."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1177\/0018720819841757","article-title":"Physiological Factors Which Influence Cognitive Performance in Military Personnel","volume":"62","author":"Martin","year":"2019","journal-title":"Hum. Factors"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G., and Prisma Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med., 6.","DOI":"10.1371\/journal.pmed.1000097"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/2046-4053-4-1","article-title":"Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) 2015 Statement","volume":"4","author":"Moher","year":"2015","journal-title":"Syst. Rev."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"g7647","DOI":"10.1136\/bmj.g7647","article-title":"Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: Elaboration and Explanation","volume":"349","author":"Shamseer","year":"2015","journal-title":"BMJ"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"75","DOI":"10.24840\/2184-0954_002.002_0008","article-title":"Fatigue assessment through non-invasive physiological monitoring in military performance: Protocol for a Systematic Review","volume":"2","author":"Bustos","year":"2018","journal-title":"Int. J. Occup. Environ. Saf."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Wohlin, C. (2014, January 13\u201314). Guidelines for snowballing in systematic literature studies and a replication in software engineering. Proceedings of the 18th International Conference on Evaluation and Assessment in Software Engineering, New York, NY, USA.","DOI":"10.1145\/2601248.2601268"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"d5928","DOI":"10.1136\/bmj.d5928","article-title":"The Cochrane Collaboration\u2019s tool for assessing risk of bias in randomised trials","volume":"343","author":"Higgins","year":"2011","journal-title":"BMJ"},{"key":"ref_41","first-page":"100","article-title":"Critical appraisal of scientific articles: Part 1 of a series on evaluation of scientific publications","volume":"106","author":"Blettner","year":"2009","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/0197-2456(95)00134-4","article-title":"Assessing the quality of reports of randomized clinical trials: Is blinding necessary?","volume":"17","author":"Jadad","year":"1996","journal-title":"Control. Clin. Trials"},{"key":"ref_43","unstructured":"Spencer, L., Ritchie, J., Lewis, J., and Dillon, L. (2021, March 10). Quality in Qualitative Evaluation: A Framework for Assessing Research Evidence. Available online: https:\/\/www.cebma.org\/wp-content\/uploads\/Spencer-Quality-in-qualitative-evaluation.pdf."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1235","DOI":"10.1016\/S0895-4356(98)00131-0","article-title":"The Delphi list: A criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus","volume":"51","author":"Verhagen","year":"1998","journal-title":"J. Clin. Epidemiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1016\/j.apergo.2012.04.003","article-title":"Neuromuscular and cardiovascular responses of Royal Marine recruits to load carriage in the field","volume":"43","author":"Fallowfield","year":"2012","journal-title":"Appl. Ergon."},{"key":"ref_46","first-page":"185","article-title":"Evaluation of occupational physical load during 6-month international crisis management operation","volume":"31","author":"Pihlainen","year":"2018","journal-title":"Int. J. Occup. Med. Environ. Health"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"419","DOI":"10.3389\/fphys.2017.00419","article-title":"Short-term, low-volume training improves heat acclimatization in an operational context","volume":"8","author":"Charlot","year":"2017","journal-title":"Front. Physiol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.jtherbio.2018.08.017","article-title":"Uncoupling psychological from physiological markers of heat acclimatization in a military context","volume":"77","author":"Malgoyre","year":"2018","journal-title":"J. Therm. Biol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1093\/milmed\/165.12.961","article-title":"Physiological and cognitive performance of soldiers conducting routine patrol and reconnaissance operations in the tropics","volume":"165","author":"Amos","year":"2000","journal-title":"Mil. Med."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1016\/j.biopsych.2004.11.014","article-title":"Severe decrements in cognition function and mood induced by sleep loss, heat, dehydration, and undernutrition during simulated combat","volume":"57","author":"Lieberman","year":"2005","journal-title":"Biol. Psychiatry"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"2420","DOI":"10.1519\/JSC.0b013e31828055e9","article-title":"Mechanical, physical, and physiological analysis of symmetrical and asymmetrical combat","volume":"27","year":"2013","journal-title":"J. Strength Cond. Res."