Health, Performance Ratings and Approachability of 50-60-Year-Old Sedentary Adults (ActIv-Study): Key Insights for Health Economy and Exercise Promotion.

Despite significant prevention efforts, the numbers of physically inactive individuals, chronic illnesses, exhaustion syndromes and sick leaves are increasing. A still unresolved problem with exercise promotion is the low participation of sedentary persons. This collective term covers heterogeneous subgroups. Their engagement with movement campaigns and resistance to change are influenced by numerous factors. Our aim was to analyse survey data on health, performance, lifestyle habits and the approachability to physical activity campaigns obtained from the Germany-wide ActIv survey. From 2888 study participants aged 50-60 years, 668 persons were categorised into the subgroups "never-athletes", "sports-dropouts", "always-athletes" and "sports-beginners". Large and significant group differences were found for BMI, assessment of quality of life, health and fitness, risk factors and health problems. In total, 42.5% of "never-athletes" and 32.5% of "sports-dropouts" did not state any barriers to sport. There are substantial disparities between the non-athlete groups in terms of their motivation to exercise. In contrast, there are comparatively minor differences in motivation between "sports-dropouts" and "sports-beginners", whose health and fitness are the primary motivators for sport. Our analyses suggest that (i) negative health and performance trends cannot be compensated for by appeals for voluntary participation in exercise programmes and (ii) powerful incentive systems are required.

Generic military simulation of a complex workplace. A new tool for applied research in military settings.

In almost any military occupational specialty soldiers must monitor and react to stimuli, store and process information, make and communicate decisions, while using different in- and output modalities. When assessing influences on performance, e.g., by sleep-deprivation or heat-stress in intervention designs, researchers face a dilemma: They can either examine highly trained military experts in their jobs, thus risking limited generalizability of their results, or use standard measures of cognitive performance with little ecological relevance. To solve this dilemma, we developed a multidimensional job simulation by abstracting a wide range of military jobs into a generic military simulation of a complex workplace (GEMS COW). It had to meet the following requirements: 1) validly and reliably measure the relevant psychological constructs of the abstracted jobs, 2) require only minimal training, and 3) score high acceptance with military specialists. GEMS COW assesses attention, short-term memory (sm), and working memory (wm) in a lifelike setting. Three studies were conducted focusing on psychometric properties (Study 1, N = 74), overall task complexity in an intervention design (Study 2, N = 54), and acceptance (Study 3, N = 22) of GEMS COW. Psychometric properties proved satisfactory (construct validities: wm = .58, attention = .45, sm =.68; retest reliability: .61-.90). The simulation has a medium to high mental difficulty and soldiers accept it as a realistic military task. GEMS COW is easy to learn and reliably measures psychological constructs in a complex generic simulation. It can be used in intervention studies and may easily be implemented in other languages.

Analgesic Use in Sports.

BACKGROUND: Consumption of medication to alleviate pain is widespread in Germany. Around 1.9 million men and women take analgesics every day; some 1.6 million persons are addicted to painkillers. Analgesic use is thought also to be common in sports, even in the absence of pain. The aim of this study was to assess the extent of painkiller use among athletes. METHODS: In line with the PRISMA criteria and the modified PICO(S) criteria, a systematic literature review was registered (Openscienceframework, https://doi. org/10.17605/OSF.IO/VQ94D) and carried out in PubMed and SURF. The publications identified (25 survey studies, 12 analyses of doping control forms, 18 reviews) were evaluated in standardized manner using the Newcastle Ottawa Scale (NOS) and AMSTAR (A MeaSurement Tool to Assess systematic Reviews). RESULTS: Analgesic use is widespread in elite sports. The prevalence varies between 2.8% (professional tennis) and 54.2% (professional soccer). Pain medication is also taken prophylactically in the absence of symptoms in some non-elite competitive sports. In the heterogeneous field of amateur sports the data are sparse and there is no reliable evidence of wide-reaching consumption of painkillers. Among endurance athletes, 2.1% of over 50 000 persons stated that they used analgesics at least once each month in connection with sports. CONCLUSION: Analgesic use has become a problem in many areas of professional/ competitive sports, while the consumption of pain medication apparently remains rare in amateur sports. In view of the increasing harmful use of or even addiction to painkillers in society as a whole, there is a need for better education and, above all, restrictions on advertising.

