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Demographic characteristics of the study populations.
Source publication
Objective: To explore the prevalence and distribution of health risk factors in airline pilots and compare these with the general population.
Methods: Health risk measures: age, sex, weight, height, body mass index (BMI), blood pressure, sleep, physical activity (PA) and fruit and vegetable intake (FV) were analysed to determine the prevalence and...
Contexts in source publication
Context 1
... pilot population consisted of commercial pilots from an international airline. Five hundred and four pilots volunteered to participate in the study (see Table 1). Pilots were invited to participate in the study at the time of completing their routine aviation medical examinations between 5 November 2019 and April 2021. ...Context 2
... health risk characteristics among pilots and the general population are given in Table 1 and comparison of health risk prevalence between groups are presented in Table 2. On average, pilots were significantly taller (p=<0.05, d=0.45) and had a lower BMI across all age groups (p=<0.05, ...Citations
... In fact, aviation pilots tend to be a healthy cohort as they undergo regular medical examinations to renew their flight license. Any parameter out of range may cause the withdrawal of the flight license, fact that makes them concern about their health and take steps to preserve it, one of them being physical activity [50,51]. This might be in line with a higher animal-based protein intake that could justify the higher serum vitamin B 12 levels found in this cohort, although the amount of protein intake was not analyzed. ...
Purpose
Hearing loss (HL) represents a major health problem worldwide, and increasingly so due to population ageing and new leisure activities, such as video gaming or virtual reality experiences. HL has a multifactorial origin including both genetic and environmental issues with nutrition status emerging as a new contributing factor. In fact, certain micronutrient deficiencies, along with excessive consumption of specific macronutrients, have been related to HL This study aimed to examine the association of HL with dietary fat intake, nutritional status biomarkers, and serum metabolic signature in aviation pilots and controls.
Methods
A cohort of aviation pilots, chronically exposed to noise pollution at work, was compared to a cohort of non-exposed university workers (controls). Hearing function was determined by tonal audiometry and dietary fat intake was assessed by three 24-h recalls. In addition, lipoprotein profiles as well as serum homocysteine (Hcy), folate, vitamins B12 and D were analysed. Two multiple linear regression models adjusted for age were constructed to explain HL variability.
Results
HL prevalence was similar and elevated in both cohorts (controls: 64% vs. noise-exposed: 65%), when compared to the American Speech-Language-Hearing Association (ASHA) classification. When comparing both cohorts, although no significant differences were found in Hcy and folate levels, controls had significantly lower vitamins B12 and D concentrations and, conversely, higher serum lipids and lipoprotein values (triglycerides, total cholesterol, HDL-cholesterol and LDL-cholesterol subfractions), suggesting the possible involvement of CV risk in HL in the control cohort. In the noise-exposed cohort, HL was associated with flight hours, Hcy, and folate (r² = 0.439), while in controls, HL was associated with Hcy and vitamin D (r² = 0.474). After adjusting for CV profile, the positive association between HL and Hcy was maintained (β = 0.444; p < 0.001), evidencing the strong involvement of this metabolite not only in CV risk, but also in HL.
Conclusion
Folate insufficiency together with hyperhomocysteinemia increased susceptibility to noise-induced HL. However, the role of Hcy in HL without noise exposure at work seems to be partially masked by an altered CV profile.
... pilots, which are associated with elevated psychological stress and fatigue [9][10][11]. ...
... Health-related quality of life was measured with the Short Health Form 12v2 (SF-12v2), a short version of the SF-36 that has demonstrated a high correlation with SF-36 scores [25] and has been widely used in previous cohort studies including airline pilots [10]. The 12-item questionnaire produces a mental component summary score (MCS), which has shown good testretest reliability and convergent validity in detecting changes in mental health over time in adults [26]. ...
... Descriptive data of the population stratified by MCS quartiles are presented in Table 1. Five hundred two airline pilots voluntarily participated in the study, which represents approximately 33% of the population within the airline [10]. Ethnicity within the population was predominantly white Caucasian, followed by Indian, Māori, and Asian (97.6%, 1.4%, 0.6%, and 0.4%, respectively). ...
