Modification in psychophysiological stress parameters of soldiers after an integral operative training prior to a real mission

(1) Background. Military personel could be defined as “Tactical Athletes”. However, experimental evidence about the effects of new HIIT trainings in comparison with traditional training schedules is lacking. The aim of this study was to experimentally analyze the modifications on psycho-physiologica...

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Autores:
Bellido-Esteban, Alberto
Ruisoto, Pablo
Tornero Aguilera, José Francisco
Clemente-Suárez, Vicente Javier
Tipo de recurso:
Article of journal
Fecha de publicación:
2022
Institución:
Corporación Universidad de la Costa
Repositorio:
REDICUC - Repositorio CUC
Idioma:
eng
OAI Identifier:
oai:repositorio.cuc.edu.co:11323/9182
Acceso en línea:
https://hdl.handle.net/11323/9182
https://doi.org/10.3390/su14052792
https://repositorio.cuc.edu.co/
Palabra clave:
Heart rate variability
Stress
Tactical athletes
Soldiers
Physical activity
Rights
openAccess
License
© 2022 by the authors. Licensee MDPI, Basel, Switzerland.
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dc.title.eng.fl_str_mv Modification in psychophysiological stress parameters of soldiers after an integral operative training prior to a real mission
title Modification in psychophysiological stress parameters of soldiers after an integral operative training prior to a real mission
spellingShingle Modification in psychophysiological stress parameters of soldiers after an integral operative training prior to a real mission
Heart rate variability
Stress
Tactical athletes
Soldiers
Physical activity
title_short Modification in psychophysiological stress parameters of soldiers after an integral operative training prior to a real mission
title_full Modification in psychophysiological stress parameters of soldiers after an integral operative training prior to a real mission
title_fullStr Modification in psychophysiological stress parameters of soldiers after an integral operative training prior to a real mission
title_full_unstemmed Modification in psychophysiological stress parameters of soldiers after an integral operative training prior to a real mission
title_sort Modification in psychophysiological stress parameters of soldiers after an integral operative training prior to a real mission
dc.creator.fl_str_mv Bellido-Esteban, Alberto
Ruisoto, Pablo
Tornero Aguilera, José Francisco
Clemente-Suárez, Vicente Javier
dc.contributor.author.spa.fl_str_mv Bellido-Esteban, Alberto
Ruisoto, Pablo
Tornero Aguilera, José Francisco
Clemente-Suárez, Vicente Javier
dc.subject.proposal.eng.fl_str_mv Heart rate variability
Stress
Tactical athletes
Soldiers
Physical activity
topic Heart rate variability
Stress
Tactical athletes
Soldiers
Physical activity
description (1) Background. Military personel could be defined as “Tactical Athletes”. However, experimental evidence about the effects of new HIIT trainings in comparison with traditional training schedules is lacking. The aim of this study was to experimentally analyze the modifications on psycho-physiological and performance response of soldiers after completing experimental integral operative training. (2) Methods. A total of 43 male subjects of a special unit force of the Spanish armed forces were randomly selected and assigned into the experimental and control groups assessed after training and after deploying in a real operation area. The experimental group underwent an integral operative pre-mission 6-week training (IOT), and the control group, the 6-week traditional training. (3) Results. HIIT-based integral operative training significantly improved combat performance (melee combat score) and the psychophysiological stress response, as measured by heart rate variability indexes. (4) Conclusion. This study provides experimental evidence supporting a new integral operative effective for improved autonomic regulation, reduced perceived stress, melee and close-quarter combat techniques, in addition to aerobic and anaerobic performance and lower body strength in comparison with the traditional training.
