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HR increased significantly in the three combat situations, and close quarter combat produced the highest sympathetic modulation of the three situations analysed. CONCLUSION Symmetrical, asymmetrical and close quarter combat situations produced an increase in sympathetic modulation, being highest in the close quarter combat situation, where actions are performed at a close distance and in closed spaces. © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.BACKGROUND This article de