Background
Lifestyle behaviors including physical activity, sleep, nutrition, smoking, and alcohol consumption are independently associated with health, yet the relationship between these behaviors and mental health has not been explored among airline pilots. The aim of this study was to measure the association between health behaviors and mental health.
Methods
A cross‐sectional study was conducted among 502 airline pilots. The primary outcome measure was the mental component score (MCS), derived from the Short Form Health Survey 12v2. We collected information regarding age, sex, ethnicity, height, body mass, alcohol consumption, tobacco smoking status, moderate‐to‐vigorous physical activity (MVPA), fruit and vegetable intake, and sleep duration.
Results
After controlling for demographic and anthropometric parameters, MVPA, fruit and vegetable intake, and sleep duration were positively correlated with MCS (p ≤ 0.001), and alcohol consumption and tobacco smoking were negatively correlated with MCS (p ≤ 0.001). Multiple linear regression analyses revealed alcohol consumption was the strongest predictor of MCS (β = −0.308, p ≤ 0.001), followed by smoking (β = −0.236, p ≤ 0.001), MVPA (β = 0.233, p ≤ 0.001), sleep (β = 0.148, p ≤ 0.001), and fruit and vegetable intake (β = 0.097, p = 0.003).
Conclusion
The results suggest that greater physical activity, sleep duration, and fruit and vegetable intake are associated with better mental health. Meanwhile, excessive alcohol consumption and tobacco smoking undermine mental health status.
... Sleep problems are common among pilots; for example, a previous survey found 24.6% of shorthaul and 23.5% of long-haul pilots reported major sleep problems 8 nights a month (3). Furthermore, previous studies found that pilots' health problems were mainly in the cervical, shoulder, and lumbar spine, such as cervical spondylosis, periarthritis of the shoulder, reflex shoulder, arm and hand pain, swelling and numbness, back and leg pain, lumbar disc herniation, and lumbar muscle strain (10,(25)(26)(27)(28). These factors were also reported in our interviews. ...
Introduction
Physical and mental health problems among pilots affect their working state and impact flight safety. Although pilots’ physical and mental health problems have become increasingly prominent, their health has not been taken seriously. This study aimed to clarify challenges and support needs related to psychological and physical health among pilots to inform development of a more scientific and comprehensive physical and mental health system for civil aviation pilots.
Methods
This qualitative study recruited pilots from nine civil aviation companies. Focus group interviews via an online conference platform were conducted in August 2022. Colaizzi analysis was used to derive themes from the data and explore pilots’ experiences, challenges, and support needs.
Results
The main sub-themes capturing pilots’ psychological and physical health challenges were: (1) imbalance between family life and work; (2) pressure from assessment and physical examination eligibility requirements; (3) pressure from worries about being infected with COVID-19; (4) nutrition deficiency during working hours; (5) changes in eating habits because of the COVID-19 pandemic; (6) sleep deprivation; (7) occupational diseases; (8) lack of support from the company in coping with stress; (9) pilots’ yearly examination standards; (10) support with sports equipment; (11) respecting planned rest time; and (12) isolation periods.
Discussion
The interviewed pilots experienced major psychological pressure from various sources, and their physical health condition was concerning. We offer several suggestions that could be addressed to improve pilots’ physical and mental health. However, more research is needed to compare standard health measures for pilots around the world in order to improve their physical and mental health and contribute to overall aviation safety.
... Нельзя недооценивать стрессогенную тяжесть и напряженность труда, повышенное воздействие коротковолнового видимого, ультрафиолетового и космического излучения при полетах на большой высоте и др. [11][12][13][14]. Характерной особенностью воздействия на организм негативных факторов авиационных полетов является их систематическое и длительное влияние [15]. ...