publishDate 2022
dc.date.accessioned.none.fl_str_mv 2022-05-19T18:03:14Z
dc.date.available.none.fl_str_mv 2022-05-19T18:03:14Z
dc.date.issued.none.fl_str_mv 2022-02-27
dc.type.spa.fl_str_mv Artículo de revista
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dc.type.content.spa.fl_str_mv Text
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dc.identifier.citation.spa.fl_str_mv Bellido-Esteban, A.; Ruisoto, P.; Tornero-Aguilera, J.F.; Clemente-Suárez, V.J. Modification in Psychophysiological Stress Parameters of Soldiers after an Integral Operative Training Prior to a Real Mission. Sustainability 2022, 14, 2792. https://doi.org/10.3390/su14052792
dc.identifier.uri.spa.fl_str_mv https://hdl.handle.net/11323/9182
dc.identifier.url.spa.fl_str_mv https://doi.org/10.3390/su14052792
dc.identifier.doi.spa.fl_str_mv 10.3390/su14052792
dc.identifier.eissn.spa.fl_str_mv 2071-1050
dc.identifier.instname.spa.fl_str_mv Corporación Universidad de la Costa
dc.identifier.reponame.spa.fl_str_mv REDICUC - Repositorio CUC
dc.identifier.repourl.spa.fl_str_mv https://repositorio.cuc.edu.co/
identifier_str_mv Bellido-Esteban, A.; Ruisoto, P.; Tornero-Aguilera, J.F.; Clemente-Suárez, V.J. Modification in Psychophysiological Stress Parameters of Soldiers after an Integral Operative Training Prior to a Real Mission. Sustainability 2022, 14, 2792. https://doi.org/10.3390/su14052792
10.3390/su14052792
2071-1050
Corporación Universidad de la Costa
REDICUC - Repositorio CUC
url https://hdl.handle.net/11323/9182
https://doi.org/10.3390/su14052792
https://repositorio.cuc.edu.co/
dc.language.iso.none.fl_str_mv eng
language eng
dc.relation.ispartofjournal.spa.fl_str_mv Sustainability
dc.relation.references.spa.fl_str_mv • Clemente-Suarez, V.J.; Palomera, P.R.; Robles-Pérez, J.J. Psychophysiological response to acute-high-stress combat situations in professional soldiers. Stress Health 2018, 34, 247–252.
• Heinrich, K.M.; Spencer, V.; Fehl, N.; Poston, W.S.C. Mission Essential Fitness: Comparison of Functional Circuit Training to Traditional Army Physical Training for Active Duty Military. Mil. Med. 2012, 177, 1125–1130.
• Bustamante-Sánchez, Á.; Tornero-Aguilera, J.F.; Fernández-Elías, V.E.; Hormeno-Holgado, A.J.; Dalamitros, A.A.; Clemente-Suárez, V.J. Effect of Stress on Autonomic and Cardiovascular Systems in Military Population: A Systematic Review. Cardiol. Res. Pract. 2020, 2020, 7986249.
• Vicente-Rodriguez, M.; Clemente-Suárez, V.J. Psychophysiological anxiety response of a rescue helicopter crew in a crane rescue manoeuvre. BMJ Mil. Health 2020, 167, 413–417.
• Moore, B.A.; Brock, M.S.; Brager, A.; Collen, J.; LoPresti, M.; Mysliwiec, V. Posttraumatic Stress Disorder, Traumatic Brain Injury, Sleep, and Performance in Military Personnel. Sleep Med. Clin. 2020, 15, 87–100.
• Curiel-Regueros, A.; Fernández-Lucas, J.; Clemente-Suárez, V.J. Effectiveness of an applied high intensity interval training as a specific operative training. Physiol. Behav. 2019, 201, 208–211.
• Tan, G.; Dao, T.K.; Farmer, L.; Sutherland, R.J.; Gevirtz, R. Heart Rate Variability (HRV) and Posttraumatic Stress Disorder (PTSD): A Pilot Study. Appl. Psychophysiol. Biofeedback 2010, 36, 27–35.
• Tornero-Aguilera, J.F.; Robles-Pérez, J.J.; Clemente-Suárez, V.J. Use of Psychophysiological Portable Devices to Analyse Stress Response in Different Experienced Soldiers. J. Med. Syst. 2018, 42, 75.
• Clemente-Suárez, V.J. Multidisciplinary intervention in the treatment of mixed anxiety and depression disorder. Physiol. Behav. 2020, 219, 112858.
• Knapik, J.J.; Bullock, S.H.; Canada, S.; Toney, E.; Wells, J.D.; Hoedebecke, E.; Jones, B.H. Influence of an injury reduction program on injury and fitness outcomes among soldiers. Inj. Prev. 2004, 10, 37–42.
• Terada, S.; Yokozeki, T.; Kawanaka, K.; Ogawa, K.; Higuchi, M.; Ezaki, O.; Tabata, I. Effects of high-intensity swimming training on GLUT-4 and glucose transport activity in rat skeletal muscle. J. Appl. Physiol. 2001, 90, 2019–2024.
