Training videos to prevent cold weather injuries.

Cold weather injuries (CWIs) are a challenge during military training, exercises and operations in Arctic conditions. Soldier performance in these challenging conditions depends on protective equipment, knowledge, personal experience, routines, and leadership. Despite the Norwegian Armed Forces' goal of zero freezing cold injuries (FCIs), there has been a persistently high incidence of FCIs among the younger soldiers with an average of 120-150 new FCIs recorded each year. Therefore, an expert working group with representatives from medical, defence and research background was established in 2020. Their task was to develop a communication package to help prevent CWIs among military personnel. Training videos and an updated and improved official website were created with a focus on practical recommendations and advice to prevent CWIs and especially FCIs. Risks, prevention and symptoms of FCIs were emphasised. The main goal of the training videos was to supplement current teaching on guidance for CWI prevention in CWOs to prevent FCIs, but following the advice may prevent non-freezing cold injuries (NFCIs) and hypothermia. This informative paper describes the background, working methods and possible implications of the training videos, which may be a potential way forward to improve cold weather training and operations.

Energy deficit increases hepcidin and exacerbates declines in dietary iron absorption following strenuous physical activity: a randomized-controlled cross-over trial.

BACKGROUND: Strenuous physical activity promotes inflammation and depletes muscle glycogen, which may increase the iron regulatory hormone hepcidin. Hepcidin reduces dietary iron absorption and may contribute to declines in iron status frequently observed following strenuous physical activity. OBJECTIVES: To determine the effects of strenuous physical activity on hepcidin and dietary iron absorption and whether energy deficit compared with energy balance modifies those effects. METHODS: This was a randomized, cross-over, controlled-feeding trial in healthy male subjects (n = 10, mean ± SD age: 22.4 ± 5.4 y, weight: 87.3 ± 10.9 kg) with sufficient iron status (serum ferritin 77.0 ± 36.7 ng/mL). Rest measurements were collected before participants began a 72-h simulated sustained military operation (SUSOPS), designed to elicit high energy expenditure, glycogen depletion, and inflammation, followed by a 7-d recovery period. Two 72-h SUSOPS trials were performed where participants were randomly assigned to consume either energy matched (±10%) to their individual estimated total daily energy expenditure (BAL) or energy at 45% of total daily energy expenditure to induce energy deficit (DEF). On the rest day and at the completion of BAL and DEF, participants consumed a beverage containing 3.8 mg of a stable iron isotope, and plasma isotope appearance was measured over 6 h. RESULTS: Muscle glycogen declined during DEF and was preserved during BAL (-188 ± 179 mmol/kg, P-adjusted < 0.01). Despite similar increases in interleukin-6, plasma hepcidin increased during DEF but not BAL, such that hepcidin was 108% greater during DEF compared with BAL (7.8 ± 12.2 ng/mL, P-adjusted < 0.0001). Peak plasma isotope appearance at 120 min was 74% lower with DEF (59 ± 38% change from 0 min) and 49% lower with BAL (117 ± 81%) compared with rest (230 ± 97%, P-adjusted < 0.01 for all comparisons). CONCLUSIONS: Strenuous physical activity decreases dietary iron absorption compared with rest. Energy deficit exacerbates both the hepcidin response to physical activity and declines in dietary iron absorption compared with energy balance. This trial was registered at clinicaltrials.gov as NCT03524690.

Perspectives on resilience for military readiness and preparedness: Report of an international military physiology roundtable.

Modern warfare operations often occur in volatile, uncertain, complex, and ambiguous (VUCA) environments accompanied by physical exertion, cognitive overload, sleep restriction and caloric deprivation. The increasingly fast-paced nature of these operations requires military personnel to demonstrate readiness and resiliency in the face of stressful environments to maintain optimal cognitive and physical performance necessary for success. Resiliency, the capacity to overcome the negative effects of setbacks and associated stress on performance, is a complex process involving not only an individual's physiology and psychology, but the influence of factors such as sex, environment, and training. The purpose of this moderated roundtable was to address five key domains of resiliency in a point/counterpoint format: physiological versus psychological resiliency, sex differences, contributions of aerobic and strength training, thermal tolerance, and the role of nature versus nurture. Each speaker was given three minutes to present and the moderator facilitated questions and discussion following the panel's presentation. The interconnectedness of the five domains highlights the need for an interdisciplinary approach to understand and build resilience to enhance military performance.