Introduction. Mitochondrial dysfunction is an important pathogenic mechanism of neurodegeneration, characterized by a progressive structural and functional loss of neurons, leading to heterogeneous clinical and pathological manifestations with subsequent impairment of the functional anatomy of the brain. Aim of research. To study the influence of occupational hazards and stress experienced by civil aviation pilots and cosmonauts on the expression of mitochondrial biomarkers in buccal epithelial cells to assess the risk of developing neurodegenerative processes. Material and methods. The study involved 23 male participants in two age groups. 4 groups of investgation were formed, according to the occupation, comparable in age. The expression of mitochondrial proteins prohibitin and parkin in the buccal epithelium of the study participants was assessed by immunohistochemical methods. Results. A decrease in the expression level of the prohibitin protein was found in the group of civil aviation pilots compared to the control group of the corresponding age. There was also a tendency to a decrease in the level of expression of the studied proteins prohibitin and parkin in the group of cosmonauts compared with the control group of the corresponding age. Conclusion. The results obtained indicate a mitochondrial dysfunction, which may increase the risk of developing neurodegenerative changes.
... Airline pilots face various occupational demands that may negatively impact cardiovascular disease risk, including shift work and erratic work schedules, circadian disruption, psychological stress and fatigue, and prolonged periods of sitting [3]. Recent studies have revealed notable prevalence of cardiovascular health risk factors among airline pilots globally, comparable to general population estimates, including hypertension, overweight and obesity, and lifestyle behavioral risks such as insufficient physical activity [3,4]. However, investigation of the relationships between such factors among airline pilots has not been well addressed. ...
... The researchers invited all pilots working for the company via organization internal communication channels, to take part in the study. Based on recent populace estimates [4], our sample size represents approximately 26% of this occupational population. Prior to participating in the study, all participants gave written consent and were informed that they could leave the study at any point if they chose to. ...
... Participants were instructed to avoid large meals, strenuous physical activity, and stimulants such as caffeine for 4 h before their physiological measurements were taken. Procedures for measuring BP and body composition have been previously described in detail [4,12]. In brief, body mass was measured using SECA 813 electronic flat scales and height with a SECA 206 stadiometer (SECA, Hamburg, Deutschland). ...
Objective
Blood pressure (BP), cardiorespiratory fitness (CRF), and body composition are independently associated with health outcomes, yet the relationship between these variables has not been explored among airline pilots. The aim of this study was to evaluate the relationship between CRF and BP, and further examine whether the relationship is mediated by body composition.
Methods
A cross-sectional study was conducted among 356 airline pilots in New Zealand. We measured height, body mass, BP, waist circumference, skinfolds, and CRF (via a WattBike cycle ergometer submaximal VO 2max test). Partial correlation coefficients were estimated to examine the relationships between all variables while controlling for age and sex. Haye's PROCESS macro and the Sobel test were utilized for the mediation analysis.
Results
All body composition variables (body mass index, waist circumference and body fat percentage) were positively correlated with all BP variables (systolic pressure, diastolic pressure and mean arterial pressure) ( P < 0.001). CRF was negatively correlated with all body composition and BP variables ( P < 0.001). The Sobel test and indirect effect were significant ( P < 0.001), confirming that all body composition variables partially mediate the relationship between CRF and all blood pressure variables.
Conclusion
Lower CRF is associated with higher blood pressure, and body composition partially mediates the relationship between these health risk factors. These findings highlight the importance of physical fitness and healthy body composition in the management of blood pressure among this occupational group.
... Cardiometabolic non-communicable diseases (NCDs) such as cardiovascular disease (CVD), stroke, and diabetes mellitus are the leading cause of mortality worldwide in the general population [1]. Professional airline pilots are susceptible to similar health concerns as those occurring in the general population [2][3][4]. However, protective factors associated with being an airline pilot, such as favorable socioeconomic status [5], the healthy worker effect [6], and being subject to regular medical examinations [7] are thought to mitigate some health risk. ...
Background:
Airline pilots experience unique occupational demands that may contribute to adverse physical and psychological health outcomes. Epidemiological reports have shown a substantial prevalence of cardiometabolic health risk factors including excessive body weight, elevated blood pressure, poor lifestyle behaviors, and psychological fatigue. Achieving health guidelines for lifestyle behavior nutrition, physical activity, and sleep are protective factors against the development of noncommunicable diseases and may mitigate the unfavorable occupational demands of airline pilots. This narrative review examines occupational characteristics for sleep, nutrition, and physical activity and outlines evidence-based strategies to inform health behavior interventions to mitigate cardiometabolic health risk factors among airline pilots.
