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HPRC Fitness Arena: Total Force Fitness
Walk into the new facility of the National Intrepid Center of Excellence (NICoE) on the campus of Naval Support Activity Bethesda, and one of the first things you will see is a sign commemorating the center’s origins, including the fact that the $65 million facility itself was donated by the Intrepid Fallen Heroes Fund. NICoE is committed to the interdisciplinary diagnosis, treatment, and long-term healing of Warfighters, and educational support for their families, from all branches of service.
Unlike many military environments, the facility is curved, spacious, quiet, and pleasant. Some notable features are the high ceilings, artwork, and state-of-the-art treatment rooms.
Patients at NICoE typically are active-duty service members with mild traumatic brain injuries (mTBI) combined with other psychological health conditions such as post-traumatic stress (PTS), anxiety, and depression. Most have already begun treatment elsewhere, often with many medications. The tranquil environment of NICoE instantly helps put them at ease and often leads to more effective treatment with fewer medications.
Recognizing that traditional therapies can’t heal all wounds, NICoE has rooms dedicated to art therapy, virtual reality, and meditation. Beautiful masks line the entrance to the art therapy room, providing a small glimpse into Warfighters’ individual and unique roads to recovery. The virtual reality room allows Warfighters to face traumatic scenarios at a pace that makes sense, an incredibly lifelike setting full of sound, movement, scents, and images. The spirituality room lets in natural light to a space with a beautiful wood floor surrounded by natural plants and a speaker system that plays sounds of nature.
An interdisciplinary approach, combining traditional and integrative medicine, contributes to NICoE’s 99% satisfaction rate, with more than 600 patients from all different services having completed their four-week program. There is no one-size-fits-all approach to healing, and the interdisciplinary makeup of the clinical team enables patients to pursue various treatment options. Providers can collaborate regularly and have cutting edge equipment at their disposal.
Patients usually bring a non-medical attendant, often a spouse or parent. Children also are welcome at NICoE. A private family room with frosted glass includes a children’s play area, and a playground is located behind the facility.
NICoE also focuses on research to help ensure long-term treatment success. There has been discussion of opening their doors to a wider range of Warfighter patients (treating more conditions) and opening more NICoE satellite centers. Referred to as Intrepid Spirits, such centers are open already at Fort Belvoir and Camp Lejeune. The Intrepid Spirit at Fort Campbell will open this summer, and ground was broken recently for one at Fort Bragg. Other bases that may receive an Intrepid Spirit include Forts Hood, Bliss, and Carson, along with Joint Base Lewis-McCord and Camp Pendleton.
Why do some people with devastating injuries do well in their recoveries and others do not? People often focus on the negative fallout, but there can be positive consequences called post-traumatic growth. Scientists use the term “disability paradox” to refer to how some people with devastating illness or injuries are still able to enjoy a good quality of life. The characteristics of these folks describe someone with a “survivor mentality.” Characteristics include:
- Subscribing meaning to one’s disability or lot in life and sharing this meaning with others.
- Not choosing to live as a victim but instead to feel empowered and motivated to deal with struggles and come out as a victor.
- Being flexible, adaptable, resilient, and rolling with the punches.
Many factors play into developing a survivor mentality. Here are some tips to help:
- Create a strong support system: family, church, community, fellow Warfighters, healthcare providers, etc. A support system should be just that—supportive, encouraging, and a promoter of independence, not an enabler for being or feeling like a victim.
- Maintain a “can do” attitude. See challenges or setbacks as an opportunity to learn and grow. Focus on strengths and abilities, not on limitations. Survivors exhibit the 4 Cs of mental toughness.
- Maintain hope and optimism; focus on the future and move from thinking about the negative aspects of injury/illness to focusing on the positives or possibilities.
Adults need seven to eight hours of sleep a day, but do you know how much sleep your children should be getting? Pre-school children (ages 3-5) need 11–12 hours a day, school-age children (ages 5-12) need at least 10 hours a day, and teens (ages 13–18) need 9–10 hours a day. But many children and teens are not getting the recommended amounts. For example, The Centers for Disease Control and Prevention (CDC) highlights how almost 70% of teens are not getting the sleep they need.
Don’t know how much sleep your child is getting? Keep a sleep diary to track his/her sleep for two weeks.
Not sure how to help your child get the best sleep possible? Try the following tips. (They’re great for adults, too.)
Make sure your child has a consistent sleep schedule, including a consistent bedtime.
Provide the same quiet, dark bedroom environment for your child every night.
Help your child or teen have a relaxing bedtime routine that helps them prepare for sleep.
