Editorial: Military human performance optimization: Contemporary issues for sustained and improved readiness.

This issue of the European Journal of Sport Science includes 8 invited state-of-the-science narrative reviews by well-established researchers in the area of military performance focused on (a) physical training; (b) musculoskeletal injury; (c) adaptive bone formation and stress fracture prevention; (d) sex differences in responses to military stress; (e) load monitoring in military settings; (g) circulating biomarkers related to resilience during military stress; (H) military nutrition research; and (I) development of military exoskeletons. Important historical, current and future scientific and research information and guidance within the context of sustained and improved military physical performance and readiness are provided. Conclusions and recommendations for protecting Soldier health and resiliency include: (1) combined physical training emphasizing higher intensity but lower volume; (2) musculoskeletal injury risk factors most supported from the literature include: female sex, prior injury and low fitness; (3) adequate sleep, vitamin D, calcium, and energy availability are all critical for creating a resilient skeleton protecting against stress fractures; (4) differences between men and women when exposed to military stress include cardiovascular strain, fat oxidation, and psychological health risk; (5) biomarkers (cortisol, epi/norepi, ILs 4, 6, 10, 18 and TNF-alpha, IGF-I, testosterone, DHEA) offer insight for internal stress; (6) monitoring physiological training load should include consideration for multiple inputs, rather than a single measure; (7) nutrition optimization includes determining operational requirements, nutritional practices and nutrient delivery strategies; and (8) future generation exoskeletons will achieve a better balance of intended movement based on individual user and interactions with internal and external constraints.