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Why did the Chikungunya cross the road?

HPRC Fitness Arena: Environment, Total Force Fitness
Cases of a mosquito-borne virus, new to the western hemisphere, have been reported in the Caribbean and recently in the U.S. Read more about this virus, where it came from and how to avoid being exposed.

West Nile. Dengue. Malaria. Chikungunya. No, that’s not a typo. Chikungunya (pronounced “chik-en-gun-ye”), a mosquito-borne virus that primarily occurs in Africa, Asia, and the Indian subcontinent, and Warfighters deployed to these regions have been exposed to this risk for some time, now, however, it is reportedly spreading to Europe and the Americas. Most of the cases in the U.S. involve individuals who have recently traveled abroad, but the Centers for Disease Control and Prevention (CDC) just reported the first locally acquired case, in Florida.

The viral illness is characterized by fever and severe joint pain, but other symptoms include headache, muscle pain, joint swelling, and rash. There is currently no antiviral drug for Chikungunya, and treatment is aimed at relieving symptoms. Most patients will recover fully on their own, although sometimes symptoms persist for several months.

It’s important to know your environment. If you’re being deployed to these regions or even going there on vacation, there are things you can do to protect yourself from mosquito bites and mosquito-borne infections. Wearing long pants, shirts with long sleeves, and insect repellent while outdoors reduces the chance of an insect bite. Other precautions include removing standing water from containers such as flowerpots and buckets and placing screens over open windows and doors.

If you think you could have been infected, you should see your doctor, especially if you have recently traveled to high-risk regions. Visit the Center for Disease Control (CDC) for more information about Chikungunya.

How does air pollution affect physical performance?

It is known that exposure to air pollutants during exercise may affect your health and performance, but what can you do about it?

Inhalation of major air pollutants has been found to decrease lung function and exacerbate symptoms of exercise-induced bronchospasms, including coughing, wheezing, and shortness of breath.  In order to meet oxygen demands during light- to moderate-intensity exercise, you take in more air with each breath. And when you breathe through your mouth, you bypass the nose’s natural filtration of large particles and soluble vapors. As your exercise intensity increases, you breathe faster and deeper, which also increases the amount of pollution inhaled and the depth it travels into your respiratory system.

If you live in or near a busy city, you are exposed to even more combustion-related pollutants—such as nitrogen oxides (NOx), carbon monoxide (CO), particulate matter (PM), and ozone—that can inflame your airways and worsen asthmatic responses. Exposure to freshly generated emissions is most common near areas of high vehicular traffic.

While indoor exercise is often a good alternative to limit exposure to outdoor pollutants, some indoor conditions may be just as toxic. Nitrogen dioxide (NO2)—the more toxic NOx—is usually higher in gas-heated homes and indoor areas with poor ventilation. Carbon monoxide poisoning is also more likely to occur indoors. When carbon monoxide is in your system, the blood carries substantially less oxygen, reducing performance and eventually leading to carbon monoxide poisoning. Be sure to choose well-ventilated areas for indoor exercise.

Particulate matter and ozone are two significant pollutants you may be exposed to outdoors. Inhalation of high levels of particulates has been shown to reduce exercise performance as much as 24.4% during short-term, high-intensity cycling. Women may be more vulnerable than men to certain particulates, associated with greater decrements in performance. Ultrafine particle concentrations are highest in freshly generated automobile exhaust, and these small particles can be carried deep into the lungs. However, the further away you are from fresh exhaust, the less concentrated the particulates.

Bad ozone occurs lower in the atmosphere; it is not directly emitted into the air but is created from chemical reactions between NOx, volatile organic compounds (VOCs), heat, and sunlight. Ozone levels also are higher in summer than in winter; and especially in larger, hotter cities, concentrations tend to peak around midday when solar radiation is highest. Exposure to ozone during exercise has been found to increase resting blood pressure, reduce lung function, and decrease exercise capacity.

The risks associated with not exercising at all are far greater than the risks of exercising outdoors; it just takes a little more planning on days and in conditions when pollution is bad.  When planning outdoor exercise activities, follow these tips to limit your exposure to pollutants:

  • Avoid exercising in areas of heavy traffic, such as along highways and during rush hour.
  • During summer, exercise earlier in the morning, when ozone levels and temperatures are not as high.
  • Check the domestic or international air-quality ratings to determine if it’s safe to exercise outside. Limit your time outside on Code Red and Code Orange days. Environmental conditions on these days are not healthy, especially for children, the elderly, and people with existing respiratory conditions.
  • Exercise indoors when the air quality indicates high ozone and particulate levels.
  • Before any demanding physical activity, limit your carbon monoxide exposure by avoiding smoky areas and long car rides in congested traffic.

Sub terra firma

Combat training is moving underground. New tactics—and, potentially, new doctrine—are being developed to help troops perform in underground environments where enemies could hide.