• Helgerud, J.; Høydal, K.; Wang, E.; Karlsen, T.; Berg, P.; Bjerkaas, M.; Simonsen, T.; Helgesen, C.; Hjorth, N.; Bach, R.; et al. Aerobic High-Intensity Intervals Improve VO2max More Than Moderate Training. Med. Sci. Sports Exerc. 2007, 39, 665–671.
• Clemente-Suárez, V.J.; Ramos-Campo, D.J. Effectiveness of Reverse vs. Traditional Linear Training Periodization in Triathlon. Int. J. Environ. Res. Public Health 2019, 16, 2807.
• Tornero-Aguilera, J.G.; Clemente-Suárez, V.J. Resisted and Endurance High Intensity Interval Training for Combat Preparedness. Aerosp. Med. Hum. Perform. 2019, 90, 32–36.
• Gibala, M.J.; Little, J.P.; MacDonald, M.J.; Hawley, J.A. Physiological adaptations to low-volume, high-intensity interval training in health and disease. J. Physiol. 2012, 590, 1077–1084.
• Clemente-Suárez, V.J. New Training Program for the New Requirements of Combat of Tactical Athletes. Sustainability 2022, 14, 1216.
• Spielberger, C.D.; Gorsuch, R.L.; Lushene, R.; Vagg, P.R.; Jacobs, G.A. Manual for the State-Trait Anxiety Inventory; Consulting Psychologists Press: Palo Alto, CA, USA, 1983.
• Delgado-Moreno, R.; Robles-Pérez, J.J.; Aznar, S.; Clemente-Suarez, V.J. Inalambric Biofeedback Devices to Analyze Strength Manifestation in Military Population. J. Med. Syst. 2018, 42, 60.
• Clemente-Suárez, V.; Fernandes, R.; Arroyo-Toledo, J.; Figueiredo, P.; González-Ravé, J.; Vilas-Boas, J. Autonomic adaptation after traditional and reverse swimming training periodizations. Acta Physiol. Hung. 2015, 102, 105–113.
• Clemente-Suárez, V.J. Periodized training achieves better autonomic modulation and aerobic performance than non-periodized training. J. Sports Med. Phys. Fit. 2018, 58, 1559–1564.
• Martín, J.P.G.; Clemente-Suárez, V.J.; Ramos-Campo, D.J. Hematological and Running Performance Modification of Trained Athletes after Reverse vs. Block Training Periodization. Int. J. Environ. Res. Public Health 2020, 17, 4825.
• Ramos, D.J.C.; Peraza, A.A.S.; Robles-Pérez, J.J.; Montañez-Toledo, P.; Clemente-Suárez, V.J. Technical Efficiency in Shackled Actions after A Short Audiovisual Training Session. Open Sports Sci. J. 2014, 7, 29–34.
• Anderson, E.H.; Eshivakumar, G. Effects of Exercise and Physical Activity on Anxiety. Front. Psychiatry 2013, 4, 27.
• Ströhle, A. Physical activity, exercise, depression and anxiety disorders. J. Neural Transm. 2008, 116, 777–784.
• Pascoe, M.; Bailey, A.P.; Craike, M.; Carter, T.; Patten, R.; Stepto, N.; Parker, A. Physical activity and exercise in youth mental health promotion: A scoping review. BMJ Open Sport Exerc. Med. 2020, 6, e000677.
• Kim, H.-G.; Cheon, E.-J.; Bai, D.-S.; Lee, Y.H.; Koo, B.-H. Stress and Heart Rate Variability: A Meta-Analysis and Review of the Literature. Psychiatry Investig. 2018, 15, 235–245.
• Saunders, T.; Driskell, J.E.; Johnston, J.H.; Salas, E. The effect of stress inoculation training on anxiety and performance. J. Occup. Health Psychol. 1996, 1, 170–186.
• Sheehy, R.; Horan, J.J. Effects of Stress Inoculation Training for 1st-Year Law Students. Int. J. Stress Manag. 2004, 11, 41–55.
• Bryan, J. The Effects of High Intensity Interval Training on PTSD Symptomology. Ph.D. Thesis, University of Victoria, Victoria, BC, Canada, 2021. Available online: https://dspace.library.uvic.ca/bitstream (accessed on 15 November 2021).
