G-Force Tolerance in Fighter Pilots: A Scoping Review With Evidence Gap Map

Abstract Background: Despite growing interest in G-force tolerance, the literature remains fragmented, lacking an integrated synthesis that encompasses physiological, cognitive, training, and equipment-related dimensions. Fighter pilots are frequently exposed to high +Gz environments, which can compromise vision, cardiovascular stability, and consciousness. Understanding G-tolerance is vital for flight safety, operational readiness, and the long-term health of aircrew. Objective: This scoping review aims to map the existing evidence on G-force tolerance in fighter pilots and identify key physiological, anthropometric, cognitive, and operational factors. It also seeks to explore enhancement strategies and assess underrepresented populations, with the goal of guiding future research and improving pilot safety and performance. Methods: The review followed the JBI methodology and adhered to the PRISMA-ScR guidelines. Searches were conducted across eight databases and grey literature, including studies published up to March 31, 2025. A total of 118 studies met the inclusion criteria, encompassing a range of study designs and international contexts. Results: Findings revealed eight key themes: assessment and prediction of G-tolerance, physical conditioning, physiological and anthropometric factors, training and prevention strategies, equipment and technology, physiological effects of high-G exposure, risks and impacts, and external influences. Although AGSM proficiency, cardiovascular reflexes, and muscular strength were consistently associated with improved tolerance, substantial gaps were found in gender representation, longitudinal tracking, and integration of real-time physiological monitoring technologies. Conclusion: This review highlights the multifactorial nature of G-force tolerance and underscores the need for personalized, interdisciplinary approaches in pilot training and assessment. It provides a comprehensive foundation for future research aimed at optimizing high-G performance, with recommendations for standardized protocols, inclusive study populations, and expanded use of wearable monitoring tools.