Methods:
Literature sources published between 1990 and 2022 were identified through electronic searches in PubMed, MEDLINE (via OvidSP), PsychINFO, Web of Science, and Google Scholar databases, and a review of official reports and documents from regulatory authorities pertaining to aviation medicine and public health was conducted. The literature search strategy comprised key search terms relating to airline pilots, health behaviors, and cardiometabolic health. The inclusion criteria for literature sources were peer-reviewed human studies, meta-analyses, systematic reviews, and reports or documents published by regulatory bodies.
Results:
The results of the review show occupational factors influencing nutrition, sleep, and physical activity behaviors and delineate evident occupational disruptions to these lifestyle behaviors. Evidence from clinical trials demonstrates the efficacy of nutrition, sleep, and physical activity interventions for enhancing the cardiometabolic health of airline pilots.
Conclusion:
This narrative review suggests that implementing evidence-based interventions focused on nutrition, physical activity, and sleep could help mitigate cardiometabolic health risk factors among airline pilots, who are particularly susceptible to adverse health outcomes due to unique occupational demands.
... Four studies (n = 16,327) reported the prevalence of hypertension (BP ≥ 140/90 mmHg) from objective measurement as 29% (Houston et al., 2010), 28% (Chen et al., 2016), 26% (Wilson et al., 2022a), and 11% (Bhat et al., 2019), with a pooled prevalence of 27.6% (27.5-27.7%). ...
... Furthermore, one study (n = 303) reported the prevalence of elevated BP (≥ 130/85 mmHg) as 38% (Alonso-Rodriguez & Medina-Font, 2012). Derived from four studies (Chen et al., 2016;Choi & Kim, 2013;Wilson et al., 2022a;Wirawan et al., 2013), the objectively measured pooled mean systolic blood pressure (SBP) was 126 ± 14 mmHg, and the objectively measured pooled mean diastolic blood pressure (DBP) was 79 ± 9 mmHg. The prevalence of self-reported known hypertension of participants in three studies was 13% (Aljurf et al., 2018), 7% (Liu et al., 2021), and 6% (Wirawan et al., 2013). ...
... From the 20 studies evaluating sleep, seven studies objectively measured sleep hours with actigraphy (n = 1,764) (Flynn- Evans et al., 2018;Lamp et al., 2019;Roach et al., 2012a;Sallinen et al., 2021;Sallinen et al., 2020;Sallinen et al., 2017;Signal et al., 2014;Wu et al., 2016b), and six used self-recall methods (n = 2,224) Bostock & Steptoe, 2013;Marqueze et al., 2017;Wilson et al., 2021a;Wilson et al., 2022a;Wu et al., 2016b). The pooled means for objective and self-recall sleep hours per night were 7.2 ± 1.1 and 7.0 ± 0.6, respectively. ...
Cardiometabolic non-communicable diseases (NCD) and their major risk factors are associated with adverse acute and chronic health outcomes and may pose risks to flight safety and economic burden. Restorative sleep, healthy nutrition, and sufficient physical activity are powerful lifestyle behaviours that are fundamental for human health and well-being, and each are independently associated with NCD risk reduction. Although occupational preventive medicine research is increasing, airline pilots are largely underrepresented in the literature. Through a series of seven studies, this PhD thesis aimed to enhance the understanding of modifiable health risk factor status for airline pilots and to investigate evidence-based strategies for promoting positive health, wellness, and NCD risk factor mitigation among airline pilots.
To identify priority health risks among airline pilots and to serve as a foundation for further studies within the thesis, Study One systematically explored the global literature pertaining to the prevalence of cardiometabolic health risk factors among airline pilots. Study Two investigated the prevalence and distribution of subjective and objective cardiometabolic health risk factors among New Zealand airline pilots and compared these with the general population. Study Three synthesised global literature and summarised evidence-based considerations regarding the health benefits of sleep hygiene, healthy eating, and physical activity for cardiometabolic health promotion in airline pilots and further discussed evidence-based considerations for enhancing health behaviours in this occupational group. Study Four evaluated the efficacy of a 17-week, three-component personalised sleep, healthy eating, and physical activity lifestyle intervention for enhancing self-report health parameters during the coronavirus disease 2019 (COVID-19) pandemic. Subsequently, Study Five performed a 12-month follow-up investigation of the longitudinal effects of the 17-week intervention on self-report health parameters in addition to body mass and blood pressure management. Study Six further evaluated the effects of the three-component lifestyle intervention with utilisation of a wider range of objective cardiometabolic health parameters. Finally, Study Seven evaluated the efficacy of a smartphone-based app delivery of the three-component lifestyle intervention as a potentially scalable strategy for enhancing health and fitness parameters in airline pilots.