Cardiovascular and thermal strain during 3-4 days of a metabolically demanding cold-weather military operation.

BACKGROUND: Cardiovascular (CV) and thermal responses to metabolically demanding multi-day military operations in extreme cold-weather environments are not well described. Characterization of these operations will provide greater insights into possible performance capabilities and cold injury risk. METHODS: Soldiers from two cold-weather field training exercises (FTX) were studied during 3-day (study 1, n = 18, age: 20 ± 1 year, height: 182 ± 7 cm, mass: 82 ± 9 kg) and 4-day (study 2, n = 10, age: 20 ± 1 year, height: 182 ± 6 cm, mass: 80.7 ± 8.3 kg) ski marches in the Arctic. Ambient temperature ranged from -18 to -4 °C during both studies. Total daily energy expenditure (TDEE, from doubly labeled water), heart rate (HR), deep body (Tpill), and torso (Ttorso) skin temperature (obtained in studies 1 and 2) as well as finger (Tfing), toe (Ttoe), wrist, and calf temperatures (study 2) were measured. RESULTS: TDEE was 6821 ± 578 kcal day-1 and 6394 ± 544 for study 1 and study 2, respectively. Mean HR ranged from 120 to 140 bpm and mean Tpill ranged between 37.5 and 38.0 °C during skiing in both studies. At rest, mean Tpill ranged from 36.0 to 36.5 °C, (lowest value recorded was 35.5 °C). Mean Tfing ranged from 32 to 35 °C during exercise and dropped to 15 °C during rest, with some Tfing values as low as 6-10 °C. Ttoe was above 30 °C during skiing but dropped to 15-20 °C during rest. CONCLUSIONS: Daily energy expenditures were among the highest observed for a military training exercise, with moderate exercise intensity levels (~65% age-predicted maximal HR) observed. The short-term cold-weather training did not elicit high CV and Tpill strain. Tfing and Ttoe were also well maintained while skiing, but decreased to values associated with thermal discomfort at rest.

Effects of exercise mode, energy, and macronutrient interventions on inflammation during military training.

Load carriage (LC) exercise may exacerbate inflammation during training. Nutritional supplementation may mitigate this response by sparing endogenous carbohydrate stores, enhancing glycogen repletion, and attenuating negative energy balance. Two studies were conducted to assess inflammatory responses to acute LC and training, with or without nutritional supplementation. Study 1: 40 adults fed eucaloric diets performed 90-min of either LC (treadmill, mean ± SD 24 ± 3 kg LC) or cycle ergometry (CE) matched for intensity (2.2 ± 0.1 VO2peak L min(-1)) during which combined 10 g protein/46 g carbohydrate (223 kcal) or non-nutritive (22 kcal) control drinks were consumed. Study 2: 73 Soldiers received either combat rations alone or supplemented with 1000 kcal day(-1) from 20 g protein- or 48 g carbohydrate-based bars during a 4-day, 51 km ski march (~45 kg LC, energy expenditure 6155 ± 515 kcal day(-1) and intake 2866 ± 616 kcal day(-1)). IL-6, hepcidin, and ferritin were measured at baseline, 3-h post exercise (PE), 24-h PE, 48-h PE, and 72-h PE in study 1, and before (PRE) and after (POST) the 4-d ski march in study 2. Study 1: IL-6 was higher 3-h and 24-h post exercise (PE) for CE only (mode × time, P < 0.05), hepcidin increased 3-h PE and recovered by 48-h, and ferritin peaked 24-h and remained elevated 72-h PE (P < 0.05), regardless of mode and diet. Study 2: IL-6, hepcidin and ferritin were higher (P < 0.05) after training, regardless of group assignment. Energy expenditure (r = 0.40), intake (r = -0.26), and balance (r = -0.43) were associated (P < 0.05) with hepcidin after training. Inflammation after acute LC and CE was similar and not affected by supplemental nutrition during energy balance. The magnitude of hepcidin response was inversely related to energy balance suggesting that eating enough to balance energy expenditure might attenuate the inflammatory response to military training.