Avoid stimulation near bedtime. That means no sodas or other drinks with caffeine* and no TVs or computers in the bedroom.
Exposure to daylight helps set up a sleep rhythm, so make sure your child spends some time outside every day.
Turn the lights down to help your children wind down about an hour before bed and avoid using TVs or computers during this time as well.
Provide a low-stress family environment. Read HPRC’s “Family relationships affect your child’s sleep” for more information.
* Some experts recommend not giving children any caffeine, but if your child or teen does consume some, the American Academy of Pediatrics suggests that children should not exceed 2.5 mg/kg per day and teens should not exceed 100 mg/day.
Vitamin D is actually a hormone that your body produces when your skin is exposed to sunlight, earning it the nickname “sunshine vitamin.” It plays key roles in reducing your risk of many health conditions, including depression, cancer, heart disease, osteoporosis, and others. Spending 10 to 15 minutes outside on a sunny day with your arms and legs uncovered can provide nearly all the vitamin D most people need—challenging when you’re wearing a long-sleeved uniform or working inside all day—but you can also get some vitamin D in your diet from fatty fish (such as salmon), mushrooms, and many fortified foods.
The Recommended Dietary Allowance for most individuals is 600 IUs. People who have a vitamin D deficiency or certain medical conditions might require supplemental vitamin D but only under the supervision of their healthcare provider. That’s because excess vitamin D can be stored in your body, putting you at risk for toxicity. Over time, too much vitamin D can lead to irregular heart rhythms, kidney damage, and other serious health problems. If you take large doses of supplemental vitamin D and eat foods that are fortified with it, you could easily obtain more than recommended amounts.
Despite the risk for toxicity, nearly one-fourth of people living in the U.S. have low vitamin D levels, so all adults and children should have their vitamin D status checked by their healthcare provider. For more information about vitamin D, read this fact sheet from the Office of Dietary Supplements.
Operation Supplement Safety (OPSS) is a joint military initiative between the Human Performance Resource Center (HPRC) and the Department of Defense (DoD) to educate service members and retirees, their family members, leaders, healthcare providers, and DoD clinicians about dietary supplements and how to choose them wisely.
OPSS has partnered with Natural Medicines Comprehensive Database (NMCD) to provide all DoD personnel with access to evidence-based information on dietary supplements, including Natural Medicines Brand Evidence-based Ratings (NMBER)®.
Now there is an Operation Supplement Safety & Natural Data (OPSS & ND) app available that can help you make an informed decision by giving you:
- Dietary supplement safety and effectiveness (NMBER) ratings.
- Interaction ratings between drugs and natural medicines, known as “adverse reactions.”
- Effectiveness ratings for natural medicines by medical condition and more.
To access the app you must first visit HPRC’s link to NMCD and sign up for your free account. Click on the Warfighter version and use your valid .mil email address. Once you’ve created your free account you will have access to the full version of the app. Up-to-date reviews of commercially available products, Natural Medicines Brand Evidence-based Ratings (NMBER)® for commercially available products, an Effectiveness Checker, and more will be at your fingertips.
If you have questions, please use the “Ask the Expert” button on the OPSS home page.
We’ve all heard of depression. If you’ve never experienced it, it’s easy to think that someone could just snap out of it if they wanted to. Depression doesn’t work like that. It can have an impact on a person in every way—physically, mentally, and emotionally, even extending to relationships—and can range from mild to severe. According to the American Psychological Association, “Depression is more than just sadness. People with depression may experience a lack of interest and pleasure in daily activities, significant weight loss or gain, insomnia or excessive sleeping, lack of energy, inability to concentrate, feelings of worthlessness or excessive guilt and recurrent thoughts of death or suicide.” Depression is an illness considered to be treatable with professional help.
This factsheet from afterdeployment.org details the signs and symptoms of depression. They also have an anonymous online assessment, general information, personal stories shared by those who’ve experienced depression, an interactive workbook that can help you challenge negative thoughts and identify depression triggers, and information about the link between behaviors and mood. Also take a look at the factsheet on Taking Charge of Depression, which includes helpful strategies.
For more information about depression or other mental states that can influence your performance, check out the section of HPRC’s website on depression. However, if you feel you are in crisis, contact the Military Crisis Line—someone is available 24/7 for online chat or via phone at 1-800-273-TALK.
Mindfulness can help you feel better equipped to handle difficult emotions. It’s a process geared to help you tune into emotional experiences rather than try to escape from them. People can feel overcome by depression, anxiety, PTSD, addiction, or other mental health problems, which, ironically, can be exacerbated by trying to forget the cause. For example, a Warfighter afflicted with PTSD often relives difficult events through dreams, flashbacks, or unwanted memories, because he/she desperately wants to avoid experiencing those events. To illustrate this idea, right now, try NOT to think of weapons. You probably thought about them that much more.
