Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Sep 22;171(5):447-451.
doi: 10.1136/military-2025-002963.

Fatigue and management of warfighter mental endurance

Arnaud Rabat  1 , J Van Cutsem  2 , S M Marcora  3 , A Lambert  1   4 , R Markwald  5 , A G Kubala  5   6 , K E Friedl  7
Affiliations
Review

Fatigue and management of warfighter mental endurance

Arnaud Rabat et al. BMJ Mil Health. .

Abstract

Mental fatigue (MF) is a psychobiological state induced by prolonged exertion that has the potential to reduce performance. In military operations, MF coincides with inadequate sleep, circadian disruption and other stressors, further increasing the risk of fatigue-related errors of judgement and reduction in physical and psychological performance. Experienced leaders can detect MF, but multimodal monitoring and assessment technologies still cannot duplicate this capability. Experiments to define signals that cue this human percept could inform future technologies. Countermeasures include engagement strategies, brain endurance training to extend physical endurance, and caffeine and modafinil to temporarily sustain performance. An infrastructure for physiological monitoring and integrated analyses will advance team performance enhancement, along with the use of explainable and interpretable artificial intelligence modelling, refined through iterative experimentation. More precise definitions that distinguish MF from other types of fatigue will help advance the development of monitoring technologies and countermeasures by targeting the right physiological and behavioural metrics.

Keywords: MEDICAL EDUCATION & TRAINING; Military Personnel; Neurophysiology; OCCUPATIONAL & INDUSTRIAL MEDICINE; Risk management.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1. Overview of the Wearable-Enhanced Watchbill Management System.
Figure 2
Figure 2. A roadmap for integrating mental fatigue into artificial intelligence models using explainable and interpretable artificial intelligence.
See this image and copyright information in PMC

References

    1. Caldwell JA. The impact of fatigue in air medical and other types of operations: a review of fatigue facts and potential countermeasures. Air Med J. 2001;20:25–32. - PubMed
    1. Head J, Tenan MS, Tweedell AJ, et al. Prior Mental Fatigue Impairs Marksmanship Decision Performance. Front Physiol. 2017;8:680. doi: 10.3389/fphys.2017.00680. - DOI - PMC - PubMed
    1. Van Cutsem J, Van Schuerbeek P, Pattyn N, et al. A drop in cognitive performance, whodunit? Subjective mental fatigue, brain deactivation or increased parasympathetic activity? It’s complicated! Cortex. 2022;155:30–45. doi: 10.1016/j.cortex.2022.06.006. - DOI - PubMed
    1. Department of the Army . Technical Memorandum ORO-T-185, Fatigue and Stress Symposium, 24-26 Jan 1952. Maryland: Operations Research Office, Johns Hopkins University, Chevy Chase; 1953. p. 139pp.
    1. Balkin TJ, Riedy SM, Rabat A, et al. The Handbook of Fatigue Management in Transportation. CRC Press. Boca Raton, Florida: 2023. Toward a more precise definition of fatigue; pp. 11–24.

LinkOut - more resources