Soldier Load Carriage, Injuries, Rehabilitation and Physical Conditioning: An International Approach.

Soldiers are often required to carry heavy loads that can exceed 45 kg. The physiological costs and biomechanical responses to these loads, whilst varying with the contexts in which they are carried, have led to soldier injuries. These injuries can range from musculoskeletal injuries (e.g., joint/ligamentous injuries and stress fractures) to neurological injuries (e.g., paresthesias), and impact on both the soldier and the army in which they serve. Following treatment to facilitate initial recovery from injuries, soldiers must be progressively reconditioned for load carriage. Optimal conditioning and reconditioning practices include load carriage sessions with a frequency of one session every 10-14 days in conjunction with a program of both resistance and aerobic training. Speed of march and grade and type of terrain covered are factors that can be adjusted to manipulate load carriage intensity, limiting the need to adjust load weight alone. Factors external to the load carriage program, such as other military duties, can also impart physical loading and must be considered as part of any load carriage conditioning/reconditioning program.

Health Risks and Interventions in Exertional Heat Stress.

BACKGROUND: With climate change, heat waves are expected to become more frequent in the near future. Already, on average more than 25 000 "heat deaths" are estimated to occur in Europe every year. However, heat stress and heat illnesses arise not just when ambient temperatures are high. Physical exertion increases heat production within the organism many times over; if not enough heat is lost, there is a risk of exertional heat stress. This review article discusses contributing factors, at-risk groups, and the diagnosis and treatment of heat illnesses. METHODS: A selective literature search was carried out on PubMed. Current guidelines and expert recommendations were also included. RESULTS: Apart from muscular heat production (>70% of converted energy), there are other factors that singly or in combination can give rise to heat stress: clothing, climate/acclimatization, and individual factors. Through its insulating properties, clothing reduces the evaporation of sweat (the most effective physiological cooling mechanism). A sudden heat wave, or changing the climate zone (as with air travel), increases the risk of a heat-related health event. Overweight, low fitness level, acute infections, illness, dehydration, and other factors also reduce heat tolerance. In addition to children, older people are particularly at risk because of their reduced physiological adaptability, (multi-)morbidity, and intake of prescription drugs. A heat illness can progress suddenly to life-threatening heat stroke. Successful treatment depends on rapid diagnosis and cooling the body down as quickly as possible. The aim is to reduce core body temperature to <40 °C within 30 minutes. CONCLUSION: Immediately effective cooling interventions are the only causal treatment for heat stroke. Time once lost cannot be made up. Prevention (acclimatization, reduced exposure, etc.) and terminating the heat stress in good time (e.g., stopping work) are better than any cure.

Index Finger Muscle Fatigue and Pistol Firing Failure.

OBJECTIVE: The aim of this study was to analyze finger strength and effects of muscle fatigue on the ability to shoot. BACKGROUND: The finger and hand muscles of soldiers are subject to high loads. For example, the trigger pull of military pistols can amount up to 58 N (≈6 kg) and could cause muscle fatigue in the trigger finger. For soldiers, however, maintaining the ability to shoot is essential for self-defense and survival. METHOD: The marksmanship training of 30 German soldiers (15 female) ages 18 to 40 years was evaluated. Three consecutive exercises with a total of 60 rounds were fired from target ranges of 5 and 10 m, equally using a single-action and double-action trigger mode. Maximum voluntary isometric contraction of the index finger (MVCIF) was measured before and after each of the three firing exercises. RESULTS: Shooting reduced MVCIF in female (88.2 ± 15.8 N to 67.3 ± 17.7 N, p < .001) and male soldiers (145.8 ± 21.7 N to 112.7 ± 26.6 N, p < .001). Of the 30 subjects, 23 were unable to shoot due to fatigue, including 15 of 15 female soldiers. The higher MVCIF was at rest, the less commonly (r = .73, p < .001) and the later (r = 0.82, p < .001) task failure occurred. Two intermissions of approximately 6 min did not suffice for a significant recovery. CONCLUSION: Excessive trigger pull weight causes muscle fatigue of the index finger and can ultimately lead to task failure during pistol marksmanship training. Short breaks are insufficient for the recovery of finger muscles. APPLICATION: This study presents a new perspective on ideal trigger pull weight, which should be carefully considered by manufacturers to allow repetitive firing and simultaneously ensure safe handling.

