Filed under: Op-Ed
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?
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.
Jack3d (sometimes known as “Jacked”) is, according to the bottle, a “powerful pre-workout supplement that increases your capacity to perform.” HPRC did an extensive search for evidence-based information on Jack3d and found that all the apparently scientific literature on the product led to its promotional website, where they offer their own reviews. Anyone taking supplements should know that there have been reports about “tainted” dietary supplements containing active ingredients of FDA-approved drugs or other compounds that are not classified as dietary supplements. But there are still testimonials, blog entries, and bodybuilding forums touting the effects of Jack3d. It’s important to know exactly what is in Jack3d and that there isn’t any information on how much of each individual ingredient is in a serving.
The label of Jack3d says that it contains 4145 mg of a “Proprietary Blend” in one scoop, with 45 servings per container. In that blend are the ingredients:
- arginine alpha-ketoglutarate,
- creatine monohydrate,
- beta alanine,
- 1,3-dimethylamylamine (geranium [stem]), and
- schizandrol A,
- as well as some flavoring and color additives.
So, what does this all mean to a consumer? There have been individual studies conducted on each of the ingredients in Jack3d. Some are more effective than others for potentially enhancing athletic performance and building muscle mass. For example, creatine may increase muscle mass and enhance exercise performance during short, high-intensity repeated exercise bouts. For more information about creatine, see HPRC’s research brief. We know that 1,3-dimethylamylamine (DMAA), a chemical from the geranium plant and also synthetically made, is used in supplements promoted for weight loss, bodybuilding, and enhanced athletic performance. According to the Natural Medicines Comprehensive Database, it’s thought to have stimulant effects. Its chemical structure is similar to that of amphetamine, and it is on the World Anti-Doping Agency’s banned substance list. No scientific literature exists on the effectiveness of DMAA for weight loss, bodybuilding, or enhanced athletic performance. Caution is advised on the use of DMAA with caffeine, since both have stimulant effects and could increase the chance of increased heart rate and blood pressure.
The amount of caffeine per scoop of Jack3d has not been released, although it has been estimated that there is less than 150 mg of caffeine/scoop. Caffeine is included on the FDA’s list as a substance “generally recognized as safe.” However, the FDA has established a maximum concentration for caffeine in cola beverages: 32.4 mg per 6 oz or 71 mg per 12 oz. Other than colas, the caffeine content of food and beverages is not regulated. The label of Jack3d states: “Do not use in combination with caffeine or any stimulants from other sources whatsoever, including but not limited to, coffee, tea, soda and other dietary supplements or medications.” Caffeine seems to increase physical endurance, but it does not seem to affect activities that require high exertion over a short period of time, such as lifting.
The main issue with Jack3d is the same one that exists with many bodybuilding products on the market. There is no way to judge the interaction between the ingredients, especially when the consumer is unable to determine how much of each ingredient is in the product. This product contains multiple ingredients and, potentially, additional and potent ingredients not listed. It also could be contaminated, as has been seen with many other supplements. The FDA has put together information on tainted products promoted for bodybuilding.
It is important to mention that Jack3d comes with serious warnings on its label. As with any supplement, be educated, be advised, and consider all the unknowns before you decide whether the possible benefits are worth risking your health.
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.
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.
Saturday May 8, 2010: This was the first day in my new PFT/OCS workout journal.
Three-mile run: never finished
Sit-ups/2 min – 59
"Tough times don't last. Tough people do." – Gregory Peck.
This is the quote that I think about every day while I’m training for my upcoming ten weeks at OCS this summer. I have never been OUT of shape, but lately I have wondering how IN shape I truly am. So it got me thinking of what is the best way to train for this “hell” that I have heard of. I started with the traditional “practice makes perfect” strategy and started running every day, doing two minutes of sit-ups, and trying to do 20 correct pull-ups without failing. I have to admit it was very hard, and I was not seeing results as fast as I had expected. I am a martial arts instructor and can roll with a student for 20 minutes without gasping for air, but after 1.5 miles of jogging, I was contemplating sleeping on the sidewalk of the street! Now, everyone knows that a basic principle of getting healthy is discipline, but it starts with disciplining your mind before your body. I have a couple Marine buddies who have gone through OCS, and they gave me a whole bunch of advice. I combined most of the things I wrote down from then and have found some helpful tips for training for OCS:
- Switch up your training regimen—so that you do not overwork certain muscles in your body. (See the HPRC website for ideas from various military fitness programs.)
- Breakfast is ESSENTIAL!—It gives you the energy to start out your day with a bang.
- Know your limits—do not train to the point of pain. When you’ve had enough, call it quits and start again tomorrow.
- Consistency is the goal—train most days unless you are sick—or incredibly sore from the 1st day, like I was. Every day does not have to be intense. [HPRC specialist’s note: At least one or two days of rest each week is advisable when ramping up to this activity level. The goal is to get to OCS strong, fit, and ready, not broken before you get there.]
- Don’t give up—I imagine that the real thing will be 10x harder then what I am doing to prepare. It helps give me the sense that things are easy now.
