Can smaller body armour improve thoracolumbar range of motion and reduce interference when female soldiers perform dynamic tasks?

Does the fit of personal protective equipment affect functional performance? A systematic review across occupational domains

“…In a majority of studies, however, this methodology is inherently biased, in that it restricts fit conditions to the available PPE sizing systems, which may not effectively accommodate the user population [ 11 , 13 , 20 , 23 , 24 ]. For example, body armour is often issued in unisex sizes, which does not provide adequate allowance for differences in size, shape, or position of breast tissue, thus preventing many female soldiers from being able to achieve correct fit in any available size [ 13 , 20 , 23 , 104 ]. Similarly, females have smaller hands but are issued the same size and design of firefighting glove, which has been associated with reduced dexterity and occupational performance detriments [ 105 , 106 ].…”

“…Dynamic fit is important to assess in the context of occupation specific tasks, as the aim of the equipment item should be to minimize restrictions on mobility, and associated fatigue, metabolic cost, performance, and injury detriments. Commonly, dynamic fit is assessed through the use of ROM and functional task performance, including occupationally relevant tasks [13,18,[110][111][112] with standardised ROM tasks and procedures having been developed for some equipment items, such as body armour [15]. These tasks typically compare encumbered and non-encumbered conditions to establish a baseline for performance measures.…”

“…However, optimal sizing and associated fit is often difficult to achieve. In the case of female soldiers, for instance, several recent publications have reported that the existing unisex sizing range does not accommodate the variety of female breast and torso shapes among the population and therefore that women in this field are more likely to be affected by fit-related PPE detriments [ 13 , 20 , 23 ]. Studies of firefighting uniforms have reached similar conclusions, reporting that oversized pants and jackets have a significant negative effect on range of motion and performance compared to pants and jackets that are correctly sized [ 11 , 24 ].…”

“…However, PPE often introduces an ergonomic, human systems integration, and mass burden to the wearer [10]. Use of body armour systems and firefighter turnout gear, for example, have been quantitatively shown to negatively impact ROM and dynamic task performance [11][12][13][14][15]. Working in hot and humid conditions while wearing PPE has also been shown to place additional physiological stress on the body that impacts cognition and comfort, ultimately leading to fatigue, decreased performance, and injury [9,16,17].…”