Bradley J. Warr

Physiological Employment Standards III: physiological challenges and consequences encountered during international military deployments

Modern international military deployments in austere environments (i.e., Iraq and Afghanistan) place considerable physiological demands on soldiers. Significant physiological challenges exist: maintenance of physical fitness and body composition, rigors of external load carriage, environmental extremes (heat, cold, and altitude), medical illnesses, musculoskeletal injuries, traumatic brain injuries, post-traumatic stress disorder, and environmental exposure hazards (i.e., burn pits, vehicle exhaust, etc.). To date there is very little published research and no comprehensive reviews on the physiological effects of deployments. The purpose of this paper is to overview what is currently known from the literature related mainly to current military conflicts with regard to the challenges and consequences from deployments. Summary findings include: (1) aerobic capacity declines while muscle strength, power and muscular endurance appear to be maintained, (2) load carriage continues to tax the physical capacities of the Soldier, (3) musculoskeletal injuries comprise the highest proportion of all injury categories, (4) environmental insults occur from both terrestrial extremes and pollutant exposure, and (5) post-deployment concerns linger for traumatic brain injury and post-traumatic stress disorder. A full understanding of these responses will assist in identifying the most effective risk mitigation strategies to ensure deployment readiness and to assist in establishment of military employment standards.

How do they compare?: an assessment of predeployment fitness in the Arizona National Guard.

Warr, BJ, Alvar, B, Dodd, D, Heumann, K, Mitros, M, Keating, C, and Swan, PD. How do they compare?: an assessment of predeployment fitness in the Arizona National Guard. J Strength Cond Res 25(11): 2955–2962, 2011—Currently, there is a paucity of literature that describes physical fitness levels in deploying service members. There has been no data collected that evaluate the Army National Guard or Reserves. This descriptive study will provide physical fitness data for soldiers in the Arizona National Guard (AZNG), allowing for a comparison between the active and reserve components. Sixty soldiers from the AZNG were tested before deployment. Body composition was measured by using air displacement plethysmography. Flexibility testing included the sit and reach (SNR), trunk extension (TE), and shoulder elevation (SE) assessments. Muscular strength was determined by the completion of 1 repetition maximum (1RM) bench press and back squat. Muscular endurance was determined by the completion of the Army push-up (P/U) and sit-up (S/U) test. Muscular power was assessed by the completion of the Wingate cycle test and the standing broad jump (SBJ). Cardiorespiratory fitness was determined by the completion of a &OV0312;o2peak test. The AZNG soldiers demonstrated a fat mass of 22.7 ± 8.9%, SNR, TE, and SE of 30.0 ± 8.9, 117.1 ± 25.2, and 145.5 ± 50.3 cm, 1RM bench press and back squat of 82.2 ± 29.9 and 104.6 ± 29.0 kg, P/U and S/U of 50 ± 18 and 53 ± 14 reps, peak power of 660.9 ± 177.8 W, SBJ of 191.8 ± 28.4 cm, and &OV0312;o2peak of 48.9 ± 8.8 ml·kg−1·min−1. This is the first study that provides descriptive data for physical fitness in a reserve component. The data demonstrate that these AZNG soldiers are relatively fit and have comparable results to their active duty counterparts. This descriptive data will provide military leadership a better understanding of the condition of soldiers before deployment and will assist them in better preparing soldiers for future conflicts.

Injuries, changes in fitness, and medical demands in deployed National Guard soldiers