Thanks to tips like these—and consistency—I managed to get a 297/300 on my PFT test in December, which allowed me to qualify for OCS training. My score was based off these results:
Three-mile run: 18:09
Sit-ups/2 min: 100
Nine seconds shorter on my run and I would have had a perfect score of 300! Yes, I was extremely happy about this—but also nervous because now I had one year to graduate, and I had to stay in this kind of shape?!
Saturday March 5, 2011:
Basically, for all those people out there who are trying to get in shape for boot camp, OCS, or even just a PFT test, take these tips into consideration. They have done amazing things for me, and I hope they work for you. Now I have more confidence in myself, more energy, and a better overlook on all this. Start preparing your mind today for what your body will be going through tomorrow.
 Physical Fitness Training (PFT)/Officer Candidate School (OCS)
We’ve seen all the recent news and reports about energy drinks and the concern about the amount of caffeine in these products. Now a new wave of products is gaining attention, aimed at helping us relax, reducing our anxiety, and helping us sleep. These “relaxation beverages,” or “anti-energy drinks,” contain ingredients such as melatonin, valerian root, kava, St. John’s Wort, L-theanine, rose hips, and chamomile. A great number of relaxation beverages have been introduced into the market over the last three years, with names such as “Dream Water,” “iChill,” “Vacation in a Bottle,” and “Unwind.” Consumers of any age can buy these drinks in convenience stores, college campuses, and online.
Part of the problem with these relaxation drinks is that some of their ingredients, particularly melatonin, have not gone through the Food and Drug Administration’s (FDA) approval process required for all food ingredients to be designated as safe or GRAS (“generally recognized as safe”). Melatonin is a hormone made by the body, but it is also available as a supplement and is often used to treat sleep disorders and jet lag. The FDA sent a warning letter last year to the manufacturers of the “Drank” beverage saying, “there is no food additive regulation in effect that provides for the safe use of melatonin…Likewise, we are not aware of any basis to conclude that melatonin is GRAS for use in conventional foods.” The manufacturers of “Drank” want their product to be classified as a dietary supplement, not as a beverage, since the FDA scrutinizes foods and beverages much more closely than dietary supplements.
People who have liver problems, liver disease, or are taking prescription drugs should be cautious about using the herb kava, an ingredient found in some of these relaxation drinks. Kava has been linked to severe liver injury, and the FDA issued a consumer advisory in 2002 with a warning that kava-containing dietary supplement products have been associated with liver-related injuries, including hepatitis, cirrhosis, and liver failure. Valerian root, a medicinal herb, is used to treat sleep disorders as well as anxiety. Although some research has been conducted on the effects of valerian on insomnia, the data are mixed, and no studies have tested the safety and effectiveness of the combination of ingredients found in relaxation beverages.
The marketing of relaxation drinks is also of concern, as it is geared toward a younger crowd, with bottles resembling the look of popular energy drinks and shots. The concern is that young adults will think nothing of having more than one of these a day. Some of these beverages have warnings on their labels stating that users should not consume them before operating/driving machinery or if pregnant or nursing.
What’s the bottom line? Buyers beware! There’s no magic pill, and there’s no magic beverage. Try to determine the causes of your stress and/or insomnia, address those issues, and then work towards establishing a healthy lifestyle overall.
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
Being in stressful situations activates the body’s physiologic stress response, which is what allows Warfighters the ability to respond to any threat at any time. In the sports world, the stress response is associated with the adrenaline rush that pumps athletes up during competitions, and gives them the edge to win.
Unlike athletes, however, Warfighters are a select group who operate in stressful situations day in and day out. Prolonged exposure to stressful situations has been found to be harmful both physically and psychologically, unless one learns how to successfully manage one’s internal response. To that end, there are programs throughout the uniformed services that teach Warfighters combat stress management techniques. Many use a stoplight system—utlizing the colors green, yellow, and red—to teach Warfighters how to calm the stress response and bring the body back into balance, in order to give it a reprieve. Successful warfighters learn these skills and apply them in theater.
These same skills, which allow one to calm the body’s physiologic response to stress, can also be applied to other areas—most notably, in one’s relationships. The stress response triggered by external threats is the same stress response that is activated during emotionally-charged conflicts with someone you care about (although the degree of stress is different). Conflict between two people creates the same internal stress, coupled with a flood of negative emotions. The techniques learned to manage combat stress are techniques that can also help Warfighters in their personal relationships.
A recent study examined 149 couples in a 15-minute discussion about a marital conflict found that positive emotions helped couples regulate, or calm, their physiologic responses after the conversation. Interestingly, how happy the individual was with their relationship did not impact this finding. This indicates that positive emotions seem to have the ability to “undo” the physiologic arousal of conflict.
The next time you get in a fight with someone you care about, try this: stop, take yourself out of the situation, and start thinking positive thoughts—either about yourself, something else, or your partner. Notice whether you feel calmer, if your body temperature decreased, if your heart rate slowed down, and if your body moved less (we tend to move more when we are upset). You might find this to be an excellent addition not only to your combat stress strategies, but also to your positive relationship strategies.
Source: Yuan, J., McCarthy, M., Holley, S. & Levenson, R. (2010). Physiologic down-regulation and positive emotion in marital interaction. Emotion, 10(4), 467-474.