Table 7.

Behavioural strategies to prevent or minimize symptoms of motion sickness

*Behavioural Therapy	Measures/features	**Level of evidence
Habituating to the motion pattern	(i) Habituate through prolonged exposure at sea (ii) Support habituation e.g., with physiotherapy exercises  – Reactive exercises, wilful counter movements of the head	AC
Reducing intersensory conflict	Reduce vestibular stimuli – Avoid movements outside the axes of motion – Avoid low-frequency movements, especially vertical ones (e.g. pitching of a ship) – On a ship: amidships is better than at the bow or stern; focus on the horizon
Synchronizing the visual system with the motion	Focus on the horizon and on a distant point – If watching the horizon is not possible, it may help to close eyes and minimize head movements -- Optokinetic exercises and visual fixation Use an ‘artificial’ horizon – E.g. head-mounted displays or special glasses that provide informationabout the horizon	C
Actively synchronizing the body with the motion	Perform active synchronizing movements (e.g., tilt head into turns), walk around actively, take over steering/control, if possible	C
Breathing technique	Practice active deep diaphragmatic breathing	C

** Evidence level (SORT rating). A: Consistent, high-quality patient-oriented evidence. B: Inconsistent or limited-quality patient-oriented evidence. C: Consensus, disease-oriented evidence, usual practice, expert opinion, or case series