Post-exposure effects of simulator sickness in motion-based flight simulators: a review of symptom duration and implications for flight fitness

Abstract

The increasing use of modern motion-based flight simulators in military and civil aviation, despite their high relevance for training, is accompanied by the occurrence of simulator sickness. While acute symptoms during simulation are well described, the duration of post-exposure complaints and their significance for subsequent real flight capability have not yet been sufficiently investigated. The aim of this exploratory review was to summarise the available studies on the (persistence of) symptoms after flight-related simulator training. A systematic literature search was conducted in PubMed, Web of Science and Scopus in accordance with PRISMA guidelines. From a total of 4,404 hits, 14 full texts were included in this review. The studies showed considerable heterogeneity in terms of participants, simulator types, exposure duration and measuring instruments. Typical symptoms included eye strain, nausea, disorientation and, less frequently, dizziness and fatigue. Only a few studies systematically investigated after-effects beyond the immediate period following the simulation. The limited available data suggest that most complaints subside significantly within four to six hours, although individual cognitive and postural impairments may persist for longer. It is currently not possible to make reliable statements about the objective restoration of flight fitness or an evidence-based minimum waiting period between simulator training and actual flight. Overall, there is a considerable need for research, particularly using modern full-motion simulators and standardised objective performance parameters, for deriving valid safety-related recommendations and examining symptom decay. https://www.crd.york.ac.uk/PROSPERO/ , identifier CRD420251161357