Impact of real and simulated flights on psychophysiological response of military pilots

Objective: The present research aimed to analyse the autonomic, anxiety, perceived exertion, and self-confidence response during real and simulated flights. Methods: This cross-sectional study participated 12 experienced male pilots (age = 33.08 (5.21)) from the Spanish Air Force. Participants had t...

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Autores:
Fuentes García, Juan Pedro
Clemente-Suárez, Vicente Javier
Marazuela-Martínez, Miguel Ángel
Tornero Aguilera, José Francisco
Villafaina, Santos
Tipo de recurso:
Article of journal
Fecha de publicación:
2021
Institución:
Corporación Universidad de la Costa
Repositorio:
REDICUC - Repositorio CUC
Idioma:
eng
OAI Identifier:
oai:repositorio.cuc.edu.co:11323/7942
Acceso en línea:
https://hdl.handle.net/11323/7942
https://doi.org/10.3390/ijerph18020787
https://repositorio.cuc.edu.co/
Palabra clave:
HRV
Army
Simulator
Flight
Anxiety
Perceived exertion
Rights
openAccess
License
CC0 1.0 Universal
id RCUC2_ed8f7a5f2005ee77135103223963169e
oai_identifier_str oai:repositorio.cuc.edu.co:11323/7942
network_acronym_str RCUC2
network_name_str REDICUC - Repositorio CUC
repository_id_str
dc.title.spa.fl_str_mv Impact of real and simulated flights on psychophysiological response of military pilots
title Impact of real and simulated flights on psychophysiological response of military pilots
spellingShingle Impact of real and simulated flights on psychophysiological response of military pilots
HRV
Army
Simulator
Flight
Anxiety
Perceived exertion
title_short Impact of real and simulated flights on psychophysiological response of military pilots
title_full Impact of real and simulated flights on psychophysiological response of military pilots
title_fullStr Impact of real and simulated flights on psychophysiological response of military pilots
title_full_unstemmed Impact of real and simulated flights on psychophysiological response of military pilots
title_sort Impact of real and simulated flights on psychophysiological response of military pilots
dc.creator.fl_str_mv Fuentes García, Juan Pedro
Clemente-Suárez, Vicente Javier
Marazuela-Martínez, Miguel Ángel
Tornero Aguilera, José Francisco
Villafaina, Santos
dc.contributor.author.spa.fl_str_mv Fuentes García, Juan Pedro
Clemente-Suárez, Vicente Javier
Marazuela-Martínez, Miguel Ángel
Tornero Aguilera, José Francisco
Villafaina, Santos
dc.subject.spa.fl_str_mv HRV
Army
Simulator
Flight
Anxiety
Perceived exertion
topic HRV
Army
Simulator
Flight
Anxiety
Perceived exertion
description Objective: The present research aimed to analyse the autonomic, anxiety, perceived exertion, and self-confidence response during real and simulated flights. Methods: This cross-sectional study participated 12 experienced male pilots (age = 33.08 (5.21)) from the Spanish Air Force. Participants had to complete a real and a simulated flight mission randomly. The heart rate variability (HRV), anxiety, self-confidence, and rating of perceived exertion were collected before and after both manoeuvres, and HRV was also collected during both simulated and real flights. Results: When studying the acute effects of real and simulated flights, the mean heart rate, the R-to-R interval, the cognitive anxiety and the perceived exertion were significantly impacted only by real flights. Furthermore, significant differences in the mean heart rate and RR interval were found when compared to the acute effects of real and simulated flights (with higher acute effects observed in real flights). Additionally, when compared the HRV values during simulated and real flights, significant differences were observed in the RR and heart rate mean (with lower RR interval and higher heart rate mean observed during real flights). Conclusion: Real flights significantly reduced the RR interval and cognitive anxiety while increased the heart rate mean and the rating of perceived exertion, whereas simulated flights did not induce any significant change in the autonomic modulation.