},{"key":"ref_52","unstructured":"Redmond, J.E., Cohen, B.S., Simpson, K., Spiering, B.A., and Sharp, M.A. (2013). Measuring Physical Activity during US Army Basic Combat Training: A Comparison of 3 Methods. US Army Med. Dep. J., Available online: https:\/\/pubmed.ncbi.nlm.nih.gov\/24146242\/."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Simpson, K., Redmond, J.E., Cohen, B.S., Hendrickson, N.R., Spiering, B.A., Steelman, R., Knapik, J.J., and Sharp, M.A. (2013). Quantification of Physical Activity Performed during US Army Basic Combat Training. US Army Med. Dep. J., 55\u201365. Available online: http:\/\/search.ebscohost.com\/login.aspx?direct=true&AuthType=ip,uid&db=a9h&AN=96354982&lang=pt-pt&site=ehost-live&scope=site.","DOI":"10.21236\/ADA610831"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.7205\/MILMED-D-12-00538","article-title":"Thermal-work strain during Marine rifle squad operations in Afghanistan","volume":"178","author":"Welles","year":"2013","journal-title":"Mil. Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"218","DOI":"10.7205\/MILMED-D-13-00299","article-title":"Cardiorespiratory responses induced by various military field tasks","volume":"179","author":"Pihlainen","year":"2014","journal-title":"Mil. Med."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"49","DOI":"10.7205\/MILMED-D-13-00289","article-title":"Impact of training patterns on injury incidences in 12 Swiss Army basic military training schools","volume":"179","author":"Wyss","year":"2014","journal-title":"Mil. Med."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"S187","DOI":"10.1519\/JSC.0000000000001117","article-title":"Examining the relationship between mental, physical, and organizational factors associated with attrition during maritime forces training","volume":"29","author":"Binsch","year":"2015","journal-title":"J. Strength Cond. Res."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1830","DOI":"10.1080\/00140139.2015.1036792","article-title":"Real-time core body temperature estimation from heart rate for first responders wearing different levels of personal protective equipment","volume":"58","author":"Buller","year":"2015","journal-title":"Ergonomics"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.physbeh.2016.06.037","article-title":"Cognitive function, stress hormones, heart rate and nutritional status during simulated captivity in military survival training","volume":"165","author":"Lieberman","year":"2016","journal-title":"Physiol. Behav."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.ijpsycho.2017.04.002","article-title":"The effects of captivity survival training on mood, dissociation, PTSD symptoms, cognitive performance and stress hormones","volume":"117","author":"Ralph","year":"2017","journal-title":"Int. J. Psychophysiol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1136\/jramc-2017-000887","article-title":"Quantification of energy expenditure of military loaded runs: What is the performance of laboratory-based equations when applied to the field environment?","volume":"164","author":"Colosio","year":"2018","journal-title":"J. R. Army Med. Corps"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"2565","DOI":"10.1249\/MSS.0000000000001716","article-title":"Sex differences in training loads during British Army basic training","volume":"50","author":"Saunders","year":"2018","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_63","first-page":"1685","article-title":"Energy balance amongst soldiers in the armed forces of the Czech Republic, the course of a normal week and continuous training","volume":"18","year":"2018","journal-title":"J. Phys. Educ. Sport"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1123\/ijsnem.2018-0041","article-title":"Energy deficiency during cold weather mountain training in NSW seal qualification students","volume":"29","author":"Beals","year":"2019","journal-title":"Int. J. Sport Nutr. Exerc. Metab."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"S364","DOI":"10.1097\/00005768-200106001-00005","article-title":"Type of activity: Resistance, aerobic and leisure versus occupational physical activity","volume":"33","author":"Howley","year":"2001","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Pihlainen, K., H\u00e4kkinen, K., Santtila, M., Raitanen, J., and Kyr\u00f6l\u00e4inen, H. (2020). Differences in Training Adaptations of Endurance Performance during Combined Strength and Endurance Training in a 6-Month Crisis Management Operation. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17051688"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1007\/s00421-018-3869-0","article-title":"Physiological and psychological determinants of whole-body endurance exercise following short-term sustained operations with partial sleep deprivation","volume":"118","author":"Keramidas","year":"2018","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"e113","DOI":"10.1093\/milmed\/usy176","article-title":"Neuromuscular Performance and Hormonal Profile during Military Training and Subsequent Recovery Period","volume":"184","author":"Salonen","year":"2019","journal-title":"Mil. Med."