The U.S. Army’s Asymmetric Warfare Group has been training joint forces in some unusual places—underground venues such as tunnels, caves, and sewers. As battlefields become more urban and enemies move underground, subterranean environments pose unique operational challenges. Although the Army does not currently have an official field manual for underground combat, this new tactical training has developed units’ ability to perform in these environments. Combat training centers are starting to integrate these kinds of complex environments into their facilities, and the Army is urging home-station training to “get creative” and use simple techniques to simulate their own underground environments. Something as simple as training in a dark room with obstacles can simulate underground areas. Israeli Defense Forces have also had success with this type of training. Being able to adapt and perform in challenging environments is a vital part of warrior resilience.

Is wicking apparel as “cool” as you think?

Clothing made from synthetic material is still popular in the sports apparel industry, with many manufacturers claiming that it improves heat regulation. That’s not what the science says, though.

Walk into any fitness center on base or take note of a group of soldiers training, and you’ll probably notice at least a few people in form-fitting synthetic t-shirts. The sports apparel industry has exploded in popularity over the past decade, with numerous manufacturers now competing to develop, market, and sell the newest pieces of clothing (shirts, shorts, underwear, socks), all geared to keep athletes cool while competing or training in hot environments. Is there any science behind these claims? Does tight-fitting clothing made of “high-tech” materials actually help with heat regulation and enhance athletic performance?

You heat up when you exercise, and sweating is the primary method your body uses to stay cool. Sweat evaporating off your skin is the most important method your body has to cool itself during exercise. High-tech materials are supposed to enhance “wicking”—the delivery of sweat away from the skin surface toward the clothing, which allows for evaporation—and limit the absorption of sweat by the clothing itself. Cotton, by contrast, absorbs moisture, so it’s not considered a good choice for exercise.

To date, there’s no evidence that this high-tech clothing improves thermoregulation when worn during exercise in hot environments. Specifically, researchers found no differences in heart rate or body and skin temperatures when subjects performed repeated 20–30 minute bouts of running outfitted in shorts, sneakers, and either a form-fitting compression or traditional cotton t-shirt. Research has also found that wicking sportswear had no effect on cooling when worn under a bulletproof vest or on a cycling sprint when worn under full ice hockey protective equipment. As of now, the best advice for staying cool during exercise in the heat is to wear lightweight clothing, stay properly hydrated, and listen to your body for signs of potential heat illness. For more information on performing in hot environments, please visit the “Heat” section of HPRC’s Environment domain.

Risks of activity at altitude

HPRC Fitness Arena: Environment, Total Force Fitness
Altitude affects what your body needs and how it responds, especially when it comes to exercise.

Performing physical activity—whether exercise or mission demands—at moderate (4,000–7,900 ft or 1,200–2,400 m) and high (7,900–13,000 ft or 2,400–4,000 m) altitudes can be challenging. At high altitude, oxygen pressure is lower, which results in less oxygen in the blood and muscle tissues. And as altitude increases, there’s a decrease in air temperature (about 2°F for every 500 ft or 150 m), less moisture (resulting in drier air), and increased solar radiation. Use sunscreen, drink plenty of water, and watch out for the signs of acute mountain sickness: headache, nausea, shortness of breath, and impaired cognition and balance.

To learn more about altitude sickness, read the article “The Invisible Enemy of the Afghanistan Mountains” on the United States Army Research Institute of Environmental Medicine (USARIEM) website. And learn more about performance at altitude in the Altitude section of HPRC's Environment domain.

Predicting acute mountain sickness

HPRC Fitness Arena: Environment, Total Force Fitness
Scientists suggest how likely you are to experience altitude sickness while at elevation.

With current and future military operations in mountainous regions, the issue of acute mountain sickness (AMS) is a significant medical concern. AMS can affect anyone, military or civilian, who is unacclimatized and/or ascends too rapidly to high altitudes. Symptoms of AMS can include headache, nausea, fatigue, dizziness, and sleep disturbances. Recently, researchers at USARIEM were able to predict the severity and prevalence of AMS after rapid ascent to various altitudes. What they found was that for every thousand-meter increase in elevation over 2,000 m, a person was over four times more likely to develop AMS. In addition, the severity of sickness doubled, and the odds that the AMS would worsen increased almost five-fold. AMS appeared to peak at 18 to 22 hours of exposure to altitude and then went away after 42 to 48 hours. The severity of sickness is greatest above 4,000 meters and may require evacuation to lower altitude or immediate medical attention. It also appears that men are more likely than women to get AMS and more likely for it to be severe. For both men and women, the more active they were at altitude, the longer it took to recover. These findings support current recommendation to limit activity as much as possible in the first 24 hours at altitude to decrease the risk for AMS.

This information should help military leaders manage and perhaps prevent AMS among troops by knowing the elevation, types of activities, and lengths of stay at altitudes.

In order to reduce the risk for AMS, acclimate to moderate elevations (2,000 – 3,000 m) if/when possible. In addition, stay hydrated and try to limit your physical activity at altitude for the first 24 hours. Read more about the effects of altitude on performance and how to minimize your risk for AMS.

Can’t touch this!

HPRC Fitness Arena: Environment, Total Force Fitness
Invasive species of plants may be growing in your back yard or along your ruck march. Know what to look for to prevent illness and injury.