PURPOSE To characterize noncombat injury/illness, determine changes in physical fitness, and evaluate the influence of these changes on medical resource utilization by National Guard (NG) Soldiers. METHODS Fifty-four Soldiers from the Arizona NG completed pre- and postdeployment fitness testing. Additionally, individual deployment medical records were inventoried. RESULTS The majority of noncombat-related medical visits (41%) were musculoskeletal in nature, followed by miscellaneous (33%) and respiratory (13%). Soldiers experienced significant decreases in percent fat mass (-11.1%, p < 0.001) and VO2 peak (-10.8%, p < 0.001). There were significant increases in push-ups (16.4%, p < 0.001), sit-ups (11.0%, p = 0.001), bench-press (10.2%, p < 0.001), and back squat (14.2%, p < 0.001) measures. VO2 peak was inversely correlated to medical resource utilization (r = -0.45 to -0.28, p < or = 0.05). The tertile of Soldiers experiencing the sharpest declines in VO2 peak had significantly more medical visits over the course of the deployment than the other two tertiles (8.0 vs. 2.6 vs. 3.1 medical visits/Soldier, p < or = 0.05). CONCLUSION The predominate noncombat medical issue was musculoskeletal injury. NG Soldiers improved their body composition, strength, and endurance but experienced significant declines in aerobic fitness while deployed. These data document the association between declining aerobic fitness and increased utilization of medical resources.

Characterization of Foot-Strike Patterns: Lack of an Association With Injuries or Performance in Soldiers

OBJECTIVES Characterize the distribution of foot-strike (FS) patterns in U.S. Army Soldiers and determine if FS patterns are related to self-reported running injuries and performance. METHODS 341 male Soldiers from a U.S. Army Combined Arms Battalion ran at their training pace for 100 meters, and FSs were recorded in the sagittal plane. Participants also completed a survey related to training habits, injury history, and run times. Two researchers classified FS patterns as heel strike (HS) or nonheel strike (NHS, combination of midfoot strike and forefoot strike patterns). Two clinicians classified the musculoskeletal injuries as acute or overuse. The relationship of FS type with two-mile run time and running-related injury was analyzed (p ≤ 0.05). RESULTS The Soldiers predominately landed with an HS (87%) and only 13% were characterized as NHS. Running-related injury was similar between HS (50.3%) and NHS (55.6%) patterns (p = 0.51). There was no difference (p = 0.14) between overuse injury rates between an HS pattern (31.8%) and an NHS pattern (31.0%). Two-mile run times were also similar, with both groups averaging 14:48 minutes. CONCLUSION Soldiers were mostly heel strikers (87%) in this U.S. Army Combined Arms Battalion. Neither FS pattern was advantageous for increased performance or decreased incidence of running-related injury.

Influence of training frequency on fitness levels and perceived health status in deployed National Guard soldiers.

Abstract Warr BJ, Scofield DE, Spiering BA, and Alvar BA. Influence of training frequency on fitness levels and perceived health status in deployed National Guard Soldiers. J Strength Cond Res 27(2): 315–322, 2013—While studies have examined changes in body composition, fitness, and other measures pre- and postdeployment, it is more difficult to characterize physical training practices during deployment. The purpose of this study was to evaluate the association between training frequency during deployment and changes in physical performance, body composition, and perceived health. Eighty-eight Soldiers (men, 76 and women, 12) from the National Guard performed 1 repetition maximum (1RM) bench press, 1RM back squat, and V[Combining Dot Above]O2peak testing within 30 days before and 10 days after deployment to Iraq or Afghanistan. Soldiers completed a questionnaire pertaining to aerobic and strength training frequency, as well as perceived changes to health. Soldiers experienced significant (p ⩽ 0.05) improvements in upper (11%) and lower body strength (14%), declines in body fat percent (−16%), but no change in V[Combining Dot Above]O2peak. About 57% of Soldiers reportedly performed aerobic training ≥3 times per week, whereas 67% performed strength training ≥3 times per week. Soldiers performing aerobic training ≥3 times per week responded differently than those who conducted aerobic training <3 times per week in V[Combining Dot Above]O2peak values (2 vs. −8%, p = 0.016). About 42% of Soldiers reported that their health improved, 36% reported no change to their health, and 22% reported that their health had declined. There was a significant association between training frequency and perceived health. About 50–58% of Soldiers who trained ≥3 times per week reported improvements in health during deployment, whereas only 21–24% of Soldiers who trained <3 times per week reported improvements in health for the same period of time. It seems that Soldiers who train ≥3 times per week experience a more advantageous response in terms of fitness levels and perceived health during deployments.

