Flight-Associated Cortisol Dynamics and Subjective Assessments of Pain and Stress in Fighter Pilots: An Exploratory Study

Authors

• Hershel Raff, Medical College of Wisconsin
• Keri R. Hainsworth, Medical College of Wisconsin
• Rachel Cutlan, Marquette University
• Katherine A. Sherman, Zablocki Veterans Affairs Medical Center
• Brian D. Stemper, Marquette UniversityFollow

Document Type

Article

Publication Date

11-2025

Publisher

Springer

Source Publication

European Journal of Applied Physiology

Source ISSN

1439-6319

Original Item ID

DOI: 10.1007/s00421-025-05837-8

Abstract

Purpose

Operating a high-performance fifth-generation fighter jet is a potential stressor in which hypothalamic–pituitary–adrenal (HPA) axis dynamics may reflect the intensity of and adaptation to the stressor. The purpose of this study was to evaluate HPA axis activity in fighter pilots and explore whether indices of activity correlated with subjective indices of stress.

Methods

We studied HPA axis dynamics in 20 experienced fifth-generation fighter pilots (18 men/2 women) by measuring salivary cortisol at various times from bedtime the night before a flight training to awakening the morning after the flight training. We also measured plasma ACTH and serum cortisol the day before the flight and immediately following the flight. These findings were correlated with prior pilot flight experience and subjective assessments of pain and stress.

Results

Seven (35%) of the pilots demonstrated normal salivary cortisol levels at all time points despite one having a high index of pain. Lower pre-flight salivary cortisol was correlated with more flight hours in the year leading up to the flight exercise. Flight day awakening salivary cortisol was inversely correlated with pilot-reported post-flight stress. In general, there were no other major correlations suggesting a disconnect between an objective measure of stress via HPA axis dynamics and subjective indices of stress and pain.

Conclusion

The acute HPA axis response in some experienced fighter pilots habituates to the stressor of flying a fighter jet during a training exercise. The experience of the pilot was a determinant of their HPA axis stress response.

Comments

European Journal of Applied Physiology, Vol. 125, No. 11 (November 2025): 3385-3395. DOI.

Recommended Citation

Raff, Hershel; Hainsworth, Keri R.; Cutlan, Rachel; Sherman, Katherine A.; and Stemper, Brian D., "Flight-Associated Cortisol Dynamics and Subjective Assessments of Pain and Stress in Fighter Pilots: An Exploratory Study" (2025). Biomedical Engineering Faculty Research and Publications. 747.
https://epublications.marquette.edu/bioengin_fac/747