Giant hogweed—no, it’s not an ingredient in one of Harry Potter’s potions; it’s a large poisonous plant that started to bloom in the northeast and northwest areas of the U.S. and parts of Canada earlier this month. If you’re out for a ruck march through the woods and you come across this plant, do not touch it. The sap can cause irritation and burns to your skin and perhaps blindness if it gets into your eyes. If you do happen to come in contact with it, be sure to wash your skin with soap and water and keep the area out of the sunlight for 48 hours. Giant hogweed can grow 14 feet or higher. It’s characterized by large leaves and white, umbrella-shaped flower clusters at the top of the plant. It may be difficult to distinguish from other non-poisonous plants such as cow parsnip, so err on the side of safety if you’re not sure. You can read more about identifying invasive species in your area from the U.S. Department of Agriculture.

Lyme disease: a “tick-ing” time bomb

HPRC Fitness Arena: Environment, Total Force Fitness
If you plan on spending some time in the woods, whether it’s doing a PRT training run or taking a hike, consider taking some measure to protect against Lyme disease.

Lyme disease is a serious concern for those who spend a lot of time in heavily wooded areas and a especially for the DoD. It’s common in the United States and around the world and is caught from the bite of two different species of ticks—the deer tick and the western blacklegged tick.

After spending time in wooded or grassy areas, check yourself all over, including your back (enlist a friend or a mirror to help). The early removal of a tick that’s attached to you is key in preventing Lyme, since the tick must be attached for 24-48 hours in order to transmit the bacteria that cause this disease. Ohio State University conducted a study using different tick-removal tools and concluded that all three tools were effective—and confirmed that early removal is more important than the type of tool that is used. The Centers for Disease Control provides easy-to-follow tips on tick removal using just tweezers.

If you know you’ve been bitten by a tick, or begin to notice symptoms such as a bullseye rash (an early sign of Lyme infection) at a bite location, fatigue, chills, fever, muscle aches, or swollen lymph nodes, you should to see your doctor. Blood tests can be used to confirm whether the symptoms are from Lyme disease. If left untreated, more severe symptoms can occur, such as loss of muscle tone in the face (called Bell’s palsy), severe or shooting pain, and heart palpitations. A typical successful treatment includes a course of antibiotics, but there can still be lingering symptoms, called chronic or post-treatment Lyme disease syndrome. When it comes to Lyme disease, the best offense is a good defense. Some tips for prevention:

  1. Wear your military uniform properly. This can help to prevent tick bites since long pants, long sleeves, and pants that are tucked into boots minimize exposed skin.
  2. Use insect repellents such as DEET or Permethrin.
  3. If you are in a wooded area, avoid tall grasses and brush. If this isn’t possible then be sure to follow tips #4–7 below as you are able.
  4. Perform a thorough skin check—especially of the hair and base of the skull at the hairline.
  5. Shower within two hours of being outside. This can help wash off ticks that are still crawling on the skin.
  6. Examine gear and pets for hitchhiking ticks.
  7. If you have access to a dryer, put your clothes in it for an hour on high heat to kill any ticks.

If you are interested in more information on diseases and conditions that are spread by ticks, insects, or other pests, you can visit the Armed Forces Pest Management Board.

Chronic Multisymptom Illness: Environment to blame?

HPRC Fitness Arena: Environment, Total Force Fitness
Veterans of Middle East deployment are experiencing health complications that have led doctors and other health professionals to investigate possible environmental causes.

Warfighters involved in Operation Desert Storm to current missions in Iraq and Afghanistan may be experiencing what the Institute of Medicine is calling “Chronic Multisymptom Illness.” Research suggests that it is connected to toxins and contaminated environments in Middle East combat zones. Those who appear to be suffering from it have apparently unexplainable symptoms lasting at least six months in two or more of the following categories: fatigue, mood and cognition issues, musculoskeletal problems, gastrointestinal problems, respiratory difficulties, and neurologic issues. Dust storms and smoke from burn pits may be the vehicles for transporting toxic metals, bacteria, viruses, and perhaps the nerve gas sarin. Experts suggest that high temperatures and low humidity in the Middle East cause people to breathe more through their mouths than through their nose, carrying the pollutants deeper into the lungs, especially during rigorous physical activity. New legislation has recently set up burn pit registries to track the medical histories of those who may have been exposed to smoke from the practice of burning waste (human, plastic bottles, etc.) using jet fuel. With the rise of unexplained medical conditions among younger veterans of recent conflicts, researchers are looking for more conclusive evidence as to what exactly is causing this chronic illness. In the meantime, the IOM has just published a report with extensive information and recommendations for treatment.

Over-hydration: too much water hurts

HPRC Fitness Arena: Environment, Total Force Fitness
Staying hydrated is essential, especially during physical exertion in the heat. But beware—too much water can be dangerous.

It’s important to get enough water, especially when it’s hot. However, too much water can lead to a dangerous condition known as hyponatremia in which the sodium levels in your blood drop too low. It’s often caused by drinking too much water and is common among military personnel, athletes, and hikers. Significant weight gain (due to fluid retention) during exercise can occur, along with longer finish times for endurance activities. If you have a Body Mass Index (BMI) below 20, you are more likely to develop this condition. For more in-depth information, read HPRC’s InfoReveal on over-hydration.

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