Unsolved Issues: Part 3, Amber Berlin

To read Part 1, click here, and to read Part 2, click here.

In order to achieve a viable solution for fatigue in pilots, we must consider the current beliefs, opinions, and assumptions in the science of fatigue and fatigue management. There is a general consensus in the scientific community about what causes fatigue, and much research has been accomplished in studying the body’s response to operation in the realm of fatigue. Several factors have been proven to contribute to an individual’s level of fatigue, including diet, level of physical activity, circadian disruption, the presence sleeping disorders and exposure to sustained stress. Since there are several factors which contribute to fatigue in pilots, each of these factors must be addressed and an appropriate solution achieved.

The situations and pressures that cause stress are known as stressors. We usually think of stressors as being negative, such as a taxing work schedule or poor relationship. However, anything that puts a high demand on you or forces you to adjust can be stressful. This includes positive events such as getting married, buying a house, or simply receiving a promotion. Prolonged stress has certain degrading effects on the body, which includes cognitive symptoms, such as the inability to concentrate; emotional symptoms, such as feeling overwhelmed; physical symptoms such as nausea and dizziness; and behavioral symptoms such as the inability to sleep.

Each individual’s tolerance for stress is unique. Some people can handle more stress than others due to their individual experiences and psychological makeup. According to an article by Dr. John Anne titled Stress Reduction – Which Techniques Can Be Used to Reduce Stress, stress creates a physical condition that increases the occurrence of various health problems:

“Chronic stress may lead to unpleasant conditions even for the strongest individuals. Prolonged stress can cause a permanent biochemical imbalance in the health system. This eventually leads to a weakened immune system and increased vulnerability for serious health conditions, which may be proven fatal in due course of time. Stress is known to develop various health complications such as asthma, cardiac complication, high blood pressure, allergy, fatigue, depression, insomnia, anxiety, irregular bladder, headaches, body pain and many more. (2007).”

If you do not manage long-term stress effectively, it can lead to long-term fatigue, failure, or one of the many forms of physical or mental ill health.

It is known that pilots experience high levels of stress due to the sustained attention and decision-making capability required to fly an aircraft. Gregory, et.al have shown that during the descent phase of flight, the pilot controlling the aircraft experiences an increased heart rate, signifying an increased level of stress. (1994). When under the effects of stress, the body responds by emitting cortisol from the adrenal glands located on the upper side of the kidneys. Cortisol is produced to assist the body’s natural response to stress, the need to fight or flee the situation. In an aviation environment, there is no one to fight, and nowhere to flee, so this cortisol is not used appropriately. With no outlet, the cortisol remains in the system in high levels for an extended period of time, doing damage to the cells of the brain and body, and resulting in sustained levels of anxiety and reduced cognitive ability.

Photo by: Michael Coghlan
Photo by: Michael Coghlan

One reliable way to reduce cortisol levels in the body is massage. According to a study conducted by the University of Miami School of Medicine, “cortisol levels decrease dramatically post massage, and have been reported decreasing by as much as 37% over recorded pre-massage levels.” (2005). Massage also increases the level of dopamine, a brain chemical which is responsible for keeping the brain alert and awake, and serotonin, which works against cortisol, producing a calm and relaxed state. (University of Miami School of Medicine, 2005).

Studies have shown that massage will decrease the effects of stress and fatigue on the body by speeding the elimination of chemical waste produced by the body, in both animals and humans. This information has been around for quite some time, as J.H. Kellogg, M.D. wrote in The Art of Massage about the ability to remove the effects of fatigue by administering massage:

