A Flight Helmet-Attached Force Gauge for Measuring Isometric Neck Muscle Strength.

INTRODUCTION: Fighter pilots must withstand high Gz-forces that can damage the cervical spine. Strength of the cervical musculature is of vital importance when it comes to preventing these G-induced neck injuries. However, there is very little evidence on valid neck muscle strength measurement methods for fighter pilots. The aim of this study was to examine the validity of a commercial force gauge attached to a pilot's helmet for measuring isometric neck muscle strength.METHODS: A total of 10 subjects performed maximal isometric cervical flexion, extension, and lateral flexion with the helmet-attached gauge and with a weight stack machine, which was used as a reference. Electromyography (EMG) activities were recorded from the right and left sternocleidomastoids and cervical erector spinae muscles during all measurements. Paired t-tests, Pearson correlation coefficient, and Wilcoxon's test were used to analyze the data.RESULTS: Difference of mean force values between the devices was statistically significant in all directions. Pearson correlation coefficient varied between 0.73 and 0.89 and it was highest in cervical flexion. EMG activities were significantly different only in the left CES during flexion.DISCUSSION: The helmet-attached gauge is a valid tool for measuring isometric neck muscle strength and is best used as a means to compare individual differences in strength levels or to track the progress of strength development.Nyländen P, Virmavirta M, Sovelius R, Kyröläinen H, Honkanen T. A flight helmet-attached force gauge for measuring isometric neck muscle strength. Aerosp Med Hum Perform. 2023; 94(6):480-484.

Relationships between psychosocial well-being and leisure time physical activity among 160.000 young Finnish men: a cross-sectional study during 2015-2021.

Evidence on the relationship between psychosocial well-being and physical activity (PA) is insufficient, especially in young adults between 18 and 29 years. Identifying protective factors for psychosocial well-being as well as factors that may promote PA behaviour in this specific age group is crucial.The aim of the present study was to explore the association between self-reported leisure time physical activity (LTPA) and a number of measures of psychosocial well-being in a large sample of Finnish young men. The sample used for this study is based on registers of the Finnish Defence Forces and consist of questionnaire-based data collected from 159,776 young healthy men (18-29 years, mean age 19 years) who started their military service during the period from 2015 to 2021. Sum scores were calculated for self-esteem and prosocial behaviour. Physical activity, number of friends and the relationship with the parents were each measured with a single question. Unadjusted and adjusted (education, financial situation of the family, family structure) logistic regression models were calculated.A multinominal logistic regression analysis showed that a higher level of LTPA was associated with a higher level of both prosocial behaviour (OR 6.12, 95% CI 5.88-6.36) and self-esteem (OR 4.41 95% CI 4.28-4.54). Further, LTPA had a positive relationship with good social relations, both with peers and parents. The odds ratio for participation in any LTPA weekly was higher (OR 2.74; CI 2.27-3.20) among those who had a close and trustworthy relationship with their parents compared to those men with more challenging relationships with their parents (OR 1.77; CI 1.46-2.14). An inactive lifestyle (PA less than once a week) seemed to be most common among men with no friends. About one third (31%) of men with no friends reported to engage in LTPA less than once a week, while only 10% of men with very many good friends reported to engage in similarly inactive LTPA behaviour.LTPA seems to be positively associated with self-esteem, prosocial behaviour and good social relations among young adult men. Actions aimed at promoting LTPA may have a positive impact on psychosocial well-being among young men, or vice versa. The relationship between PA and psychosocial well-being is complex and interrelated.

Association between spinal disorders and different domains of physical activity among young adult men.

Background: There is limited evidence of how physical activity (PA) associates with low back pain (LBP) and neck pain (NP). Particularly, the association between occupational or commuting PA and LBP/NP is unclear. The aim of the present cross-sectional study was to investigate the association between spinal disorders and different physical activity domains in young and healthy adult men. Methods: Self-reported leisure time, occupational and commuting PA, as well as LBP and NP, were studied using questionnaires among young Finnish males (n = 1,630). Logistic regression analysis was used to study the associations of PA domains, physical fitness, and spinal disorders. Regression models were adjusted for age, education, smoking, waist circumference, and the other PA domains. Results: There was a positive association between moderate leisure-time PA and both LBP (OR: 1.51, 95% CI: 1.18-1.95) and NP (OR: 1.29, 95% CI: 1.00-1.66) compared to low PA. Furthermore, moderate (OR: 1.31, 95% CI: 1.00-1.71) and high (OR: 1.53, 95% CI: 1.15-2.02) leisure time PA groups had a higher likelihood of lumbago. Moderate (OR: 0.67, 95% CI: 0.51-0.90) and high (OR: 0.68, 95% CI: 0.48-0.95) occupational PA groups had lower likelihood for radiating LBP, while high occupational PA (OR: 0.72, 95% CI: 0.52-0.99) had lower likelihood for lumbago. Conclusions: The associations between physical activity and LBP or NP seem to vary between different domains of physical activity among young healthy men. Commuting and occupation-related PA appear not to be harmfully associated with LPB or NP, whereas moderate-level leisure time PA may be associated with increased LBP and NP, and the respective high level may be associated with an increase in the prevalence of lumbago.