Exercise Testing in Sports Medicine.

BACKGROUND: Bicycle and treadmill exercise tests are used in sports medicine and occupational medicine to detect latent disease, to monitor treatment, and to measure patients' physical performance ability and reserve. In this review, we describe the indications, contraindications, and manner of performance of these tests, along with the variables tested, criteria for evaluation, (sub)maximal stress, and the factors that affect these tests, including age, sex, and medications. METHODS: This review is based on pertinent articles retrieved by a selective literature search and on the ergometry guidelines of four medical specialty societies. RESULTS: The proper performance of ergometric stress tests calls for preparation and monitoring by qualified staff as well as standardized testing conditions. Ergometric studies are indispensable as a clinical diagnostic method for the early recognition of disease, for follow-up over time, and for individual counseling. The patient's maximal achievable performance is a predictor of morbidity and mortality. Among the variables that can be measured in the submaximal performance range, the respiratory rate, heart rate, and lactate performance curves are more accurate prognostic predictors than the so-called threshold values (physical working capacity, anaerobic-aerobic threshold). Ergometric stress tests can be used to detect (among other conditions) latent hypertension, pulmonary diseases (e.g., exertional asthma), pabnormal ECG changes, and cardiovascular disorders (e.g., ischemia, arrhythmia, congestive heart failure). The ergometric findings are influenced by the choice of stress-inducing protocol. They provide important information for the planning and monitoring of exercise training and for the treatment of persons suffering from diverse physical conditions, as well as for leisure-time athletes. They are less suit- able for use in the design of training programs for high-performance athletes. CONCLUSION: Ergometric stress tests provide important data in clinical and preventive medicine. The findings are often difficult to interpret because of the wide range of normal findings, the use of different stress-inducing protocols, and the lack of gen- erally accepted reference values. The establishment of a nationwide fitness and health registry for ergometric data would be very helpful for the individualized inter- pretation of test findings and for the monitoring of exercise training and therapy.

Strength Training for Women as a Vehicle for Health Promotion at Work.

BACKGROUND: Women, on average, have less muscle strength than men. This anthropometric-physiological trait may make them more vulnerable to ex - cessive physical strain, injury, and inability to work. Strength training is used for preventive health maintenance and to lessen musculoskeletal symptoms. In this context, we studied whether the degree of muscle strength has any effect on women's health in everyday working life, and also the effects of strength training for women on their health in the workplace. METHODS: We systematically searched the PubMed/MEDLINE, Embase, CINAHL, Web of Science, CENTRAL, and SPOLIT databases for pertinent publications, in accordance with the PRISMA criteria for literature searches. We analyzed all of the retrieved randomized controlled trials conducted on women aged 18 to 65 to determine the effects of training on muscle strength, physical performance ability, and health-related parameters including body composition, musculo - skeletal pain, and subjective well-being. RESULTS: We did not find any studies that provided answers to the first question. As for the second question, the selection criteria were met by 12 of the 4969 retrieved studies, which dealt with the effect of strength training on health in the occupational environment and involved a total of 1365 female subjects. These studies were carried out in heterogeneous subject groups, with a variety of overlapping interventions consisting of both strength and endurance training. Significantly increased strength was found in all studies, as was a reduction of pain in all of the studies where this question was asked. Inconsistent results were obtained with respect to body weight, body composition, and subjective well-being. CONCLUSION: The interventions that were conducted in these studies succeeded in increasing strength and reducing pain, even when the training was brief and of low intensity. This was true not only for women working in occupations requiring unusual physical strength, but also for those in sedentary occupations. The small number of studies performed on this subject to date is surprising in view of the high prevalence of musculoskeletal symptoms in women.

