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HPRC Fitness Arena: Total Force Fitness
A new DoD-sponsored report titled Promoting Psychological Resilience in the U.S. Military has been released by RAND Corporation and is available in full-text print and downloadable pdf formats. The RAND National Defense Research Institute (RAND NDRI) conducted a focused literature review to identify individual, family, unit and community-level factors for promoting psychological resilience. The study also included a review of resilience programs.
The full report can be downloaded from the RAND website.
What has the Human Performance Resource Center (HPRC) been doing this past year to make our Warfighters safer? A lot! HPRC has a number of missions, but the most important one—and the one that all of HPRC’s other tasks support—is to provide evidence-based information on Human Performance Optimization (HPO). HPO involves giving our Warfighters the training and information they need to effectively carry out their missions in any environment, with the resilience to avoid injury and illness and the ability to recover quickly if injured or ill. As it turns out, HPO embodies all the domains of Total Force Fitness (TFF)—physical fitness, nutrition, dietary supplements, extreme environments, family/social issues, and psychological fitness—that ADM Mullen is asking the services to embrace.
Some of the accomplishments of HPRC this year are:
- Responding to questions from the field (mostly from Warfighters and providers) at the average rate of one per day and growing. These questions cover topics such as proper hydration, dietary supplement use, sleep requirements, managing altitude sickness, how to beat heat illness, and fitness fueling. Every question answered has the potential of protecting our Warfighters from inaccurate commercial information and harmful practices and of increasing their resilience.
- Overseeing a workgroup of subject matter experts (SMEs) who developed a white paper on High-Intensity Training that helps put in perspective the information available on these popular training programs. A scientific paper will be published in the near future.
- Overseeing the workgroup of SMEs who are developing the concept of Total Force Fitness for ADM Mullen, Chairman, Joint Chiefs of Staff.
- Developing and expanding a website that is now servicing more than a thousand people a week by supplying needed information on HPO and TFF.
- Supplying “healthy tips” to entities such as the Uniformed Services publication The Pulse and the Military Times.
- Partnering with multiple organizations across the services and DoD to help collaborate and coordinate efforts in HPO/TFF.
These examples provide a good snapshot of the activity level at HPRC. The staff and volunteer SMEs are working hard to make our Warfighters safer and more resilient to both physical and mental trauma. Who could ask for a better mission?
Warfighters are deployed to all kinds of environments, including hot and dry conditions where sun exposure is a concern. Choosing a "broad-spectrum" product that protects against sunburn, skin cancer, and premature skin aging is important, but product labeling can be confusing. Now, however, the Food and Drug Administration (FDA) is taking steps to regulate the labeling of sunscreen products in order to help consumers choose a product that will protect them from sun damage to the skin.
The new measures include a regulation, effective one year from now, that requires sunscreens to undergo a standard test if they want to be labeled as a “broad spectrum” product. Those that pass the test will be allowed to use “broad spectrum” on their packaging, which indicates a product that provides protection against both ultraviolet B radiation (UVB) and ultraviolet A radiation (UVA). UVB rays are primarily responsible for sunburn, but both UVA and UVB rays are harmful and can cause sunburn, skin cancer, and premature skin aging.
Other provisions in the FDA regulation include:
- A warning about the risk of skin cancer and early skin aging on the labels of sunscreen products that are not broad spectrum.
- The amount of time the consumer can expect protection from a product with water resistance claims must be stated on the front label. The FDA, based on standard testing, will allow either a 40-minute or 80-minute timeframe on labels.
- Products will no longer be allowed make a claim of “waterproof” or “sweatproof” or use the term “sunblock,” nor can they make the claim of immediate or instant protection or protection for more than two hours without reapplication.
Additional measures regarding the labeling of sunscreen products have been proposed. To learn more, view the FDA’s full article.
The USDA announced on June 2, 2011, that its classic food guide Pyramid is being replaced with the easy-to-understand and interactive MyPlate. Using a “familiar mealtime visual,” MyPlate is intended to remind Americans about balancing meals with the five food groups: fruits, vegetables, grains, protein, and dairy. Based on the 2010 Dietary Guidelines, notable changes to the new guide are the inclusion of more fruits and vegetables, less grains, and the re-categorization of oils as providing “essential nutrients” but not appearing on the plate.