In Study One, A total of 47 studies derived from 20 different countries among a total pooled sample of 36,454 airline pilots were reviewed. The systematic review revealed substantial prevalence of > 50% for overweight and obesity, insufficient physical activity, and elevated fatigue among airline pilots globally. Further, this study highlighted the heterogeneity in methodology and lacking quality and quantity among the current literature pertaining to airline pilots, identifying the need for further research to better understand health risk factors and risk factor mitigation strategies among airline pilots.
In Study Two, the cross-sectional comparison of health risk factor prevalence between airline pilots (n = 504) and the general population (n = 2,033) identified notable and similar health risk factor prevalence between groups, with elevated prevalence of short sleep, physical inactivity, ‘at risk’ for hypertension, and lower positive self-rated health among airline pilots. Accordingly, findings called for further research to examine targeted, cost-effective intervention methods for promoting healthy body weight, managing blood pressure, and enhancing health behaviours to mitigate the risks of occupational morbidity, medical conditions causing loss of license, medical incapacity, and to support flight safety.
In Study Three, the narrative review outlined occupational health risks in airline pilots, summarised the evidence on health benefits of sleep hygiene, healthy eating, and physical activity as preventive medicine, and discussed evidence-based considerations for promoting health behaviours in this occupational group.
In Study Four, 38 airline pilots completed an acute 17-week personalised sleep hygiene, healthy eating, and physical activity intervention which elicited significant improvements in sleep quality and quantity, fruit and vegetable intake, and moderate-to-vigorous physical activity compared to the control group and suggested that achieving health guidelines for these behaviours promoted positive mental and physical health.
Study Five, provides further support that the personalised three-component lifestyle intervention can elicit and sustain long-term improvements in body mass and blood pressure management, health behaviours, and perceived subjective health in overweight and obese airline pilots and may support quality of life during an unprecedented global pandemic.
In Study Six, further implementation of the personalised three-component lifestyle intervention among 67 overweight airline pilots elicited significant (p = < 0.001) positive change associated with moderate to large effects sizes for objective health measures (VO2max, body mass, skinfolds, girths, blood pressure, resting heart rate, push-ups, plank isometric hold) and self-report health (weekly moderate-to-vigorous physical activity, sleep quality and quantity, fruit and vegetable intake, and self-rated health) at 4-months post-intervention, relative to the control group (n = 58).
Lastly, Study Seven utilised a randomised control trial design to deliver a smartphone-based app three-component lifestyle intervention among 94 airline pilots, which elicited positive changes associated with trivial to large effects sizes for objective health measures (Cooper’s 12-minute exercise test, resting heart rate, push-ups, plank isometric hold) and self-report health (weekly moderate-to-vigorous physical activity, sleep quality and quantity, fruit and vegetable intake, self-rated health, and perceived stress and fatigue) at 4-months post-intervention, relative to the control group (n = 92).
In summary, the studies in this thesis provide a foundation for understanding cardiometabolic health risk factor prevalence among airline pilots. Furthermore, our series of controlled clinical trials provide preliminary evidence that a personalised three-component physical activity, healthy eating, and sleep hygiene intervention can elicit short-term improvements and may promote sustained long-term positive adaptations in objective and subjective health parameters in airline pilots.
These findings are important for health care professionals and researchers to provide insight regarding the efficacy of lifestyle interventions for promoting health, and to inform practices relating to disease prevention, health promotion, and public health policy making. Furthermore, in relation to the limited literature base pertaining to health behaviour intervention research among airline pilots, our findings provide novel contributions to this field.
... According to Syabilah et al., (2015), the burden and work demands for the pilot are very high, especially for commercial airplane pilots, one of the professions with the highest stress levels in the world. According to Wilson et al. (2022), pilots have better health status than the general group because of work demands that encourage pilots to always be in top shape (fit). However, being a pilot is a profession with high risk. ...