Soldier Health Habits and the Metabolically Optimized Brain.

Human performance enhancement was the subject of a NATO workshop that considered the direct benefits of individual soldier health and fitness habits to brain health and performance. Some of the important health and fitness include physical activity and purposeful exercise, nutritional intake, sleep and rest behaviors, psychological outlook and mindfulness, and other physiologically based systemic challenges such as thermal exposure. These influences were considered in an integrated framework with insights contributed by each of five participating NATO member countries using representative research to highlight relevant interrelationships. Key conclusions are that (1) understanding the neurobiological bases and consequences of personal health behaviors is a priority for soldier performance research, and this also involves long-term brain health consequences to veterans and (2) health and fitness habits have been underappreciated as reliably effective performance enhancers and these should be preferred targets in the development of scientifically based recommendations for soldier brain health and performance.

Even One Is Too Much: Sole Presence of One of the Risk Factors Overweight, Lack of Exercise, and Smoking Reduces Physical Fitness of Young Soldiers.

Health and physical fitness are key factors for soldiers. Increased sedentary military work, significant sitting periods during commuting and leisure time, and unhealthy dietary habits have caused a considerable increase in the number of physically unfit soldiers. Even worse, the adoption of harmful lifestyle habits occurs increasingly earlier in life. The aim of this cross-sectional study was (a) to determine the physical fitness of young male soldiers and (b) to investigate the association between physical fitness and both the presence and frequency of the health risk factors overweight, smoking, and lack of exercise. A total of 4,553 volunteers aged 18-25 years performed the Basis Fitness Test consisting of the 3 disciplines agility (11 × 10 m shuttle sprint), strength (flexed-arm hang), and endurance (1,000-m run). The presence and frequency of risk factors were determined by means of anthropometric measures (body mass index, waist circumference) and questionnaire data. The portion of soldiers without risk factors decreased from 49.4% (18-year-olds) to 16.4% for 25-year-olds. Persons without risk factors completed the agility test in 41.1 ± 3.7 seconds, flexed-arm hang in 60.1 ± 19.7 seconds, and 1,000-m run in 235 ± 32 seconds. Physical performance in all dimensions tested (agility, strength, endurance) notably deteriorated with the sole presence of one of the risk factors overweight, smoking, and lack of exercise. Any further risk factor led to further fitness decreases (p < 0.001). Mean performances of soldiers with 3 risk factors were 46.7 ± 4.1 seconds (11 × 10 m shuttle sprint), 27.6 ± 6.4 seconds (flexed-arm hang), and 298 ± 45 seconds (1,000-m run). Impacts of unhealthy lifestyles and significant losses in physical fitness are already visible in young male soldiers. Armed Forces must intensify their efforts to maintain health and performance of their soldiers.

Concept for a Predeployment Assessment of Basic Military Fitness in the German Armed Forces.

