Differential recovery rates of fitness following U.S. Army Ranger training.

OBJECTIVES: To investigate tactically-related physical performance and body composition recovery following U.S. Army Ranger training. DESIGN: Prospective cohort. METHODS: Physical performance was comprehensively assessed using a tactically-related performance battery (i.e., Ranger Athlete Warrior assessment) in 10 male Soldiers at baseline (BL) two-weeks (P1), and six-weeks (P2) post-Ranger School. Body composition was determined using DXA. A one-way repeated measures ANOVA was used followed by Bonferroni-adjusted pairwise comparisons when group differences existed (p≤0.05). Pearson correlation coefficients were used to establish associations between changes in fitness and body composition. RESULTS: All performance domains except the bench press and deadlift worsened following training. Speed/mobility (Illinois agility test, seconds - BL: 16.20±0.86 vs. P2: 18.66±2.09), anaerobic capacity (300-yard shuttle run, seconds - BL: 62.95±6.17 vs. P2: 67.23±5.91), core strength (heel clap, repetitions - BL: 15.80±4.08 vs. P2: 11.50±4.95), and aerobic endurance (beep test, stage - BL: 9.95±2.18 vs. P2: 7.55±1.07) had not recovered by P2. Only upper body muscular endurance and strength (metronome push-up and pull-up, respectively) were similar to BL by P2. Percent body fat increased from 15.62±3.94 (BL) to 19.33±2.99 (P2) (p<0.001). There were no significant associations between changes in body composition and performance. CONCLUSIONS: A comprehensive characterization of physical performance and body composition revealed Rangers did not experience full recovery of fitness six weeks after training. Optimal recovery strategies are needed to return Soldiers to a state of readiness following arduous training.

Normal Weight Status in Military Service Members Was Associated With Intuitive Eating Characteristic.

The purpose of this study was to determine the relationship between individual weight status and intuitive eating or motivation for eating characteristics. Participants were predominantly white (57%), Army (91%), enlisted (72%), males (71%), with a mean age of 30 ± 9 years and mean body mass index (BMI) of 27.0 ± 4.2 kg/m(2). The cross-sectional, descriptive study included active duty service members (n = 295) recruited from Texas and Washington. Validated Motivation for Eating Scale (MFES) and Intuitive Eating Scale were administered and BMI (m/kg(2)) was dichotomized at <25 or ≥25 kg/m(2). Descriptive, correlation, t-test, and logistic regression analysis were conducted for BMI category with demographic, lifestyle, and MFES/Intuitive Eating Scale scores (α = 0.05; 80% power). Thirty-six percent were normal BMI (22.7 ± 1.6 kg/m(2)) and 64% were overweight/obese BMI (29.3 ± 3.3 kg/m(2)). Mean BMI was 27.8 ± 4.2 kg/m(2) (males) and 24.8 ± 3.4 kg/m(2) (females) (p < 0.001). Physical MFES type was predominant (77% normal BMI vs. 66% overweight; p = 0.001). Males ate for physical rather than emotional reasons (p = 0.014). Each 1-point increase in Reliance on Internal Hunger Satiety Score was associated with 34% lower odds of being overweight. Disparity existed between sex and intuitive eating characteristic. Increasing awareness of eating influences may improve weight-related dietary behaviors.

Pharmacological and non-pharmacological interventions for reducing rocuronium bromide induced pain on injection in children and adults.