publishDate 2021
dc.date.accessioned.none.fl_str_mv 2021-03-01T14:59:37Z
dc.date.available.none.fl_str_mv 2021-03-01T14:59:37Z
dc.date.issued.none.fl_str_mv 2021-01-18
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.issn.spa.fl_str_mv 1661-7827
1660-4601
dc.identifier.uri.spa.fl_str_mv https://hdl.handle.net/11323/7942
dc.identifier.doi.spa.fl_str_mv https://doi.org/10.3390/ijerph18020787
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 1661-7827
1660-4601
Corporación Universidad de la Costa
REDICUC - Repositorio CUC
url https://hdl.handle.net/11323/7942
https://doi.org/10.3390/ijerph18020787
https://repositorio.cuc.edu.co/
dc.language.iso.none.fl_str_mv eng
language eng
dc.relation.references.spa.fl_str_mv 1. Gerathewohl, S.J. Fidelity of Simulation and Transfer of Training: A Review of the Problem; US Department of Transportation, Federal Aviation Administration, Office of Aviation Medicine: Washington, DC, USA, 1969.
2. Dahlstrom, N.; Nahlinder, S. Mental workload in aircraft and simulator during basic civil aviation training. Int. J. Aviat. Psychol. 2009, 19, 309–325. [CrossRef]
3. Wilson, G.F. An analysis of mental workload in pilots during flight using multiple psychophysiological measures. Int. J. Aviat. Psychol. 2002, 12, 3–18. [CrossRef]
4. Alaimo, A.; Esposito, A.; Orlando, C.; Simoncini, A. Aircraft Pilots Workload Analysis: Heart Rate Variability Objective Measures and NASA-Task Load Index Subjective Evaluation. Aerospace 2020, 7, 137. [CrossRef]
5. Wilson, G.F. A comparison of three cardiac ambulatory recorders using flight data. Int. J. Aviat. Psychol. 2002, 12, 111–119. [CrossRef]
6. Cao, X.; MacNaughton, P.; Cadet, L.R.; Cedeno-Laurent, J.G.; Flanigan, S.; Vallarino, J.; Donnelly-McLay, D.; Christiani, D.C.; Spengler, J.D.; Allen, J.G. Heart rate variability and performance of commercial airline pilots during flight simulations. Int. J. Environ. Res. Public Health 2019, 16, 237. [CrossRef] [PubMed]
7. Magnusson, S. Similarities and differences in psychophysiological reactions between simulated and real air-to-ground missions. Int. J. Aviat. Psychol. 2002, 12, 49–61. [CrossRef]
8. Thayer, J.F.; Ahs, F.; Fredrikson, M.; Sollers, J.J., III; Wager, T.D. A meta-analysis of heart rate variability and neuroimaging studies: Implications for heart rate variability as a marker of stress and health. Neurosci. Biobehav. Rev. 2012, 36, 747–756. [CrossRef]
9. Shaffer, F.; McCraty, R.; Zerr, C.L. A healthy heart is not a metronome: An integrative review of the heart’s anatomy and heart rate variability. Front. Psychol. 2014, 5, 1040. [CrossRef]
10. Fuentes-Garcia, J.P.; Pereira, T.; Castro, M.A.; Carvalho Santos, A.; Villafaina, S. Psychophysiological stress response of adolescent chess players during problem-solving tasks. Physiol. Behav. 2019, 209, 112609. [CrossRef]
11. Fuentes, J.P.; Villafaina, S.; Collado-Mateo, D.; de la Vega, R.; Olivares, P.R.; Clemente-Suárez, V.J. Differences between high vs low performance chess players in heart rate variability during chess problems. Front. Psychol. 2019, 10, 409. [CrossRef]
12. Beauchaine, T. Vagal tone, development, and Gray’s motivational theory: Toward an integrated model of autonomic nervous system functioning in psychopathology. Dev. Psychopathol. 2001, 13, 183–214. [CrossRef] [PubMed]
13. Berntson, G.G.; Norman, G.J.; Hawkley, L.C.; Cacioppo, J.T. Cardiac autonomic balance versus cardiac regulatory capacity. Psychophysiology 2008, 45, 643–652. [CrossRef] [PubMed]
14. Diaz-Manzano, M.; Fuentes, J.P.; Fernandez-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. [CrossRef] [PubMed]