Military fitness is defined as a hierarchical 4-level construct in the German armed forces: (a) "Fundamental/Baseline Fitness," (b) "Basic Military Fitness," (c) "Task Fitness," and (d) "Mission Fitness." "Fundamental/Baseline Fitness" is assessed with the "Basic Fitness Test." However, this test alone is not sufficient to assess readiness for the physical demands of deployments. The first part of the article describes the development of a tool mirroring the specific physiological requirements of military operations on a joint forces level. The "Basic Military Fitness Tool" (BMFT) combines 4 crucial military demands into one single timed test run performed with field uniform (5 kg), body armor (13.4 kg), and helmet (1.6 kg): (a) maneuver under fire: 130 m run with changes in direction, velocity, and body position, (b) casualty rescue: 40 m of dragging a 50 kg load, (c) load carrying: 100 m carrying of two 18 kg loads, and (d) load lifting: lifting a 24 kg load on to a 1.25 m high rack 5 times. The second part covers the first assessment of BMFT selectivity between high- and low-performing groups. Muscle mass and strength are important factors for working with loads. Thus, female soldiers are expected to need more time to complete BMFT because of their on average lower muscle mass. Eighteen female (age = 28.5 ± 6.6 years, lean body mass [LBM] = 45.0 ± 4.5 kg; mean ± SD) and 104 male soldiers (age = 30.0 ± 8.4, LBM = 64.3 ± 7.1) completed isometric strength testing (hand grip = 344.3 ± 51.4 N and 547.3 ± 79.1 N, elbow flexors = 118.9 ± 16.9 and 235.1 ± 42.0, knee extensors = 433.2 ± 87.4 and 631.4 ± 111.4) and BMFT (259.2 ± 44.0 and 150.0 ± 21.1 s). Except age, all variables differed significantly (p < 0.01) between groups.

Diving medicine in clinical practice.

BACKGROUND: Diving is a popular sport, and some recreational divers have medical risk factors. Their health can be endangered by high extracorporeal (ambient) pressure and its many systemic effects. METHODS: We review relevant publications on free (breath-hold) diving, scuba diving, medical evaluation for diving, barotrauma, decompression sickness, and diving with medical risk factors, which were retrieved by a selective search of PubMed. RESULTS: Free diving or scuba diving, even at seemingly innocuous depths, puts considerable stress on the cardio - vascular system, ears, and lungs. Unexpected events while diving, diminished functional reserve, and pre-existing medical illnesses increase the risk of a diving accident. An international survey revealed that minor incidents occur in 1.3% of all dives, and decompression accidents in 2 of every 10 000 dives. A properly conducted medical examination to determine diving fitness, followed by appropriate counseling, can make a life-threatening diving accident less likely. CONCLUSION: To be able to certify diving fitness and give competent medical advice about diving, physicians must be well informed about the physical and physiological changes of diving and the associated risks to health, and they need to know how to perform a medical evaluation of prospective divers. In Germany, any licensed physician may judge a person fit to dive. It is recommended that this be done in adherence to the relevant evaluation standards and recommendations of the medical specialty associations. Randomized controlled trials on the effect of preventive behavior would be desirable, as would a central registry of diving accidents.

Results of a workplace health campaign: what can be achieved?

BACKGROUND: Effective health promotion in the workplace is now essential because of the rising health-related costs for businesses, the increasing pressure arising from international competition, prolonged working lives, and the aging of the work force. The basic problem of prevention campaigns is that the target groups are too rarely reached and sustainable benefits too rarely achieved. In 2011, we carried out a broad-based health and fitness campaign to assess how many personnel could be motivated to participate in a model study under nearly ideal conditions. METHOD: 1010 personnel were given the opportunity to participate in various kinds of sports, undergo sports-medicine examinations, attend monthly expert lectures, and benefit from nutritional offerings and Intranet information during work hours. Pseudonymized questionnaires were used to classify the participants according to their exercise behavior as non-active, not very active, and very active. The participants' subjective responses (regarding, e.g., health, exercise, nutrition, and the factors that motivated them to participate in sports or discouraged them from doing so) were recorded, as were their objective data (measures of body size and strength). The duration of the study was one year. RESULTS: 490 of the 1010 personnel (48.5%, among whom 27.2% were nonactive, 44.1% not very active, and 28.7% very active) participated in the initial questionnaire and testing. By the end of the study, this figure had dropped to 17.8%; diminished participation affected all three groups to a comparable extent. A comparison of dropouts and non-dropouts revealed that older age was a stable predictor for drop-out (bivariate odds ratio [OR] 1.028, p = 0.006; multivariate OR 1.049, p = 0.009). The study participants reported beneficial effects on their health and health awareness, performance ability, psychological balance, stress perception, exercise and dietary behavior. CONCLUSION: Even under optimal conditions and with high use of staff resources, this model study (which cannot be universally implemented) did not lead to comprehensive and sustained personnel participation. This finding suggests that the currently available prevention instruments are insufficient for the effective and cost-efficient promotion of health and fitness in the workplace.