Relationship Between Accelerometer-Based Physical Activity, Sedentary Behavior, and Mental Health in Young Finnish Men.

Healthy lifestyle behaviors including physical activity (PA) have been recognized to contribute positively to mental health. Most of the evidence on relationship between PA and mental health relies on self-reported PA results. Device-based measures on PA or sedentary behavior (SB) are less frequently used in mental health research. The present study aimed at examining the relationship between mental health and PA/SB measured by accelerometers in young Finnish men. The sample consisted of 409 men (mean age 28 ± 7 years), who participated in the military refresher training in Finland. Self-rated mental health was measured with Mental Health Inventory (MHI-5) and short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) measuring mental health both from the perspective of mental health problems and mental well-being. PA was measured with accelerometer from the perspective of light, moderate, vigorous, and total activity, as well as SB. Linear regression models and compositional analysis were applied. Age, education, marital status, employment status, BMI, alcohol use and smoking were used as covariates. Evidence on relationship between total PA (standardized regression coefficient 0.340; 95% CI 0.022-0.657, p = 0.036) and SB (standardized regression coefficient -0.340; 95% CI -0.657 to -0.022, p = 0.036) with symptoms of mental health problems was found after adjusting for age, education, marital and employment status. The relationship was marginally significant (p = 0.056) after adjusting also for BMI, alcohol use and smoking. No evidence on relationship between PA or SB and mental well-being was found, neither in standard linear regression analysis nor in compositional approach. In our sample of young adult men, PA seemed to have a stronger relationship with symptoms of mental health problems rather than with mental well-being. The findings lead to a conclusion that all PA per se may not be independently associated with mental well-being in young adult males and raise the question whether the domain of PA and its context play a critical role in these relationships.

+Gz Exposure and Flight Duty Limitations.

BACKGROUND: High +Gz exposure is known to cause spinal problems in fighter pilots, but the amount of tolerable cumulative +Gz exposure or its intensity is not known. The aims of this study were to assess possible breaking points during a flight career and to evaluate possible determinants affecting pilots' spines.METHODS: Survival analysis was performed on the population who started their jet training in 1995-2015. The endpoint was permanent flight duty restriction due to spinal disorder. Then the quantified Gz exposure and possible confounding factors were compared between those pilots with permanent flying restriction and their matched controls. Cumulative Gz exposure was measured sortie by sortie with fatigue index (FI) recordings. FI is determined by the number of times certain levels of Gz are exceeded during the sorties.RESULTS: The linear trend of the survival curve indicates an annual 0.86% drop out rate due to spinal problems among the fighter pilot population. A conditional logistic regression did not find any difference in the FI between cases and controls (OR 0.96, 95%CI 0.87-1.06). No statistical difference was found for flight hours, a sum of intensive flying periods, fitness tests, or with nicotine product use. Additionally, a maximum +Gz limitation without airframe restriction was assessed and is presented as a useful tool to manage loading and developed symptoms.DISCUSSION: No particular breaking point during follow-up or individual factor was found for Gz induced spinal disorders. The results of the study outline the multifactorial nature of the problem. Thus, multifactorial countermeasures are also needed to protect pilots' health.Sovelius R, Honkanen T, Janhunen M, Mäntylä M, Huhtala H, Leino T. +Gz exposure and flight duty limitations. Aerosp Med Hum Perform. 2022; 93(4):390-395.

Childhood Sports Participation Is Associated With Health-Related Quality of Life in Young Men: A Retrospective Cross-Sectional Study.

The aim of the study was to examine whether sports participation (SP), engagement in competitive sports (CS), and the type of sport undertaken at the age of 12 are associated with the physical and mental components of health-related quality of life (HRQoL) in young adulthood. The data were collected using questionnaires prior to a compulsory military refresher training course in Finland. The sample consisted of 784 men (mean age 26 years). HRQoL was measured with RAND 36 and childhood SP with a series of questions. Data were analyzed with logistic regression. Higher frequency of SP, participation in district-level CS; performing team, endurance, or extreme sports; and playing yard games in childhood were after adjustments all associated with better HRQoL in early adulthood. The association was mainly found with the mental component, and to a lesser extent with the physical component, of HRQoL. Team (OR 1.43, CI 1.00-2.06) and extreme sports (OR 1.77, CI 1.19-2.63) were associated with better mental HRQoL, while playing yard games (OR 0.62, CI 0.44-0.89) reduced the likelihood for having low physical HRQoL. SP in childhood-in the forms of team or individual sports, but also as informal physical activity, such as playing yard games-is associated with HRQoL in young adulthood.