• Herman, J.P. Neural control of chronic stress adaptation. Front. Behav. Neurosci. 2013, 7, 61.
• Amat, J.; Paul, E.; Zarza, C.; Watkins, L.R.; Maier, S.F. Previous Experience with Behavioral Control over Stress Blocks the Behavioral and Dorsal Raphe Nucleus Activating Effects of Later Uncontrollable Stress: Role of the Ventral Medial Prefrontal Cortex. J. Neurosci. 2006, 26, 13264–13272.
• Pyne, J.M.; Constans, J.I.; Wiederhold, M.D.; Gibson, D.P.; Kimbrell, T.; Kramer, T.L.; Pitcock, J.A.; Han, X.; Williams, D.K.; Chartrand, D.; et al. Heart rate variability: Pre-deployment predictor of post-deployment PTSD symptoms. Biol. Psychol. 2016, 121, 91–98.
• Castaldo, R.; Melillo, P.; Bracale, U.; Caserta, M.; Triassi, M.; Pecchia, L. Acute mental stress assessment via short term HRV analysis in healthy adults: A systematic review with meta-analysis. Biomed. Signal Process. Control 2015, 18, 370–377.
• Soylu, Y.; Arslan, E.; Sogut, M.; Kilit, B.; Clemente, F. Effects of self-paced high-intensity interval training and moderate-intensity continuous training on the physical performance and psychophysiological responses in recreationally active young adults. Biol. Sport 2021, 38, 555–562.
• Astorino, T.A.; Edmunds, R.M.; Clark, A.; King, L.; Gallant, R.A.; Namm, S.; Fischer, A.; Wood, K.M. High-Intensity Interval Training Increases Cardiac Output and VO2max. Med. Sci. Sports Exerc. 2017, 49, 265–273.
• Olney, N.; Wertz, T.; LaPorta, Z.; Mora, A.; Serbas, J.; Astorino, T.A. Comparison of Acute Physiological and Psychological Responses Between Moderate-Intensity Continuous Exercise and Three Regimes of High-Intensity Interval Training. J. Strength Cond. Res. 2018, 32, 2130–2138.
• Engel, F.A.; Ackermann, A.; Chtourou, H.; Sperlich, B. High-Intensity Interval Training Performed by Young Athletes: A Systematic Review and Meta-Analysis. Front. Physiol. 2018, 9, 1012.
• Sperlich, B.; De Marées, M.; Koehler, K.; Linville, J.; Holmberg, H.-C.; Mester, J. Effects of 5 Weeks of High-Intensity Interval Training vs. Volume Training in 14-Year-Old Soccer Players. J. Strength Cond. Res. 2011, 25, 1271–1278.
• Diaz-Manzano, M.; Fuentes, J.P.; Fernández-Lucas, J.; Aznar-Lain, S.; Clemente-Suárez, V.J. Higher use of techniques studied and performance in melee combat produce a higher psychophysiological stress response. Stress Health 2018, 34, 622–628.
• Tornero-Aguilera, J.F.; Pelarigo, J.G.; Clemente-Suárez, V.J. Psychophysiological Intervention to Improve Preparedness in Military Special Operations Forces. Aerosp. Med. Hum. Perform. 2019, 90, 953–958.
• Tornero-Aguilera, J.F.; Fernandez-Elias, V.E.; Clemente-Suárez, V.J. Ready for Combat, Psychophysiological Modifications in a Close-Quarter Combat Intervention After an Experimental Operative High-Intensity Interval Training. J. Strength Cond. Res. 2020, 36, 732–737.
• Nibbeling, N.; Oudejans, R.; Ubink, E.M.; Daanen, H. The effects of anxiety and exercise-induced fatigue on shooting accuracy and cognitive performance in infantry soldiers. Ergonomics 2014, 57, 1366–1379.
