| ObjectiveThis study tried to establish a potential comprehensive evaluation system of exercise-induced fatigue for soldiers(SEIF),based on the analysis of potential indicators and practical data of soldiers;and further,assess the discrepancy of fatigue susceptibility among new recruits with different traditional Chinese medicine constitutions.MethodsThis study covered four parts.Firstly,a literature study was done to review potential indicators of exercise-induced fatigue applied on human beings.Relative books were collected from the Library of Navy Medical University;for potential literature,a multitude of electronic databases were searched,including China Biomedical Literature Database,Chongqing VIP Chinese Science and Technology Periodical Database,Wangfang database,China National Knowledge Infrastructure,PubMed and Web of Science.Secondly,a study of consensus based on Delphi method was conducted to screen out potential SEIF indicators.Thirdly,several potential indicators were meassured among new recruits in a Chinese navy troop in 2018.Indicators with good discrimination were picked out by comparing their change within group(before and after training),and among groups with different fatigue degrees(classified by Borg’s Rating of Perceived Scale,measured as RPE score).A multi-indicator evaluation formula was constructed via regression analysis.Finally,the influence of constitution on SEIF was explored by analyzing the fatigue susceptibility of new recruits with different constitutions.ResultsIn Part 1,a total of 2971 papers or books were included.We screened out more than 100indicators of EIF and classified them into 4 main categories(12 subcategories)according to the method of measurement.In Part 2,a consensus was reached,covering 32 potential indicators for SEIF.Among these indicators,11 were highly recommended.All the recommended indicators involve six physical systems:the cardiopulmonary and oxygen transport system,substance and energy metabolism level,skeletal muscle and tissue oxidative level,neurological and psychological status,endocrine system function,and exercise capacity.In Part 3,568 new recruits were enrolled and 19 indicators were measured.The results showed that basic heart rate,vertical jump hight,score of Profile of Mood State Questionnaire,and Pittsburgh Sleep Quality Index had significant between-group difference(P<0.05).When compared with base-line,10 indicators had significant difference:creatine kinase,total bilirubin,direct bilirubin and heart-rate recovery time were significantly declined in all groups(P<0.05);testosterone/cortisol ratio were significantly declined in groups 1 and 2(P<0.05)with no significant difference in groups 3 and 4(P>0.05);hemoglobin,red blood cell and blood lactic acid were significantly increased in all groups(P<0.05);testosterone and cortisol were significantly increased in groups 1,2 and 3(P<0.05)with no significant difference in group 4(P>0.05).But these 10 indicators did not show between-group difference(P>0.05).Besides,reaction time,urine occult blood,urine protein,urine leukocyte and oxyhemoglobin saturation almost have no within-and between-group difference(P<0.05),though oxyhemoglobin saturation has slight increase in group 3 after training(mean=0.76%,P<0.05,but lower than1%).The analysis of between-group difference showed that when RPE≥13,many physical indicators were changed.Binary Logistic Regression model was used to obtain a predictive model for SEIF.The accuracy of the model was 85.7%,the specificity was 97.2%,and the sensitivity was 34.7%,with Cox&Snell R~2 as 0.226 and Nagelkerke R~2 as 0.367.In Part 4,791 new recruits were enrolled.As the analysis of constitution distribution showed,constitution of yin-yang harmony and yin-yang subharmony were the main types(42.7%and 20.0%).Biased constitutions cover phlegm-dampness(8.8%),yin asthenia(7.1%),qi asthenia(7.1%),damp-heat(6.6%),yang asthenia(3.5%),qi stagnation(1.9%)and allergic constitution(2.3%).No recruit has the constitution of blood stasis.The analysis of fatigue susceptibility implied that the incidence of moderate or severe fatigue(RPE≥13)are varied among different constitions after training.Constitution of yin-yang harmony had the lowest incidence(19.2%),followed by yin-yang subharmony(29.7%).Participants with constitution of damp heat and yang deficiency had higher incidence than that of yin-yang subharmony,but the difference was not significant enough(34.6%,32.1%vs.29.7%,all P>0.05).The incident of moderate or severe fatigue increased from 44.6%(constitution of qi asthenia),45.7%(phlegm-dampness),46.4%(yin asthenia)and 53.3%(qi stagnation)to 61.1%(allergic constitution),which were significantly different from that of constitution of yin-yang harmony or subharmony(P<0.05).ConclusionUp to now,there is no standard evaluation of SEIF,though,there are many indicators for the evaluation of EIF for human beings.After consus,experts recommended only 32 indicators.The possible indicators of SEIF taking place in Navy training for new recruits are basic heart rate,vertical jump height,score of Profile of Mood State Questionnaire,and Pittsburgh Sleep Quality Index.When RPE≥13,many physiological and psychological indicators are fluctuant.So recruits with RPE≥13 may be the main target population of SEIF.The predictive model had high accuracy and specificity to predict SEIF among new recruits but the prediction effect is not ideal since its sensitivity was low.Soldiers with constitution of qi asthenia,qi stagnation,phlegm-dampness,yin asthenia,and the allergic constitution are fatigue susceptible populations during Navy recruit training period.These types of constitution have the value of further research. |
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