The result is a simple visual graphic of a balanced meal that families can use as a tool to make sure the portions of the major food groups are covered in meals. The simplicity of the graphic helps ALL family members, especially children, become more engaged in what and how much they should be eating. An interactive plate on the MyPlate website allows users to click on each section of the plate, which then displays a page for the selected food group with description, key message, and a list with pictures of single-serving sizes of some common foods in that group. These changes allow families to easily identify what a healthy, balanced meal looks like. Also featured is an Interactive Tools section that enables users to develop personalized plans and learn about specific healthy food choices. When all family members know the basics of healthy eating, mealtime can truly be a shared event.
MyPlate can also encourage family discussions about healthy foods, which can help develop good eating habits by all members of a family. For example, you can find out if there are any particular foods that family members like or dislike, and then find and offer alternatives in the specific food group of a disliked item. This will help eliminate the likelihood that someone will skip the essential healthy components of a meal. Get everyone excited and involved during mealtime! Fun meals shared as a family can promote healthy eating habits for children that they can carry into adulthood and can reinforce family bonding.
Keep in mind that MyPlate isn’t designed as strict rule to be followed—it’s perfectly fine to have dairy products directly on the plate instead of in a cup. Desserts, which are currently placed in the “Empty Calories” section, are okay when consumed in moderation in appropriate portions. You may still have to seek out other sources for how to prepare foods in healthy ways and to determine for the nutrition content of many food items. The information on MyPlate should be used as a tool to build a foundation of knowledge about food choices and help set healthy eating goals for your family. Families should take this change as an opportunity to get the entire family involved in healthy eating.
NBA superstar Shaquille O'Neal recently announced that he will retire from professional basketball after 19 seasons and four championship rings. In addition to that announcement, O'Neal announced via a YouTube video that he, like 12 million other Americans, had been diagnosed with sleep apnea.
According to his girlfriend, the seven-feet-tall, 300-plus-pounds center snored excessively during the night, and she noticed that his chest would often cease movement entirely. After participating in a Harvard University–sponsored sleep study he was diagnosed with a mild case of sleep apnea and was advised to begin wearing a CPAP (Continuous Positive Airway Pressure) mask, a respiratory ventilation therapy that assists the wearer’s breathing while asleep. O'Neal's story has a happy ending—because of the recent diagnosis and subsequent treatment, O’Neal reports that he feels more energetic and that his overall quality of life has improved. He is also happy and comfortable with the treatment. Other professional athletes suffering from sleep apnea have not been so fortunate. In 2006, Reggie White, defensive end for the Philadelphia Eagles and Green Bay Packers—one of the greatest players in football history—reportedly died from causes related to sleep apnea.
What exactly is sleep apnea? And how does it affect athletic performance? People with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times during the night and often for a minute or longer. According to the American Sleep Apnea Association, there are three types of apnea: obstructive, central, and mixed. Of the three types, obstructive sleep apnea (OSA) is the most common. Weight can contribute to sleep apnea. In 2009, a study by Sweden's Karolinska Institute showed that overweight and obese men who lost weight during a calorie-restricted diet over nine weeks had major improvements in their sleep apnea symptoms.
Other risk factors for obstructive sleep apnea include certain physical attributes, such as having a thick neck (which describes many athlete body types), deviated septum, receding chin, and enlarged tonsils or adenoids. Allergies or other medical conditions that cause nasal congestion and blockage can also contribute to sleep apnea.
Signs of sleep apnea include loud and chronic snoring, choking, snorting, or gasping during sleep, long pauses in breathing, and daytime sleepiness regardless of how much time you spend sleeping. Other common signs and symptoms of sleep apnea include waking up with a dry mouth or sore throat, morning headaches, restless or fitful sleep, insomnia or nighttime awakenings, going to the bathroom frequently during the night, waking up feeling out of breath, forgetfulness and difficulty concentrating, moodiness, irritability, or depression.
Untreated, sleep apnea can cause high blood pressure and other cardiovascular diseases, memory problems, weight gain, impotency, and headaches. Moreover, left untreated, it may be responsible for job impairment and motor vehicle crashes.
In terms of athletic/sports performance, sleep apnea is a major concern because sleep apnea causes a disruption to healthy sleep patterns, which in turn can affect physical performance. According to a 2007 Stanford University study of sleep and athletic performance, athletes who extend the amount of sleep they get and reduce their sleep debt are more likely to improve their performance. Conversely, if an athlete does not get a good night’s sleep, then the next day he/she is tired, sleepy, or irritable. In such cases, physical performance also is impaired, since there is limited energy reserve due to the lack of adequate or good-quality sleep. Sleep apnea not only has an impact on athletes—it affects the military, as well.