Muscular Fitness Improves during the First Year of Academy Studies among Fighter Pilot Cadets.

Background: An adequate level of muscular fitness is related to occupational performance in military personnel, including pilots flying high performance aircraft. The aim of this study was to describe the baseline level and the change in muscular fitness between the first and the second years of the Air Force Academy among fighter pilot cadets. Methods: The muscular strength and endurance test results of 182 male fighter pilot cadets were analyzed during their first year in the Air Force Academy and one year after. Maximal isometric strength tests included trunk flexion, trunk extension and bilateral leg extension tests, whereas muscle endurance was measured with modified a sit-up test and seated alternative dumbbell press. Results: The maximal isometric bilateral strength of the leg extensor muscles increased from 220 ± 42 to 232 ± 42 kg. The maximal isometric trunk extension strength increased from 117 ± 21 to 120 ± 19 kg and trunk flexion from 82 ± 16 to 86 ± 17 kg. Muscle endurance increased from 68 ± 13 to 75 ± 15 repetitions/min in seated dumbbell press and from 47 ± 12 to 51 ± 13 repetitions/min in sit-up test. Conclusions: Both maximal strength and muscular endurance improved among fighter pilot cadets, which indicates that occupational performance is well maintained or improved from the perspective of physical fitness during the early phase of academy studies. Education in the Air Force Academy, including physical education, seems beneficial in improving muscular fitness among military pilots.

Cross-sectional area of the paraspinal muscles and its association with muscle strength among fighter pilots: a 5-year follow-up.

BACKGROUND: A small cross sectional area (CSA) of the paraspinal muscles may be related to low back pain among military aviators but previous studies have mainly concentrated on spinal disc degeneration. Therefore, the primary aim of the study was to investigate the changes in muscle CSA and composition of the psoas and paraspinal muscles during a 5-year follow up among Finnish Air Force (FINAF) fighter pilots. METHODS: Study population consisted of 26 volunteered FINAF male fighter pilots (age: 20.6 (±0.6) at the baseline). The magnetic resonance imaging (MRI) examinations were collected at baseline and after 5 years of follow-up. CSA and composition of the paraspinal and psoas muscles were obtained at the levels of 3-4 and 4-5 lumbar spine. Maximal isometric strength tests were only performed on one occasion at baseline. RESULTS: The follow-up comparisons indicated that the mean CSA of the paraspinal muscles increased (p < 0.01) by 8% at L3-4 level and 7% at L4-5 level during the 5-year period. There was no change in muscle composition during the follow-up period. The paraspinal and psoas muscles' CSA was positively related to overall maximal isometric strength at the baseline. However, there was no association between LBP and muscle composition or CSA. CONCLUSIONS: The paraspinal muscles' CSA increased among FINAF fighter pilots during the first 5 years of service. This might be explained by physically demanding work and regular physical activity. However, no associations between muscle composition or CSA and low back pain (LBP) experienced were observed after the five-year follow-up.

Assessment of Muscular Fitness as a Predictor of Flight Duty Limitation.

Introduction: The high acceleration (Gz) exposure among military pilots flying fighter aircraft has been associated with an increased risk for cervical and lumbar disorders. It has been suggested that an adequate level of physical performance could reduce the risk of experiencing these disorders. The Finnish Air Force has for several years used aerobic (bicycle ergometer) and muscular fitness tests (battery of five tests) in the selection process of military pilot candidates in order to evaluate their physical fitness level. The aim of the study was to determine if these selection phase tests and anthropometry measures can predispose those individuals who might be at risk of developing severe spinal disorders leading to permanent flight duty limitations later during their military pilots' career. Materials and Methods: The study population consisted of 23 pilots flying with Gz limitation (+2 Gz, +4 Gz or +5 Gz) due to spinal disorders and 50 experienced (+1,000 flight hours) symptomless controls flying actively in operative missions. Data obtained retrospectively for all subjects included anthropometry, physical (aerobic and muscular fitness) test results and self-reported physical activity levels at a pilot selection phase. Aerobic fitness was measured with a maximal ergometer test and muscular endurance was evaluated with a test battery (standing long jump, pull-ups, sit-ups, back extensions, and push-up tests). Results: Fighter pilots flying without Gz limitation had significantly better mean (±SE) results in pull-up (14.4 ± 4.2 vs. 11.5 ± 2.0, p < 0.05) and back extension (71.1 ± 14.1 vs. 60.0 ± 12.2, p < 0.05) tests during the pilot selection when compared with the limited pilots. Similarly, the non-limited pilots had a better total muscular fitness test score (13.7 ± 1.7 vs. 12.4 ± 1.6, p < 0.05) during the pilot selection. They had also participated in significantly more competitive sports (54% vs. 22%, p < 0.05) at the time of selection when compared with pilots flying with Gz limitation due to spinal disorders. The aerobic fitness test results and anthropometric measures were not statistically different among the groups. Conclusions: Higher levels of muscular fitness, particularly axial strength in military pilot selection may have a protective role for reducing spinal disorders which if developed, can often lead to limiting the availability of pilots for flight duty. The present findings also do not support the assumption that aerobic fitness above the required minimum level would protect pilots from developing spinal disorders and, therefore, from limiting flight duty.