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"517","DOI":"10.2165\/00007256-200333070-00004","article-title":"Heart rate monitoring","volume":"33","author":"Achten","year":"2003","journal-title":"Sports Med."},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Cilhoroz, B., Giles, D., Zaleski, A., Taylor, B., Fernhall, B., and Pescatello, L. (2020). Validation of the Polar V800 heart rate monitor and comparison of artifact correction methods among adults with hypertension. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0240220"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1519\/JSC.0000000000001662","article-title":"Validation of heart rate monitor Polar RS800 for heart rate variability analysis during exercise","volume":"32","author":"Hernando","year":"2018","journal-title":"J. Strength Cond. Res."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"391","DOI":"10.3389\/fphys.2016.00391","article-title":"Comparative analysis of the equivital EQ02 lifemonitor with holter ambulatory ECG device for continuous measurement of ECG, heart rate, and heart rate variability: A validation study for precision and accuracy","volume":"7","author":"Akintola","year":"2016","journal-title":"Front. Physiol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1080\/15459624.2012.747404","article-title":"Validity and reliability of multiparameter physiological measurements recorded by the Equivital LifeMonitor during activities of various intensities","volume":"10","author":"Liu","year":"2013","journal-title":"J. Occup. Environ. Hyg."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1080\/026404198366920","article-title":"Heart rate monitors: State of the art","volume":"16","author":"Laukkanen","year":"1998","journal-title":"J. Sports Sci."},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Garber, C.E., Blissmer, B., Deschenes, M.R., Franklin, B.A., Lamonte, M.J., Lee, I.M., Nieman, D.C., and Swain, D.P. (2011). Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: Guidance for prescribing exercise. Med. Sci. Sports Exerc., 1334\u20131359.","DOI":"10.1249\/MSS.0b013e318213fefb"},{"key":"ref_76","first-page":"113","article-title":"High performance training and racing","volume":"349","author":"Edwards","year":"1993","journal-title":"Heart Rate Monit. Book"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/S0735-1097(00)01054-8","article-title":"Age-Predicted Maximal Heart Rate Revisited","volume":"37","author":"Tanaka","year":"2001","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.irbm.2020.04.001","article-title":"A Review of Methods for Non-Invasive Heart Rate Measurement on Wrist","volume":"42","author":"Gehin","year":"2021","journal-title":"IRBM"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"130","DOI":"10.23736\/S0026-4806.20.06695-1","article-title":"Heart rate as a predictor of cardiovascular risk","volume":"112","author":"Seravalle","year":"2021","journal-title":"Minerva Med."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"7772","DOI":"10.3390\/s100807772","article-title":"A review of accelerometry-based wearable motion detectors for physical activity monitoring","volume":"10","author":"Yang","year":"2010","journal-title":"Sensors"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1136\/bjsports-2018-099643","article-title":"How well do activity monitors estimate energy expenditure? A systematic review and meta-analysis of the validity of current technologies","volume":"54","author":"Turicchi","year":"2020","journal-title":"Br. J. Sports Med."},{"key":"ref_82","unstructured":"ISO, and IOFS (2004). ISO 9886: 2004 Ergonomics\u2014Evaluation of Thermal Strain by Physiological Measurements, International Standards Institution."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"e1842","DOI":"10.7205\/MILMED-D-16-00251","article-title":"Thermoregulatory Response to Exercise After Exertional Heat Stroke","volume":"182","author":"Sagui","year":"2017","journal-title":"Mil. Med."},{"key":"ref_84","doi-asserted-by":"crossref","unstructured":"Nutong, R., Mungthin, M., Hatthachote, P., Ukritchon, S., Imjaijit, W., Tengtrakulcharoen, P., Panichkul, S., Putwatana, P., Prapaipanich, W., and Rangsin, R. (2018). Personal risk factors associated with heat-related illness among new conscripts undergoing basic training in Thailand. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0203428"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"e841","DOI":"10.7205\/MILMED-D-12-00524","article-title":"Skin Temperature and Heart Rate Can Be Used to Estimate Physiological Strain during Exercise in the Heat in a Cohort of Fit and Unfit Males","volume":"178","author":"Cuddy","year":"2013","journal-title":"Mil. Med."