So what can you do if you suspect that you or your sleep partner has sleep apnea? The only way to be sure is to undergo a sleep test, which is done in a sleep lab where patients sleep in a special bedroom with electrodes and other sensors attached to various parts of the body. There, you will be monitored throughout the night to keep track of whether and how often you stop breathing, how low your O2 sat (oxygen saturation) goes, and what your brainwaves are doing while you're sleeping.
For additional resources on sleep and sleep apnea, please visit the following:
Since the beginning of Operation Enduring Freedom and Operation Iraqi Freedom, approximately two million U.S. troops have deployed. The operational tempo associated with these conflicts has led to longer and more frequent deployments with fewer rest periods in between. The inevitable stress is a challenge for military and civilian communities, even as families work hard to reintegrate their families and normal routines.
In response to these ongoing demands, the Chairman of the Joint Chiefs of Staff directed the development of the Total Force Fitness (TFF) initiative, a new Department of Defense model that focuses on the health, readiness, and performance of our Warfighters. (See the Total Force Fitness section of HPRC’s website for more information on this initiative.)
Following this initiative, a team of Joint-Service and DoD experts lead by COL Bowles of the Uniformed Services University of the Health Sciences (USUHS) came together to create a model that promotes family fitness, resilience, and optimal well-being for service members and their families. This model, which is still in development, is called The Military Family Fitness Model (MFFM).
The MFFM first examines stress-inducing demands placed on military and civilian families from sudden deployment and the return home. Then, looking to build on the resilience of the family, MFFM provides guidelines, skills, and resources for the individual, family, and community to protect against the negative effects of stress. As sources of stress increase, certain behaviors indicate the need for more support (e.g., family strife, children acting out, job instability for non-service members, family role conflict, non-supportive relationships outside the family, and/or domestic violence). With MFFM, families have individual, family, and community resources for additional support. The aim of the model is to foster a multi-level approach that strengthens family resilience and, as a result, Warfighter resilience.
Individual approaches to addressing stress include breathing exercises, yoga, mindfulness exercises, and cognitive restructuring. Family strategies include developing and maintaining strong communication skills, shared family routines, and the building of support networks. The bottom line of the MFFM is that at any point along the model, individuals, families, and communities can strengthen resilience resources to promote total family resilience and fitness.
Members of the MFFM team presented the Military Family Fitness Model at the USDA/DoD Family Resilience conference at the end of April. We encourage you to get more information on the conference presentation, read the abstract, and see the PowerPoint slides presented.
Soldier 360° is a resilience program being implemented by the Army for Warfighters who have combat experience and their families. In fact, Warfighters take the second half of the two-week class with their spouses, while childcare is provided for those who need it. It’s aimed at non-commissioned officers who are nominated by their commanders. The course provides Warfighters with information and strategies on stress management, anger management, relaxation, health, communication, conflict resolution, nutrition, sleep, combat stress, and management of non-optimal behaviors. It also teaches physical fitness, yoga, meditation, conditioning, injury prevention, and pain management. The program combines financial counseling with Military and Family Life Consultant Program counselors, acupuncturists, physicians, and a myriad of others. Read another article from Army.mil for more information.
True total force fitness and overall well-being are crucial to Warfighter readiness and success, and awareness of this is now spreading like wildfire. Admiral Mullen’s Total Force Fitness Initiatives center on the importance of mind, body, family, and environment for overall Warfighter resilience.
There are numerous programs within the military designed to support and enhance Warfighter resilience – some unit specific and some branch or joint-service specific. The HPRC is in the process of gathering information on these myriad programs and highlighting those that are clearly evidence-based, that highlight the importance of mind-body integration, and that teach Warfighter-relevant skills and strategies for performance optimization.
Last week we added a section in our Total Force Fitness domain on the Comprehensive Soldier Fitness (CSF) program. We describe the program, give step-by-step information about its components, and highlight where to go for more information and program participation.
To give you a brief overview, CSF is an integrated Total Force Fitness (TFF) resilience-building program developed by the Army in collaboration with researchers in positive psychology and resilience building. CSF is designed to give Warfighters, their families, and their communities the knowledge, skills, and behaviors to “thrive in their lives” and successfully adapt to life’s challenges. Consistent with some of the components of Total Force Fitness identified by the DoD, CSF has five basic sectors: physical, social, emotional, spiritual, and family.