15. Hormeño-Holgado, A.J.; Clemente-Suárez, V.J. Effect of different combat jet manoeuvres in the psychophysiological response of professional pilots. Physiol. Behav. 2019, 208, 112559. [CrossRef] [PubMed]
16. Sauvet, F.; Jouanin, J.C.; Langrume, C.; Van Beers, P.; Papelier, Y.; Dussault, C. Heart rate variability in novice pilots during and after a multi-leg cross-country flight. Aviat. Space Environ. Med. 2009, 80, 862–869. [CrossRef]
17. 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. [CrossRef]
18. Bustamante-Sánchez, A.; Tornero-Aguilera, J.F.; Fernández-Elías, V.E.; Hormeño-Holgado, A.J.; Dalamitros, A.A.; ClementeSuárez, V.J. Effect of Stress on Autonomic and Cardiovascular Systems in Military Population: A Systematic Review. Cardiol. Res. Pract. 2020, 2020. [CrossRef]
19. Bustamante-Sánchez, Á.; Delgado-Terán, M.; Clemente-Suárez, V.J. Psychophysiological response of different aircrew in normobaric hypoxia training. Ergonomics 2019, 62, 277–285. [CrossRef]
20. Tornero Aguilera, J.F.; Gil-Cabrera, J.; Clemente-Suárez, V.J. Determining the psychophysiological responses of military aircrew when exposed to acute disorientation stimuli. BMJ Mil. Health 2020. [CrossRef]
21. Bustamante-Sánchez, Á.; Clemente-Suárez, V.J. Psychophysiological response in night and instrument helicopter flights. Ergonomics 2020, 63, 399–406. [CrossRef]
22. Gil-Cabrera, J.; Tornero Aguilera, J.F.; Sanchez-Tena, M.A.; Alvarez-Peregrina, C.; Valbuena-Iglesias, C.; Clemente-Suárez, V.J. Aviation-Associated Spatial Disorientation and Incidence of Visual Illusions Survey in Military Pilots. Int. J. Aerosp. Psychol. 2020, 1–8. [CrossRef]
23. Laborde, S.; Mosley, E.; Thayer, J.F. Heart Rate Variability and Cardiac Vagal Tone in Psychophysiological Research - Recommendations for Experiment Planning, Data Analysis, and Data Reporting. Front. Psychol. 2017, 8, 213. [CrossRef] [PubMed]
24. Da Costa de Rezende Barbosa, M.P.; da Silva, N.T.; de Azevedo, F.M.; Pastre, C.M.; Marques Vanderlei, L.C. Comparison of Polar ((R)) RS800G3 heart rate monitor with Polar ((R)) S810i and electrocardiogram to obtain the series of RR intervals and analysis of heart rate variability at rest. Clin. Physiol. Funct. Imaging 2016, 36, 112–117. [CrossRef] [PubMed]
25. Tarvainen, M.P.; Niskanen, J.-P.; Lipponen, J.A.; Ranta-Aho, P.O.; Karjalainen, P.A. Kubios HRV–heart rate variability analysis software. Comput. Methods Programs Biomed. 2014, 113, 210–220. [CrossRef] [PubMed]
26. Camm, A.J.; Malik, M.; Bigger, J.T.; Breithardt, G.; Cerutti, S.; Cohen, R.J.; Coumel, P.; Fallen, E.L.; Kennedy, H.L.; Kleiger, R.E. Heart rate variability: Standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Ann. Noninvasive Electrocardiol. 1996, 1, 151–181.
27. Lipponen, J.A.; Tarvainen, M.P. A robust algorithm for heart rate variability time series artefact correction using novel beat classification. J. Med. Eng. Technol. 2019, 43, 173–181. [CrossRef]
28. Tarvainen, M.P.; Ranta-Aho, P.O.; Karjalainen, P.A. An advanced detrending method with application to HRV analysis. IEEE Trans. Biomed. Eng. 2002, 49, 172–175. [CrossRef]
29. Shaffer, F.; Ginsberg, J.P. An Overview of Heart Rate Variability Metrics and Norms. Front. Public Health 2017, 5, 258. [CrossRef]
30. Cox, R.H.; Martens, M.P.; Russell, W.D. Measuring anxiety in athletics: The revised competitive state anxiety inventory–2. J. Sport Exerc. Psychol. 2003, 25, 519–533. [CrossRef]
31. Andrade Fernández, E.M.; Lois Río, G.; Arce Fernández, C. Propiedades psicométricas de la versión española del Inventario de Ansiedad Competitiva CSAI-2R en deportistas. Psicothema 2007, 19, 150–155.
