Bridging Total Force Fitness and Whole Health in Cardiovascular Disease Prevention.

INTRODUCTION: The Cardiovascular Disease (CVD) Prevention project is a VA-DoD initiative, supported by the Joint Incentive Fund. The goal of the project is to create an innovative, 3D virtual space within the VA-Virtual Medical Center (VA-VMC) platform that provides Veterans and Active Duty Service Members with educational resources on the prevention of CVD. MATERIALS AND METHODS: The Performance Health and Wellness Center is a new center within the VA-VMC. The space enables users to explore information and actionable resources on various risk factors related to CVD through independent and provider-led instruction, using a personalized 3D avatar. RESULTS: Partners of DoD and VA envision users engaging with the learning resources securely and with a sense of anonymity, which can foster self-directed learning and healthy behavior change. The DoD is particularly invested in promoting CVD prevention through the early adoption of positive health behaviors and the Total Force Fitness framework. The VA team is also committed to supporting users by providing professionally led classes and support groups on various CVD risk factors like tobacco, diabetes, nutrition, and exercise. CONCLUSIONS: This project is a unique and important collaboration during a time when telehealth and telemedicine services are in greater demand. The VA-VMC advances accessible, relevant, and evidence-based educational services for DoD and VA populations, and the Performance Health and Wellness Center, itself, presents Total Force Fitness concepts and a whole-person care approach while encouraging users to be actively involved in shared decision-making with their health care providers.

Operational Physical Performance and Fitness in Military Women: Physiological, Musculoskeletal Injury, and Optimized Physical Training Considerations for Successfully Integrating Women Into Combat-Centric Military Occupations.

This article summarizes presentations from a 2014 United States Department of Defense (DoD) Health Affairs Women in Combat symposium addressing physiological, musculoskeletal injury, and optimized physical training considerations from the operational physical performance section. The symposium was held to provide a state-of-the-science meeting on the U.S. DoD's rescinding of the ground combat exclusion policy opening up combat-centric occupations to women. Physiological, metabolic, body composition, bone density, cardiorespiratory fitness, and thermoregulation differences between men and women were briefly reviewed. Injury epidemiological data are presented within military training and operational environments demonstrating women to be at a higher risk for musculoskeletal injuries than men. Physical training considerations for improved muscle strength and power, occupational task performance, load carriage were also reviewed. Particular focus of this article was given to translating physiological and epidemiological findings from the literature on these topics toward actionable guidance and policy recommendations for military leaders responsible for military physical training doctrine: (1) inclusion of resistance training with special emphasis on strength and power development (i.e., activation of high-threshold motor units and recruitment of type II high-force muscle fibers), upper-body strength development, and heavy load carriage, (2) moving away from "field expediency" as the major criteria for determining military physical training policy and training implementation, (3) improvement of load carriage ability with emphasis placed on specific load carriage task performance, combined with both resistance and endurance training, and (4) providing greater equipment resources, coaching assets, and increased training time dedicated to physical readiness training.

Women in Combat: Summary of Findings and a Way Ahead.

The Women in Combat Symposium was held at the Defense Health Headquarters April 29 to May 1, 2014, cohosted by the Office of the Assistant Secretary of Defense for Health Affairs and the Consortium for Health and Military Performance. The conference was a call to renew and extend research investment and policy commitment to recognize operational scenarios, requirements, health priorities, and combat-related injury exposures uniquely relevant to the performance and well-being of female Service members. Symposium participants worked in groups to identify knowledge and capability gaps critical to the successful integration, health, and performance of female Service members in combat roles and to develop recommendations for researchers and policy makers to address gaps in three specific areas of concern: Leadership and Peer Behavior, Operational Performance, and Health and Well-Being. Consensus findings are summarized as 20 research gaps and accompanying recommendations. Each represents an opportunity to advance health and performance outcomes and to leverage female Service members' strengths and capacities to the general benefit of all Service members and their families.

Women and exertional heat illness: identification of gender specific risk factors.

OBJECTIVE: With the expanding role of women into previously closed combat military occupational specialties, women will likely be exposed more to challenging and extreme conditions. Physical work or exercise in extreme environments could increase the risk for exertional heat illness (EHI) and exertional heat stroke (EHS), the most severe type of EHI. Although men have higher rates of EHS than women, women have slightly higher rates of other EHI. Women may respond differently to exertion in the heat than men, as they typically have higher percentage of body fat (BF%) and lower aerobic power. Further, published pilot-data using the Israeli heat tolerance test (HTT) indicate that women are more likely to be classified as heat intolerant than men. The objectives of the present study were to (1) compare male and female classification patterns of heat tolerance, and (2) identify EHI risk factors that might account for the relationship between heat tolerance classification and sex. METHODS: Fifty-five male and 20 female participants were recruited from military and university communities to participate in a standardized HTT. Subjects underwent measures to calculate anthropometric variables (BF%, body surface area, and waist circumference), a maximal oxygen uptake test to assess aerobic power (VO2max), and a standardized HTT, which consisted of treadmill walking at 5 km/h at a 2% grade for 120 minutes at 40°C and 40% relative humidity. Heat intolerance was defined as attaining a maximum heart rate (HR) greater than 150 bpm or a core body temperature (Tc) more than 38.5°C. Separate hierarchical regressions were conducted using categorical (heat tolerant/intolerant) and continuous (physiological strain index, maximum HR, Tc) HTT outcomes. Risk factors were identified with and without controlling for sex. RESULTS: Women were 3.7 (95% CI, 1.21-11.24) times more likely to be heat intolerant than men (χ²=6.85, P<.01). Compared to men, women had significantly higher BF% and lower body surface area, waist circumference, and VO2max. All heat intolerant participants had lower VO2max and higher BF% than those who were classified as heat tolerant. When VO2max and BF% were entered into regression equations to predict HTT outcomes, sex became nonsignificant; VO2max predicted maximum HR and physiological strain index after controlling for sex. CONCLUSION: The present study found that differences between men and women in heat tolerance classification are largely explained by VO2max. The higher rates of heat intolerance among women likely correlate with higher EHI risk, and underscore the need to understand the physiological and thermoregulatory differences between men and women. As lower aerobic power is a major risk factor for EHI, maximizing the aerobic power of women will be critical to force health protection and readiness as they integrate into combat military occupational specialties.