CSF was initially developed for the Army community, but it has now been adapted for use by the Air Force, Navy, and Marines. In addition, CSF provides training tools specifically designed for family members. Most of the training materials require AKO/DKO access, but the main exception is the family member materials, which are available for immediate download (with registration).
We hope that this new area of our website will be useful, help foster resilience in all, and provide a one-stop shop for previewing some resilience programs ongoing within the military.
Tainted dietary supplements most often occur among products typically marketed for weight loss, sexual enhancement, and bodybuilding. They can have deceptive labeling as well as undeclared, harmful ingredients. The question is: How can consumers protect themselves from these products?
The Food and Drug Administration (FDA) has recently taken some steps to help consumers look out for potentially harmful dietary supplement products. Consumers and healthcare professionals can receive notifications from the FDA by subscribing to the RSS feed. The Commissioner of Food and Drugs also sent a letter to the dietary supplement industry reminding them of their responsibility to prevent the sale of tainted products in the United States. The FDA has also made it easier to report to the FDA about tainted products.
Some of these tainted dietary supplement products contain active ingredients of FDA-approved drugs or other compounds that are not classified as dietary ingredients. These products can have serious side effects, including death. The FDA has identified roughly 300 tainted products that are not legal dietary supplements and are warning consumers about the serious side effects of these products. Consumers should be cautious of:
- Product ads that claim to “melt your fat away,” or claim that “diet and exercise [are] not required,” or products that use the words “guaranteed,” “scientific breakthrough,” or “totally safe.”
- Products that use numerous testimonials about “results seen” from using the product.
- Any product that is labeled or marketed in a foreign language. Consumers should not buy or consume these products.
- Products that are marketed as herbal alternatives to FDA-approved drugs.
- Products marketed and sold on the Internet.
There have been some recent voluntary recalls due to FDA investigations of dietary supplement products. Some of these have included weight-loss products that contained the prescription drug ingredient sibutramine. Sexual enhancement products have also been recalled for containing the undeclared drug ingredients sulfosildenafil and tadalafil. Other products marketed as supplements have been identified as containing various prescription drug ingredients.
It is important that consumers be aware that, under the Dietary Supplement Health and Education Act of 1994, companies do not need FDA approval prior to marketing such products. Thus, generally speaking, the FDA does not approve dietary supplements.
Consumers need to be savvy when they make product purchases, and when in doubt, check with a healthcare professional or registered dietitian to determine if you need a dietary supplement product and to help determine what could be a tainted product. If it looks too good to be true, chances are it is. For more information, read the “FDA’s Beware of Fraudulent ‘Dietary Supplements’.”
The amount of the time spent sleeping is decreasing: the average amount of sleep reported for middle-aged people in the late 1050s—around eight to nine hours—has decreased in recent times to about seven or eight hours. And the number of individuals who sleep less than six hours each night has significantly increased. These changes in sleep patterns may be indicative of sleep deprivation in society at large. This is not surprising, as the modern society seems to offer twice as much work (on the job, at home, etc.) and half as much time to complete it. Consequently, we are awake for extended periods of time, thus reducing the amount of time we spend sleeping.
However, we all know that sleep is essential! Sleep is vital to restore and renew many body systems; and sleep deprivation may result in poor performance, increased sleepiness, reduced alertness, delayed response time, difficulty maintaining attention, decreased positive mood, and increased long-term health risks. Some research studies have even shown that sleep deprivation is associated with increased risk of death.
So adequate sleep is vital for everyone to optimally perform the activities of daily living. But you may wonder, “How can I determine how much sleep I need to function at my best?” Dr. Michael Bonnet, director of the Sleep Laboratory at the Dayton. Ohio, Department of Veterans Affairs Medical Center provides a very simple but practical test you can use to determine how much sleep you need. According to him, if you need an alarm clock to wake up, try going to bed a little earlier the following night (e.g., 15 minutes earlier). If you still need an alarm clock to wake up the next morning, push your bedtime a little earlier again (i.e., another 15 minutes). Continue doing this until you no longer need an alarm to wake up.
I actually tried this test and found out I was not the “night owl” I thought I was. It looks like I function at my best if I retire for the night a couple of hours earlier than I used to. Sleep is important! It significantly affects your performance, health, and quality of life. And it is especially important to Warfighters, who can rarely get enough when deployed. So in addition to a healthy diet and regular exercise, try to get enough sleep each night whenever your situation makes it possible.
Source: National Sleep Foundation