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spelling Bellido-Esteban, Alberto6b7d521c00cadf8c91b1c1be11fcd878Ruisoto, Pabloc36234579b7ea916176d9b7dc1c2284d600Tornero Aguilera, José Franciscoc27d249013aa22f304b73dd692e750d7600Clemente-Suárez, Vicente Javier95c0347b8f91ec5b43e3b415c06954166002022-05-19T18:03:14Z2022-05-19T18:03:14Z2022-02-27Bellido-Esteban, A.; Ruisoto, P.; Tornero-Aguilera, J.F.; Clemente-Suárez, V.J. Modification in Psychophysiological Stress Parameters of Soldiers after an Integral Operative Training Prior to a Real Mission. Sustainability 2022, 14, 2792. https://doi.org/10.3390/su14052792https://hdl.handle.net/11323/9182https://doi.org/10.3390/su1405279210.3390/su140527922071-1050Corporación Universidad de la CostaREDICUC - Repositorio CUChttps://repositorio.cuc.edu.co/(1) Background. Military personel could be defined as “Tactical Athletes”. However, experimental evidence about the effects of new HIIT trainings in comparison with traditional training schedules is lacking. The aim of this study was to experimentally analyze the modifications on psycho-physiological and performance response of soldiers after completing experimental integral operative training. (2) Methods. A total of 43 male subjects of a special unit force of the Spanish armed forces were randomly selected and assigned into the experimental and control groups assessed after training and after deploying in a real operation area. The experimental group underwent an integral operative pre-mission 6-week training (IOT), and the control group, the 6-week traditional training. (3) Results. HIIT-based integral operative training significantly improved combat performance (melee combat score) and the psychophysiological stress response, as measured by heart rate variability indexes. (4) Conclusion. This study provides experimental evidence supporting a new integral operative effective for improved autonomic regulation, reduced perceived stress, melee and close-quarter combat techniques, in addition to aerobic and anaerobic performance and lower body strength in comparison with the traditional training.9 páginasapplication/pdfengMDPI AGSwitzerland© 2022 by the authors. Licensee MDPI, Basel, Switzerland.Atribución 4.0 Internacional (CC BY 4.0)https://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Modification in psychophysiological stress parameters of soldiers after an integral operative training prior to a real missionArtículo de revistahttp://purl.org/coar/resource_type/c_6501http://purl.org/coar/resource_type/c_2df8fbb1Textinfo:eu-repo/semantics/articlehttp://purl.org/redcol/resource_type/ARThttp://purl.org/coar/version/c_970fb48d4fbd8a85https://www.mdpi.com/2071-1050/14/5/2792Sustainability• Clemente-Suarez, V.J.; Palomera, P.R.; Robles-Pérez, J.J. Psychophysiological response to acute-high-stress combat situations in professional soldiers. Stress Health 2018, 34, 247–252.• Heinrich, K.M.; Spencer, V.; Fehl, N.; Poston, W.S.C. Mission Essential Fitness: Comparison of Functional Circuit Training to Traditional Army Physical Training for Active Duty Military. Mil. Med. 2012, 177, 1125–1130.• Bustamante-Sánchez, Á.; Tornero-Aguilera, J.F.; Fernández-Elías, V.E.; Hormeno-Holgado, A.J.; Dalamitros, A.A.; Clemente-Suárez, V.J. Effect of Stress on Autonomic and Cardiovascular Systems in Military Population: A Systematic Review. Cardiol. Res. Pract. 2020, 2020, 7986249.• Vicente-Rodriguez, M.; Clemente-Suárez, V.J. Psychophysiological anxiety response of a rescue helicopter crew in a crane rescue manoeuvre. BMJ Mil. Health 2020, 167, 413–417.• Moore, B.A.; Brock, M.S.; Brager, A.; Collen, J.; LoPresti, M.; Mysliwiec, V. Posttraumatic Stress Disorder, Traumatic Brain Injury, Sleep, and Performance in Military Personnel. Sleep Med. Clin. 2020, 15, 87–100.• Curiel-Regueros, A.; Fernández-Lucas, J.; Clemente-Suárez, V.J. Effectiveness of an applied high intensity interval training as a specific operative training. Physiol. Behav. 