Flight success and accidents rely on the pilot's condition. To date, there is no psychometrically tested instrument to measure the psychological well-being of pilots. This study aims to develop items for measuring the well-being of commercial pilots in Indonesia. The constructs, dimensions, and indicators were formulated through literature reviews and interviews with pilots about their well-being. We develop well-being as a state in which a person feels positive, healthy, prosperous, comfortable, and valued in their work, able to control and contribute to the social environment. The instrument conveyed six dimensions, namely (1) positive emotion, (2) health, (3) competence, (4) recognition, (5) work security, and (6) social relationship. We implemented summated rating scale model (Likert's scale) to write 80 items on a 6-point scale. The scoring was from 1 (never/strongly not agree) to 6 (almost always/strongly agree); the scores for the unfavourable items were reversed. We applied CVI and SCVI methods to examine the instrument's content validity, corrected-item total correlation to test the item homogeneity, and Cronbach's alpha formula to assess the scale reliability. In content validity, we included two psychometrics experts and one well-being expert to evaluate the items' quality via qualitative and quantitative methods. In the qualitative approach, the expert appraised the item's sentence: whether it derived from the indicators, dimensions, and construct, and whether the sentences were comprehended. In quantitative form, the experts assigned scores from 1 to 4, indicating the item's relevance with the construct, clarity, simplicity, and freedom of ambiguity. We recruited 117 commercial pilots via convenience sampling. The content validity testing suggested that 31 items should be revised.
... Four studies (n = 16,327) reported the prevalence of hypertension (BP ≥ 140/90 mmHg) from objective measurement as 29% [32], 28% [27], 26% [56], and 11% [23], with a pooled prevalence of 27.6% (27.5-27.7%). Furthermore, one study (n = 303) reported the prevalence of elevated BP (≥130/85 mmHg) as 38% [21]. ...
... Furthermore, one study (n = 303) reported the prevalence of elevated BP (≥130/85 mmHg) as 38% [21]. Derived from four studies [3,27,56,57], the objectively measured pooled mean systolic blood pressure (SBP) was 126 ± 14 mmHg, and the objectively measured pooled mean diastolic blood pressure (DBP) was 79 ± 9 mmHg. The prevalence of self-reported known hypertension of participants in three studies was 13% [20], 7% [38], and 6% [57]. ...
... From the 20 studies evaluating sleep, seven studies objectively measured sleep hours with actigraphy (n = 1764) [29,35,48,[50][51][52][53]59], and six used self-recall methods (n = 2224) [17,24,39,56,59,62]. The pooled means for objective and self-recall sleep hours per night were 7.2 ± 1.1 and 7.0 ± 0.6, respectively. ...
Background:
The occupational demands of professional airline pilots such as shift work, work schedule irregularities, sleep disruption, fatigue, physical inactivity, and psychological stress may promote adverse outcomes to cardiometabolic health. This review investigates the prevalence of cardiometabolic health risk factors for airline pilots.
Methods:
An electronic search was conducted utilizing PubMed, MEDLINE (via OvidSP), CINAHL, PsycINFO, SPORTDiscus, CENTRAL, and Web of Science for publications between 1990 and February 2022. The methodological quality of included studies was assessed using two quality assessment tools for cross-sectional and clinical trial studies. The prevalence of physiological, behavioral, and psychological risk factors was reported using descriptive analysis.
Results:
A total of 48 studies derived from 20 different countries, reviewing a total pooled sample of 36,958 airline pilots. Compared with general population estimates, pilots had a similar prevalence for health risk factors, yet higher sleep duration, lower smoking and obesity rates, less physical activity, and a higher overall rate of body mass index >25.
Conclusions:
The research reported substantial prevalence >50% for overweight and obesity, insufficient physical activity, elevated fatigue, and regular alcohol intake among pilots. However, the heterogeneity in methodology and the lack of quality and quantity in the current literature limit the strength of conclusions that can be established. Enhanced monitoring and future research are essential to inform aviation health practices and policies (Systematic Review Registration: PROSPERO CRD42022308287).