32. Spielberger, C.D.; Gonzalez-Reigosa, F.; Martinez-Urrutia, A.; Natalicio, L.; Natalicio, D.S. Development of the Spanish edition of the state-trait anxiety inventory. Interam. J. Psychol. 1971, 5, 145–158.
33. Borg, G. Perceived exertion as an indicator of somatic stress. Scand. J. Rehabil. Med. 1970, 2, 92–98. [PubMed]
34. Fritz, C.O.; Morris, P.E.; Richler, J.J. Effect size estimates: Current use, calculations, and interpretation. J. Exp. Psychol. Gen. 2012, 141, 2. [CrossRef] [PubMed]
35. Coolican, H. Research Methods and Statistics in Psychology; Psychology Press: East Sussex, UK, 2017.
36. Delgado-Moreno, R.; Robles-Pérez, J.J.; Aznar-Laín, S.; Clemente-Suárez, V.J. Effect of experience and psychophysiological modification by combat stress in soldier’s memory. J. Med. Syst. 2019, 43, 150. [CrossRef]
37. Delgado-Moreno, R.; Robles-Pérez, J.J.; Clemente-Suárez, V.J. Combat stress decreases memory of warfighters in action. J. Med. Syst. 2017, 41, 124. [CrossRef]
38. Bustamante-Sánchez, Á.; Clemente-Suárez, V.J. Psychophysiological Response to Disorientation Training in Different Aircraft Pilots. Appl. Psychophysiol. Biofeedback 2020, 45, 241–247. [CrossRef]
39. Hankins, T.C.; Wilson, G.F. A comparison of heart rate, eye activity, EEG and subjective measures of pilot mental workload during flight. Aviat. Space Environ. Med. 1998, 69, 360.
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spelling Fuentes García, Juan PedroClemente-Suárez, Vicente JavierMarazuela-Martínez, Miguel ÁngelTornero Aguilera, José FranciscoVillafaina, Santos2021-03-01T14:59:37Z2021-03-01T14:59:37Z2021-01-181661-78271660-4601https://hdl.handle.net/11323/7942https://doi.org/10.3390/ijerph18020787Corporación Universidad de la CostaREDICUC - Repositorio CUChttps://repositorio.cuc.edu.co/Objective: The present research aimed to analyse the autonomic, anxiety, perceived exertion, and self-confidence response during real and simulated flights. Methods: This cross-sectional study participated 12 experienced male pilots (age = 33.08 (5.21)) from the Spanish Air Force. Participants had to complete a real and a simulated flight mission randomly. The heart rate variability (HRV), anxiety, self-confidence, and rating of perceived exertion were collected before and after both manoeuvres, and HRV was also collected during both simulated and real flights. Results: When studying the acute effects of real and simulated flights, the mean heart rate, the R-to-R interval, the cognitive anxiety and the perceived exertion were significantly impacted only by real flights. Furthermore, significant differences in the mean heart rate and RR interval were found when compared to the acute effects of real and simulated flights (with higher acute effects observed in real flights). Additionally, when compared the HRV values during simulated and real flights, significant differences were observed in the RR and heart rate mean (with lower RR interval and higher heart rate mean observed during real flights). Conclusion: Real flights significantly reduced the RR interval and cognitive anxiety while increased the heart rate mean and the rating of perceived exertion, whereas simulated flights did not induce any significant change in the autonomic modulation.Fuentes García, Juan Pedro-will be generated-orcid-0000-0002-8299-1092-600Clemente-Suárez, Vicente Javier-will be generated-orcid-0000-0002-2397-2801-600Marazuela-Martínez, Miguel ÁngelTornero Aguilera, José