2019, 201, 208–211.• Tan, G.; Dao, T.K.; Farmer, L.; Sutherland, R.J.; Gevirtz, R. Heart Rate Variability (HRV) and Posttraumatic Stress Disorder (PTSD): A Pilot Study. Appl. Psychophysiol. Biofeedback 2010, 36, 27–35.• Tornero-Aguilera, J.F.; Robles-Pérez, J.J.; Clemente-Suárez, V.J. Use of Psychophysiological Portable Devices to Analyse Stress Response in Different Experienced Soldiers. J. Med. Syst. 2018, 42, 75.• Clemente-Suárez, V.J. Multidisciplinary intervention in the treatment of mixed anxiety and depression disorder. Physiol. Behav. 2020, 219, 112858.• Knapik, J.J.; Bullock, S.H.; Canada, S.; Toney, E.; Wells, J.D.; Hoedebecke, E.; Jones, B.H. Influence of an injury reduction program on injury and fitness outcomes among soldiers. Inj. Prev. 2004, 10, 37–42.• Terada, S.; Yokozeki, T.; Kawanaka, K.; Ogawa, K.; Higuchi, M.; Ezaki, O.; Tabata, I. Effects of high-intensity swimming training on GLUT-4 and glucose transport activity in rat skeletal muscle. J. Appl. Physiol. 2001, 90, 2019–2024.• Helgerud, J.; Høydal, K.; Wang, E.; Karlsen, T.; Berg, P.; Bjerkaas, M.; Simonsen, T.; Helgesen, C.; Hjorth, N.; Bach, R.; et al. Aerobic High-Intensity Intervals Improve VO2max More Than Moderate Training. Med. Sci. Sports Exerc. 2007, 39, 665–671.• Clemente-Suárez, V.J.; Ramos-Campo, D.J. Effectiveness of Reverse vs. Traditional Linear Training Periodization in Triathlon. Int. J. Environ. Res. Public Health 2019, 16, 2807.• Tornero-Aguilera, J.G.; Clemente-Suárez, V.J. Resisted and Endurance High Intensity Interval Training for Combat Preparedness. Aerosp. Med. Hum. Perform. 2019, 90, 32–36.• Gibala, M.J.; Little, J.P.; MacDonald, M.J.; Hawley, J.A. Physiological adaptations to low-volume, high-intensity interval training in health and disease. J. Physiol. 2012, 590, 1077–1084.• Clemente-Suárez, V.J. New Training Program for the New Requirements of Combat of Tactical Athletes. Sustainability 2022, 14, 1216.• Spielberger, C.D.; Gorsuch, R.L.; Lushene, R.; Vagg, P.R.; Jacobs, G.A. Manual for the State-Trait Anxiety Inventory; Consulting Psychologists Press: Palo Alto, CA, USA, 1983.• Delgado-Moreno, R.; Robles-Pérez, J.J.; Aznar, S.; Clemente-Suarez, V.J. Inalambric Biofeedback Devices to Analyze Strength Manifestation in Military Population. J. Med. Syst. 2018, 42, 60.• Clemente-Suárez, V.; Fernandes, R.; Arroyo-Toledo, J.; Figueiredo, P.; González-Ravé, J.; Vilas-Boas, J. Autonomic adaptation after traditional and reverse swimming training periodizations. Acta Physiol. Hung. 2015, 102, 105–113.• Clemente-Suárez, V.J. Periodized training achieves better autonomic modulation and aerobic performance than non-periodized training. J. Sports Med. Phys. Fit. 2018, 58, 1559–1564.• Martín, J.P.G.; Clemente-Suárez, V.J.; Ramos-Campo, D.J. Hematological and Running Performance Modification of Trained Athletes after Reverse vs. Block Training Periodization. Int. J. Environ. Res. Public Health 2020, 17, 4825.• Ramos, D.J.C.; Peraza, A.A.S.; Robles-Pérez, J.J.; Montañez-Toledo, P.; Clemente-Suárez, V.J. Technical Efficiency in Shackled Actions after A Short Audiovisual Training Session. Open Sports Sci. J. 2014, 7, 29–34.• Anderson, E.H.; Eshivakumar, G. Effects of Exercise and Physical Activity on Anxiety. Front. Psychiatry 2013, 4, 27.• Ströhle, A. Physical activity, exercise, depression and anxiety disorders. J. Neural Transm. 2008, 116, 777–784.• Pascoe, M.; Bailey, A.P.; Craike, M.; Carter, T.; Patten, R.; Stepto, N.; Parker, A. Physical activity and exercise in youth mental health promotion: A scoping review. BMJ Open Sport Exerc. Med. 2020, 6, e000677.• Kim, H.-G.; Cheon, E.-J.; Bai, D.-S.; Lee, Y.H.; Koo, B.-H. Stress and Heart Rate Variability: A Meta-Analysis and Review of the Literature. Psychiatry Investig. 2018, 15, 235–245.• Saunders, T.; Driskell, J.E.; Johnston, J.H.; Salas, E. 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