Practicing mindfulness mediation means focusing on whatever you are experiencing in the present moment. It can be a structured meditation activity, but because mindfulness is about being present, you can purposefully engage in mindfulness anytime, anywhere. A common meditative approach is to focus on a physical experience such as your breathing, noticing where your attention wanders, and gently guiding it back to your breath; it allows you to experience sadness, anger, fear, and other unpleasant emotions, letting them pass without clinging to the idea of making them go away.”
If you have ever “white-knuckled” your way through an amusement park ride (or ridden in a car with a driver you didn’t trust), you may remember thinking, “When will this be over? Please let it be over…” This shows that focusing on how long something lasts can make it feel like an eternity. By engaging in mindfulness, you will feel less threatened by certain emotions, and you will be less likely to engage in problematic forms of escape (such as drinking, drugs, or simply spacing out).
When people experience difficult emotions, they often cope by engaging the language center of the brain, using words internally to wrestle with the experience. But when people have difficulty re-evaluating why they feel the way they do, this leads to a circular internal debate (such as “I shouldn’t feel this way, but I do, but I shouldn’t…”), which can be pointless and can actually cause more distress. Emotions can be dealt with not just through words but also by tapping into their physical elements (noticing how you feel in your body). When people engage in regular mindfulness practice, the parts of their brains tuned into physical sensations are activated while they experience hard emotions. And people who regularly have this part of their brain activated tend to be more emotionally steady.
Unfortunately, it’s difficult to escape unwanted emotions. And more problems will probably pop up as you try to escape. But if you’re willing to face hard emotions, letting them come and go like waves on a beach, then mindfulness practice can help you have a different experience. Tune in to HPRC for more mindfulness resources, and take advantage of the fact that mindfulness is everywhere now, whether part of your martial arts or yoga class or filling the self-help shelves of your local bookstore. Become more mindful, and you can feel better equipped to handle tough emotions; your mind and body will engage them more productively.
The saying goes that “less is more,” but when it comes to exercise intensity, that might not be the case. We know that some exercise is better than no exercise, but is more-intense exercise better than moderate exercise? How hard should you push? And what are the benefits? With the growing popularity of high-intensity workouts, it’s important to consider both the risks and the benefits.
The role of intensity during exercise has been studied before. For example, the risk of death in older adults is lower for those who walk at a faster pace than for those who walk at a more leisurely pace. However, new research demonstrates that pushing yourself during a workout not only helps make you mentally tough but may also release chemicals into your body that help you develop bigger, stronger muscles.
During “stressful” or high-intensity exercise, your body kicks into “fight or flight” mode and releases hormones such as adrenaline and dopamine to push your system into high gear: increased heart rate, increased breathing rate, and increased oxygen to muscles. A recent study found that these hormones, when released during stressful exercise, sent messages to muscle cells to develop larger and more efficient muscles—at least in mice. The body only releases these chemicals when it feels stressed (for example, during intense exercise). If the body doesn’t feel stressed (as during light exercise), it doesn’t release these chemicals, so it can’t send signals to the muscles.
The good news is that exercise intensity is relative, so anyone should be able to exercise at a level that releases these hormones. Whether you’re just starting out or you’re a seasoned athlete, you can exercise to a level that is intense for you. Shooting for your target heart rate is a good start to gauging intensity. Not every workout needs to top out the intensity scale. In fact, doing too much too often can lead to overtraining and potential injury. Remember to listen to your body and incorporate rest or light days into your workout regimen.
Dietary supplements containing ephedra are illegal. What is ephedra and why is it illegal in the United States? Read HPRC’s new Operation Supplement Safety (OPSS) FAQ about ephedra to find out.
Also, be sure to check out our other OPSS FAQs, and if you still can’t find what you are looking for, use our “As the Expert” button located on the OPSS home page.
PTSD was finally recognized as a medical condition when recent advances in neuroscience showed that the brain no longer works properly after trauma. Your brain has an alarm system to help ensure your survival; it’s useful as long as it works properly. When the alarm system malfunctions because traumatic events pushed it to its limits, the part of the brain responsible for thinking and memory can’t function properly. When this happens, a person with PTSD can’t compare what’s happening now with events in the past when they were safe. However, there are treatments to help “rewire” the brain, so it can work properly again. Learn more about this in “How post-traumatic stress affects your brain”.