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1080\/23328940.2016.1156801","article-title":"Heat strain during military training activities: The dilemma of balancing force protection and operational capability","volume":"3","author":"Hunt","year":"2016","journal-title":"Temperature"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.autneu.2016.01.001","article-title":"Thermoregulatory disorders and illness related to heat and cold stress","volume":"196","author":"Cheshire","year":"2016","journal-title":"Auton. Neurosci."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1080\/02640414.2015.1102315","article-title":"Respiratory frequency is strongly associated with perceived exertion during time trials of different duration","volume":"34","author":"Marcora","year":"2016","journal-title":"J. Sports Sci."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"922","DOI":"10.3389\/fphys.2017.00922","article-title":"Respiratory frequency during exercise: The neglected physiological measure","volume":"8","author":"Massaroni","year":"2017","journal-title":"Front. Physiol."},{"key":"ref_90","doi-asserted-by":"crossref","unstructured":"Nicol\u00f2, A., Bazzucchi, I., Haxhi, J., Felici, F., and Sacchetti, M. (2014). Comparing continuous and intermittent exercise: An \u201cisoeffort\u201d and \u201cisotime\u201d approach. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0094990"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"2138","DOI":"10.1249\/MSS.0b013e31825e825a","article-title":"Computational methods for estimating energy expenditure in human physical activities","volume":"44","author":"Liu","year":"2012","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"142","DOI":"10.15837\/ijccc.2016.1.1333","article-title":"A Context-Aware mHealth System for Online Physiological Monitoring in Remote Healthcare","volume":"11","author":"Zhang","year":"2015","journal-title":"Int. J. Comput. Commun. Control"},{"key":"ref_93","first-page":"1453","article-title":"Life sign decision support algorithms","volume":"107","author":"Savell","year":"2004","journal-title":"Medinfo"},{"key":"ref_94","doi-asserted-by":"crossref","unstructured":"Anwer, S., Li, H., Antwi-Afari, M.F., Umer, W., and Wong, A.Y. (2020). Cardiorespiratory and Thermoregulatory Parameters Are Good Surrogates for Measuring Physical Fatigue during a Simulated Construction Task. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17155418"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"105667","DOI":"10.1016\/j.cmpb.2020.105667","article-title":"Linear and nonlinear analyses of normal and fatigue heart rate variability signals for miners in high-altitude and cold areas","volume":"196","author":"Chen","year":"2020","journal-title":"Comput. Methods Programs Biomed."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1097\/JOM.0000000000001530","article-title":"Effect of a Simulated Mine Rescue on Physiological Variables and Heat Strain of Mine Rescue Workers","volume":"61","author":"Konrad","year":"2019","journal-title":"J. Occup. Environ. Med."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"1511","DOI":"10.1519\/JSC.0b013e31826caef8","article-title":"Heart Rate Variability Threshold Values for Early-Warning Nonfunctional Overreaching in Elite Female Wrestlers","volume":"27","author":"Tian","year":"2013","journal-title":"J. Strength Cond. Res."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1007\/s00420-020-01641-3","article-title":"The association between heart rate variability, reaction time, and indicators of workplace fatigue in wildland firefighters","volume":"94","author":"Jeklin","year":"2021","journal-title":"Int. Arch. Occup. Environ. Health"},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"03121001","DOI":"10.1061\/(ASCE)CO.1943-7862.0002038","article-title":"Evaluation of Physiological Metrics as Real-Time Measurement of Physical Fatigue in Construction Workers: State-of-the-Art Review","volume":"147","author":"Anwer","year":"2021","journal-title":"J. Constr. Eng. Manag."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.autcon.2017.03.003","article-title":"Monitoring fatigue in construction workers using physiological measurements","volume":"82","author":"Aryal","year":"2017","journal-title":"Autom. Constr."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1097\/NNA.0000000000000983","article-title":"Changes in Fatigue Levels and Sleep Measures of Hospital Nurses during Two 12-Hour Work Shifts","volume":"51","author":"Cho","year":"2021","journal-title":"J. Nurs. Adm."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/16\/8815\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:48:28Z","timestamp":1760165308000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/16\/8815"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,20]]},"references-count":101,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2021,8]]}},"alternative-id":["ijerph18168815"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18168815","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,20]]}}}