+Gz Exposure and Spinal Injury-Induced Flight Duty Limitations.

BACKGROUND: The present study aimed to find out if possible differences in early military flight career +Gz exposure level could predict permanent flight duty limitations (FDL) due to spinal disorders during a pilot's career. METHODS: The study population consisted of 23 pilots flying with Gz limitation (max limitation ranging from +2 Gz to +5 Gz) due to spinal disorders and 50 experienced (+1000 flight hours) symptomless controls flying actively in operative missions in the Finnish Air Force. Data obtained for all subjects included the level of cumulative Gz exposure measured sortie by sortie with fatigue index (FI) recordings and flight hours during the first 5 yr of the pilot's career. RESULTS: The mean (± SD) accumulation of FI in the first 5 yr of flying high-performance aircraft was 8.0 ± 1.8 among the pilots in the FDL group and 7.7 ± 1.7 in the non-FDL group. There was no association between flight duty limitations and early career cumulative +Gz exposure level measured with FI or flight hours. DISCUSSION: According to the present findings, it seems that the amount of cumulative +Gz exposure during the first 5 yr of a military pilot's career is not an individual risk factor for spinal disorders leading to flight duty limitation. Future studies conducted with FI recordings should be addressed to reveal the relationship between the actual level of +Gz exposure and spinal disorders, with a longer follow-up period and larger sample sizes.Honkanen T, Sovelius R, Mäntysaari M, Kyröläinen H, Avela J, Leino TK. +Gz exposure and spinal injury-induced flight duty limitations. Aerosp Med Hum Perform. 2018; 89(6):552-556.

Neck and Shoulder Muscle Activation Among Experienced and Inexperienced Pilots in +Gz Exposure.

BACKGROUND: The aim of the present study was to compare differences in electromyography (EMG) activation of the neck and shoulder muscles between groups of inexperienced and experienced pilots during controlled +Gz exposure in a centrifuge. METHODS: The subjects were volunteer cadets (inexperienced group) and lieutenants (experienced group) undergoing their first centrifuge training. The first group did not have any high performance aircraft (HPA) experience, while the latter one had a 1-yr experience of intense flying of HPA. During the centrifuge run, EMG activity was recorded from the left and right shoulder, neck flexor, and neck extensor muscles. RESULTS: The pilots without HPA experience had significantly higher muscle activity in the neck flexor and extensor muscles during the last 5 s of the recorded period at G levels exceeding +7.4. DISCUSSION: Muscle activity in the neck and shoulder muscles was gradually higher among the whole study group with increasing +Gz forces. Because pilots without any HPA experience had significantly higher muscle activity than their counterparts with experience of HPA, we suppose that the experience of high +Gz forces might lead to lower muscle activation in the same flight mission.Honkanen T, Oksa J, Mäntysaari MJ, Kyröläinen H, Avela J. Neck and shoulder muscle activation among experienced and inexperienced pilots in +Gz exposure. Aerosp Med Hum Perform. 2017; 88(2):90-95.

Functional test measures as risk indicators for low back pain among fixed-wing military pilots.

PURPOSE: The purpose of this study was to find out the risk value of functional fitness test (FFT) results for low back pain (LBP) among fixed-wing military pilots. METHODS: A total of 104 male military pilots were recruited for this study. The study was conducted with a self-administered questionnaire and FFT. The functional tests were performed in the beginning of study (baseline). The questionnaire was carried out at the baseline and 5 years later. RESULTS: The isometric low back endurance test result was associated with physical activity-related LBP experienced 5 years later. Demographic information was not associated with LBP. The prevalence of overall LBP was 71% and the flight-related LBP prevalence was 31% at the baseline. DISCUSSION: Our findings show that LBP among military pilots is a common problem but it is also associated with tasks other than flying. The functional test results were not associated with flight-related LBP but adequate isometric back endurance may have protective role in LBP caused in physical activities. When trying to find the pilots with increased risk of flight-related LBP, a more sensitive set of tests should be considered.