SYSTEMATIC REVIEW article
Front. Physiol.
Sec. Environmental, Aviation and Space Physiology
Post-exposure effects of simulator sickness in motion-based flight simulators: a review of symptom duration and implications for flight fitness
- NW
Nico Willebrand genannt Overgahr 1,2
- DF
David Feibus 3,4
- SS
Stefan Sammito 3,1
1. Otto-von-Guericke-Universitat Magdeburg, Magdeburg, Germany
2. 33rd Tactical Air Wing, Büchel, Germany
3. German Air Force Centre of Aerospace Medicine, Cologne, Germany
4. ESEP, US Air Force, Cologne, Germany
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Abstract
Introduction: 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. Methods: 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. Results: 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. Discussion: 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.Overall, there is a considerable need for research, particularly using modern full-motion simulators and standardised objective performance parameters, in order to be able to derive valid safety-related recommendations and examing symptom decay.
Summary
Keywords
Aerospace Medicine, Flight safety, flight simulator, full-motion simulator, Military aviation, Motion Sickness, Simulator sickness
Received
06 April 2026
Accepted
31 July 2026
Copyright
© 2026 Willebrand genannt Overgahr, Feibus and Sammito. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Stefan Sammito
Disclaimer
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