Francisco-will be generated-orcid-0000-0002-0747-8133-600Villafaina, Santosapplication/pdfengCorporación Universidad de la CostaCC0 1.0 Universalhttp://creativecommons.org/publicdomain/zero/1.0/info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2International Journal of Environmental Research and Public Healthhttps://www.mdpi.com/1660-4601/18/2/787HRVArmySimulatorFlightAnxietyPerceived exertionImpact of real and simulated flights on psychophysiological response of military pilotsArtículo 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/ARTinfo:eu-repo/semantics/acceptedVersion1. Gerathewohl, S.J. Fidelity of Simulation and Transfer of Training: A Review of the Problem; US Department of Transportation, Federal Aviation Administration, Office of Aviation Medicine: Washington, DC, USA, 1969.2. Dahlstrom, N.; Nahlinder, S. Mental workload in aircraft and simulator during basic civil aviation training. Int. J. Aviat. Psychol. 2009, 19, 309–325. [CrossRef]3. Wilson, G.F. An analysis of mental workload in pilots during flight using multiple psychophysiological measures. Int. J. Aviat. Psychol. 2002, 12, 3–18. [CrossRef]4. Alaimo, A.; Esposito, A.; Orlando, C.; Simoncini, A. Aircraft Pilots Workload Analysis: Heart Rate Variability Objective Measures and NASA-Task Load Index Subjective Evaluation. Aerospace 2020, 7, 137. [CrossRef]5. Wilson, G.F. A comparison of three cardiac ambulatory recorders using flight data. Int. J. Aviat. Psychol. 2002, 12, 111–119. [CrossRef]6. Cao, X.; MacNaughton, P.; Cadet, L.R.; Cedeno-Laurent, J.G.; Flanigan, S.; Vallarino, J.; Donnelly-McLay, D.; Christiani, D.C.; Spengler, J.D.; Allen, J.G. Heart rate variability and performance of commercial airline pilots during flight simulations. Int. J. Environ. Res. Public Health 2019, 16, 237. [CrossRef] [PubMed]7. Magnusson, S. Similarities and differences in psychophysiological reactions between simulated and real air-to-ground missions. Int. J. Aviat. Psychol. 2002, 12, 49–61. [CrossRef]8. Thayer, J.F.; Ahs, F.; Fredrikson, M.; Sollers, J.J., III; Wager, T.D. A meta-analysis of heart rate variability and neuroimaging studies: Implications for heart rate variability as a marker of stress and health. Neurosci. Biobehav. Rev. 2012, 36, 747–756. [CrossRef]9. Shaffer, F.; McCraty, R.; Zerr, C.L. A healthy heart is not a metronome: An integrative review of the heart’s anatomy and heart rate variability. Front. Psychol. 2014, 5, 1040. [CrossRef]10. Fuentes-Garcia, J.P.; Pereira, T.; Castro, M.A.; Carvalho Santos, A.; Villafaina, S. Psychophysiological stress response of adolescent chess players during problem-solving tasks. Physiol. Behav. 2019, 209, 112609. [CrossRef]11. Fuentes, J.P.; Villafaina, S.; Collado-Mateo, D.; de la Vega, R.; Olivares, P.R.; Clemente-Suárez, V.J. Differences between high vs low performance chess players in heart rate variability during chess problems. Front. Psychol. 2019, 10, 409. [CrossRef]12. Beauchaine, T. Vagal tone, development, and Gray’s motivational theory: Toward an integrated model of autonomic nervous system functioning in psychopathology. Dev. Psychopathol. 2001, 13, 183–214. [CrossRef] [PubMed]13. Berntson, G.G.; Norman, G.J.; Hawkley, L.C.; Cacioppo, J.T. Cardiac autonomic balance versus cardiac regulatory capacity. Psychophysiology 2008, 45, 643–652. [CrossRef] [PubMed]14. Diaz-Manzano, M.; Fuentes, J.P.; Fernandez-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. [CrossRef] [PubMed]15. Hormeño-Holgado, A.J.; Clemente-Suárez, V.J. Effect of different combat jet manoeuvres in the psychophysiological response of professional pilots. Physiol. Behav. 