Physical fitness, weight, smoking, and exercise patterns in young adults.

INTRODUCTION: The health and physical fitness of adolescents and young adults are important not just to the individuals concerned, but also to society as a whole. Many studies from many different countries have dealt with the prevalence of overweight, the risk factors for it, and the morbidity it causes, but no more than a few have addressed the effects of unhealthy lifestyles on physical fitness. In this study, we show that young adults' physical performance depends on the number of risk factors they possess. We also compare the young adults' physical performance with that of adolescents aged 10 to 17. METHODS: We obtained cross-sectional data on the weight, smoking status, athletic activity, time to run 1 km, and ability to perform a chin-up on a horizontal bar of 8048 subjects aged 10 to 25. The young adults were divided into groups depending on the number of risk factors they possessed from the following list: overweight, smoking, and lack of exercise. RESULTS: 28.4% of the men and 35.4% of the women aged 18 to 25 had none of these risk factors and exhibited the best physical performance. The more risk factors were present, the worse physical performance became. The 24- and 25-year-olds performed at the same level as the 14- and 15-year-olds. DISCUSSION: Unhealthy lifestyles can impair physical fitness even before any chronic disease arises. Possession of even a single risk factor is associated with significantly worse performance. Unless comprehensive and effective interventions are introduced in school and at work, the further cementation and worsening of unhealthy lifestyles will be hard to stop.

Importance of sports during youth and exercise barriers in 20- to 29-year-old male nonathletes differently motivated for regular physical activities.

The number of sedentary young adults has dramatically increased in past decades, and sedentary lifestyles are adopted at an increasingly earlier age. Little is known about barriers or predictors to (re)initiate regular physical activity in this group. The purpose of the study is to (a) identify subgroups in nonathletes differing in their amenability to physical exercise, (b) to analyze them for differences in barriers and intention to exercise, and (c) compare importance of sports during youth in nonathletes to trained peers. Using a health and fitness questionnaire 589 nonathletes were queried in the cross-sectional survey and compared with 270 trained peers. Athletic abstainers (A), lower (L), and higher (H) motivated nonathletes were separated based on previous engagement in sports. Of the nonathletes, 54.7% reported only 1 barrier to exercise. Although this feature was most prominent in H (71.5%), the other groups showed significantly more barriers and a broader distribution. Similar characteristics but minor differences were observed for perceived importance of sports during youth. The most significant differences between athletes and nonathletes emerged enquiring the attitude and activity of the parents. The majority of nonathletes (72.8%) indicate their intention to exercise in the future. Their intention differed significantly in H (88.1%), L (76.1%), and A (59.1%). However, there are good reasons to doubt that most of those intending nonathletes will actually become physically active. Even in the analyzed narrow age range of men different motivated groups of nonathletes were found. Because of the differences in receptiveness and approachability health promotion policies may not only consider the often recommended tailored interventions but also carefully designed incentive programs.

A new approach to assess movements and isometric postures of spine and trunk at the workplace.

Low back pain is regarded as the primary cause of occupational disability in many countries worldwide. However, there is a lack of valid assessment of kinematic spine and trunk parameters to provide further insight into occupational spine loads. A new 3-dimensional mobile measurement system (3D-SpineMoveGuard) was developed and evaluated by means of repeated dynamic and isometric trunk positions by 10 male and 10 female volunteers. The interclass correlation coefficient indicates high test-retest reliability (r = 0.975-0.999) of the 3D-SpineMoveGuard. Moreover, analysis of validity revealed almost identical results for the new measurement system. The evaluation study indicates a good scientific quality for the use in occupational task analyses. The objective assessment of indirectly measured spine and trunk kinematics will give further insight to predict and prevent job-related spine loads.