U.S. Army Physical Demands Study: Development of the Occupational Physical Assessment Test for Combat Arms soldiers

OBJECTIVES The United States Army sought to create a legally defensible, scientifically validated physical pre-employment screening test. The purpose of this study was to identify a single combination of predictor tests that would predict physical performance on all of the criterion measure task simulations relevant to the Combat Arms military occupational specialties. DESIGN Concurrent validation. METHODS Data from 838 (608 males, 230 females) soldiers who completed both the criterion measure task simulations of a military occupational specialty and up to 14 predictor tests were used in the development of the test batteries. Stepwise regressions were used to identify test batteries that significantly predicted performance on the criterion measure task simulations of the military occupational specialties. RESULTS Three test batteries were developed based on different subsets of the predictor tests: Test Battery 1 consisted of the medicine ball put, squat lift, beep test, standing long jump, and arm ergometer (adjusted R2=0.80-0.85, p<0.01); Test Battery 2 consisted of the medicine ball put, squat lift, beep test, and standing long jump (adjusted R2=0.79-0.80, p<0.01); and Test Battery 3 consisted of the standing long jump, 1-minute push-ups, 1-minute sit-ups, 300m sprint, and Illinois agility test (adjusted R2=0.55-0.71, p<0.01). CONCLUSIONS Test Battery 2 was selected as the Armys Occupational Physical Assessment Test. It was highly predictive of performance of the Combat Arms military occupational specialties, required no complex equipment, and covered a range of physical fitness domains.

U.S. Army physical demands study: Identification and validation of the physically demanding tasks of combat arms occupations

OBJECTIVES In 2013, the U.S. Army began developing physical tests to predict a recruits ability to perform the critical, physically demanding tasks (CPDTs) of combat arms jobs previously not open to women. The purpose of this paper is to describe the methodology and results of analyses of the accuracy and inclusiveness of the critical physically demanding task list. While the job analysis included seven combat arms jobs, only data from the 19D Cavalry Scout occupation are presented as the process was similar for all seven jobs. DESIGN Job analysis METHODS: As the foundation, senior subject matter experts from each job reviewed materials and reached consensus on the CPDTs and performance standards for each job. The list was reviewed by Army leadership and provided to the researchers. The job analysis consisted of reviewing job and task related documents and field manuals, observing >900 soldiers performing the 32 CPDTs, conducting two focus groups for each job, and analyzing responses to widely distributed job analysis questionnaires. RESULTS Of the 32 CPDTs identified for seven combat jobs, nine were relevant to 19D soldiers. Focus group discussions and job analysis questionnaire results supported the tasks and standards identified by subject matter experts while also identifying additional tasks. CONCLUSIONS The tasks identified by subject matter experts were representative of the physically demanding aspects of the 19D occupation.

The female athlete triad: patients do best with a team approach to care.

LEARNING OBJECTIVES List the diagnostic criteria for the female athlete triad and identify its prevalence Describe the components of the female athlete triad Discuss ways to screen for the female athlete triad Review treatment options for the female athlete triad and their associated difficulties &NA; Low energy availability, menstrual dysfunction, and diminished bone mineral density make up the female athlete triad‐a complex disorder that has wide‐ranging severity.

Self-Management of Unreported Musculoskeletal Injuries in a U.S. Army Brigade

BACKGROUND There is a paucity of literature describing the accuracy of musculoskeletal injury reporting in the U.S. Army. PURPOSE To investigate symptom-management behaviors as well as factors associated with seeking medical treatment among active duty Soldiers who reported that they had concealed at least one musculoskeletal injury. METHODS Anonymous surveys were completed by Soldiers (N = 1,388; 1,269 males, 74 females, and 45 no response) assigned to an Infantry Brigade Combat Team. Soldiers were asked to self-report injuries sustained in the last 12 months and whether or not they reported those injuries to a medical provider. Descriptive statistics were used to analyze treatment alternatives. Chi-square test was used to assess any significant relationships between injury and various demographics. RESULTS There were 808 (58%) Soldiers who stated they had an injury that they did not report. Over-the-counter pain relief medication (81%) was the most commonly selected alternative treatment. CONCLUSION Over-the-counter pain medication was frequently used for symptom management among Soldiers who did not report their injury to a medical provider.