2019, 208, 112559. [CrossRef] [PubMed]16. Sauvet, F.; Jouanin, J.C.; Langrume, C.; Van Beers, P.; Papelier, Y.; Dussault, C. Heart rate variability in novice pilots during and after a multi-leg cross-country flight. Aviat. Space Environ. Med. 2009, 80, 862–869. [CrossRef]17. 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. [CrossRef]18. Bustamante-Sánchez, A.; Tornero-Aguilera, J.F.; Fernández-Elías, V.E.; Hormeño-Holgado, A.J.; Dalamitros, A.A.; ClementeSuárez, V.J. Effect of Stress on Autonomic and Cardiovascular Systems in Military Population: A Systematic Review. Cardiol. Res. Pract. 2020, 2020. [CrossRef]19. Bustamante-Sánchez, Á.; Delgado-Terán, M.; Clemente-Suárez, V.J. Psychophysiological response of different aircrew in normobaric hypoxia training. Ergonomics 2019, 62, 277–285. [CrossRef]20. Tornero Aguilera, J.F.; Gil-Cabrera, J.; Clemente-Suárez, V.J. Determining the psychophysiological responses of military aircrew when exposed to acute disorientation stimuli. BMJ Mil. Health 2020. [CrossRef]21. Bustamante-Sánchez, Á.; Clemente-Suárez, V.J. Psychophysiological response in night and instrument helicopter flights. Ergonomics 2020, 63, 399–406. [CrossRef]22. Gil-Cabrera, J.; Tornero Aguilera, J.F.; Sanchez-Tena, M.A.; Alvarez-Peregrina, C.; Valbuena-Iglesias, C.; Clemente-Suárez, V.J. Aviation-Associated Spatial Disorientation and Incidence of Visual Illusions Survey in Military Pilots. Int. J. Aerosp. Psychol. 2020, 1–8. [CrossRef]23. Laborde, S.; Mosley, E.; Thayer, J.F. Heart Rate Variability and Cardiac Vagal Tone in Psychophysiological Research - Recommendations for Experiment Planning, Data Analysis, and Data Reporting. Front. Psychol. 2017, 8, 213. [CrossRef] [PubMed]24. Da Costa de Rezende Barbosa, M.P.; da Silva, N.T.; de Azevedo, F.M.; Pastre, C.M.; Marques Vanderlei, L.C. Comparison of Polar ((R)) RS800G3 heart rate monitor with Polar ((R)) S810i and electrocardiogram to obtain the series of RR intervals and analysis of heart rate variability at rest. Clin. Physiol. Funct. Imaging 2016, 36, 112–117. [CrossRef] [PubMed]25. Tarvainen, M.P.; Niskanen, J.-P.; Lipponen, J.A.; Ranta-Aho, P.O.; Karjalainen, P.A. Kubios HRV–heart rate variability analysis software. Comput. Methods Programs Biomed. 2014, 113, 210–220. [CrossRef] [PubMed]26. Camm, A.J.; Malik, M.; Bigger, J.T.; Breithardt, G.; Cerutti, S.; Cohen, R.J.; Coumel, P.; Fallen, E.L.; Kennedy, H.L.; Kleiger, R.E. Heart rate variability: Standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Ann. Noninvasive Electrocardiol. 1996, 1, 151–181.27. Lipponen, J.A.; Tarvainen, M.P. A robust algorithm for heart rate variability time series artefact correction using novel beat classification. J. Med. Eng. Technol. 2019, 43, 173–181. [CrossRef]28. Tarvainen, M.P.; Ranta-Aho, P.O.; Karjalainen, P.A. An advanced detrending method with application to HRV analysis. IEEE Trans. Biomed. Eng. 2002, 49, 172–175. [CrossRef]29. Shaffer, F.; Ginsberg, J.P. An Overview of Heart Rate Variability Metrics and Norms. Front. Public Health 2017, 5, 258. [CrossRef]30. Cox, R.H.; Martens, M.P.; Russell, W.D. Measuring anxiety in athletics: The revised competitive state anxiety inventory–2. J. Sport Exerc. Psychol. 2003, 25, 519–533. [CrossRef]31. 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