“In cases of exhaustion from excessive mental, nervous, or muscular work, general massage secures the most marked and satisfactory results, relieving the sense of fatigue in a most wonderful manner, and in cases of muscular exhaustion, restoring muscular power in a remarkably short space of time. Ranke, Helmholtz, Du Bois-Raymond, and more recently, Abelous, have conclusively shown that special toxic substances are produced as the result of muscle work, and that the phenomena of fatigue are due to the influence of these substances upon the nervous and muscular systems. Zabloudowski has shown that frogs completely exhausted by faradization of the muscles, although not restored by fifteen minutes’ rest, were revived at once by massage, and were even able to do twice as much work as before. In another experiment, a man lifted with his little finger, one kilo (2 1-5 lbs.) 840 times, lifting the weight once a second. The muscles of his finger were then completely exhausted. After five minutes’ massage he was able to lift the same weight 1100 times, and his muscles were even then not greatly fatigued. Mental fatigue is also relieved by massage, through its effect upon the circulation and the eliminative organs. The toxic substances produced by mental activity, are more rapidly oxidized and removed from the body, while the hastened blood current more thoroughly repairs and cleanses the wearied nerve tissues. The entire nervous stem, through the improved nutrition induced by massage, experiences general reconstructive effects. (1895).”

A certified massage therapist, Vicki Platt, highlighted recent findings on the effects of massage in the workplace, including a five-week study at Bowling Green State University, proving massage has the ability to increase mental alertness:

“The individuals who participated in the study were massaged twice a week and completed a math test in half the time, with half the errors as the control group. (2007).”

The investigations listed herein have shown that massage is one of the most effective ways of influencing the human body’s ability to eliminate toxic substances, and thereby recover from both mental and physical fatigue. Massage has the ability to speed the recovery from fatigue at several times the rate of rest alone, and revive the muscles to potentially do more work than they previously could. As massage speeds the removal of the chemicals that build up in the brain, the way is cleared for the continued chemical processes of decision making and sustained attention required for flight. As the waste products are removed, mental clarity is restored and faster response times become possible. Massage results in faster recovery from fatigue in pilots and resets the body’s ability to handle the next dose of stress and fatigue aviation schedules deliver. This information is not new, but it has not been applied to the aviation industry as a legitimate finding on fatigue, and as of now there are no programs available that incorporate these principles.

A massage program, when applied to the aviation industry, has the potential to reduce fatigue in pilots and thereby increase safety, and should be incorporated for those positions which normally experience high levels of stress. While it’s not practical or cost effective to provide each pilot with a personal post-flight massage, obtaining a massage chair for regular home use, and a couple of massage chairs in each pilot’s lounge is highly recommended to relieve the effects of fatigue in pilots, promote better sleep, and keep cortisol levels to a minimum. A program to finance massage chairs during flight training would put the solution for the problem of fatigue in pilots where it’s needed the most, and has the potential to reduce training times due to the increased ability to focus and process information. An airline safety program element to provide massage chairs for post-flight use in pilot lounges would increase safety and reduce overall healthcare costs for the airline. As we hold consistently high standards for our pilots, we can also give them the tools to be successful in delivering consistently excellent results. Massage is the missing link in the fight against fatigue in pilots. Although it seems like a luxury item to many, science has proven it to be a necessity for the sustained 24-hour operations and attentional requirements of our top performers, the pilots.

Think you wouldn’t drink and fly a plane? You might be doing something similar without even knowing it. As our journey to cognitive excellence continues, we’ll see the scientific comparison between being awake and being drunk in Unsolved Issues: Part IV, Stress and Fatigue in Aviation: Looking at Continuous Wakefulness and Sleep

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References:

Anne, John. (2007). Stress Reduction – Which Techniques can be used to Reduce Stress.

Gregory, K. B; Miller, D. L; Lebacqz, J. V.; Mcnally, K. L; Weldon, K. J; Rosekind, M. R; Co, E. L;Smith, R. M; Gander, P. H. (1994). Fatigue in Operational Settings: Examples from the Aviation Environment. Human Factors 36:2 p. 327-338.

Kellogg, J.H. (1895). The Art of Massage. Retrieved from here and here.

Platt, Vicki. (2007) Massage, The Healing Power of Touch can Help Relieve Pain.

University of Miami School of Medicine. (2005). International Journal of Neuroscience. Cortisol decreases and serotonin and dopamine increase following massage therapy. Int J Neurosci. 2005 Oct;115(10):1397-413.

Featured Image: Matthew Juzenas

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