BACKGROUND: Rocuronium bromide is a routinely used muscle relaxant in anaesthetic practice. Its use, however, is associated with intense pain on injection. While it is well established that rocuronium bromide injection causes pain in awake patients, anaesthetized patients also tend to show withdrawal movements of the limbs when this muscle relaxant is administered. Various strategies, both pharmacological and non-pharmacological, have been studied to reduce the incidence and severity of pain on rocuronium bromide injection. We wanted to find out which of the existing modalities was best to reduce pain on rocuronium injection. OBJECTIVES: The objectives of this review were to assess the ability of both pharmacological and non-pharmacological interventions to reduce or eliminate the pain that accompanies rocuronium bromide administration. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2013, Issue 7), MEDLINE via Ovid SP (1966 to July 2013) and EMBASE via Ovid SP (1980 to July 2013). We also searched specific websites. We reran the searches in February 2015 and will deal with the 11 studies of interest found through this search when we update the review. SELECTION CRITERIA: We included all randomized controlled trials (RCTs) that compared the use of any drug or a non-pharmacological method with control patients, or those receiving no treatment to reduce the severity of pain with rocuronium injection. Our primary outcome was pain on rocuronium bromide injection measured by a pain score assessment. Our secondary outcomes were rise in heart rate and blood pressure following administration of rocuronium and adverse events related to the interventions. DATA COLLECTION AND ANALYSIS: We used the standardized methods for conducting a systematic review as described in the Cochrane Handbook for Systematic Reviews of Interventions. Two authors independently extracted details of trial methodology and outcome data from reports of all trials considered eligible for inclusion. We made all analyses on an intention-to-treat basis. We used a fixed-effect model where there was no evidence of significant heterogeneity between studies and a random-effects model if heterogeneity was likely. MAIN RESULTS: We included 66 studies with 7840 participants in the review, though most analyses were based on data from fewer participants. In total there are 17 studies awaiting classification. No studies were at a low risk of bias. We noted substantial statistical and clinical heterogeneity between trials. Most of the studies reported the primary outcome pain as assessed by verbal response from participants in an awake state but some trials reported withdrawal of the injected limb as a proxy for pain after induction of anaesthesia in response to rocuronium administration. Few studies reported adverse events and no study reported heart rate and blood pressure changes after administration of rocuronium. Lidocaine was the most commonly studied intervention drug, used in 29 trials with 2256 participants. The risk ratio (RR) of pain on injection if given lidocaine compared to placebo was 0.23 (95% confidence interval (CI) 0.17 to 0.31; I² = 65%, low quality of evidence). The RR of pain on injection if fentanyl and remifentanil were given compared to placebo was 0.42 (95% CI 0.26 to 0.70; I² = 79%, low quality of evidence) and (RR 0.10, 95% CI 0.04 to 0.26; I² = 74%, low quality of evidence), respectively. Pain on injection of intervention drugs was reported with the use of lidocaine and acetaminophen in one study. Cough was reported with the use of fentanyl (one study), remifentanil (five studies, low quality evidence) and alfentanil (one study). Breath holding and chest tightness were reported with the use of remifentanil in two studies (very low quality evidence) and one study (very low quality evidence), respectively. The overall rate of complications was low. AUTHORS' CONCLUSIONS: The evidence to suggest that the most commonly investigated pharmacological interventions reduce pain on injection of rocuronium is of low quality due to risk of bias and inconsistency. There is low or very low quality evidence for adverse events, due to risk of bias, inconsistency and imprecision of effect. We did not compare the various interventions with one another and so cannot comment on the superiority of one intervention over another. Complications were reported more often with use of opioids.

Bone formation is suppressed with multi-stressor military training.

PURPOSE: To determine the effects of US Army Ranger Training, an 8-week, physically demanding program (energy expenditure of 2,500-4,500 kcal/day) with energy restriction (deficit of 1,000-4,000 kcal/day) and sleep deprivation (<4 h sleep/night) on bone metabolism. METHODS: Blood was collected from 22 men (age 24 ± 4 years) before and after training. Follow-up measurements were made in a subset of 8 subjects between 2 and 6 weeks after training. Serum was analyzed for bone formation biomarkers [bone alkaline phosphatase (BAP) and osteocalcin (OCN)], bone resorption biomarkers [C-telopeptide cross-links of type I collagen (CTX) and tartrate-resistant acid phosphatase (TRAP5b)], calcium, parathyroid hormone (PTH), and vitamin D 25(OH)D increased significantly by 37.3 ± 45.2 % with training [corrected]. A repeated-measures ANOVA with time as the only factor was used to analyze data on the subset of 8 subjects who completed follow-up data collection. RESULTS: BAP and OCN significantly decreased by 22.8 ± 15.5% (pre 41.9 ± 10.1; post 31.7 ± 7.8 ng/ml) and 21.0 ± 23.3% (pre 15.0 ± 3.5; post 11.3 ± 2.1 ng/ml), respectively, with training, suggesting suppressed bone formation. OCN returned to baseline, while BAP remained suppressed 2-6 weeks post-training. TRAP5b significantly increased by 57.5 ± 51.6% (pre 3.0 ± 0.9; post 4.6 ± 1.4 ng/ml) from pre- to post-training, suggesting increased bone resorption, and returned to baseline 2-6 weeks post-training. PTH Increased significantly by 37.3 ± 45.2% with training. No changes in CTX, calcium, or PTH were detected. CONCLUSIONS: These data indicate that multi-stressor military training results in increased bone resorption and suppressed bone formation, with recovery of bone metabolism 2-6 weeks after completion of training.

Recovery of endocrine and inflammatory mediators following an extended energy deficit.

CONTEXT: Due to current operational requirements, elite soldiers deploy quickly after completing arduous training courses. Therefore, it is imperative that endocrine and inflammatory mediators have fully recovered. OBJECTIVE: Our objective was to determine whether a short-term (2-6 wk) recovery period was sufficient to restore endocrine and inflammatory homeostasis after sustained energy deficit. DESIGN: Before and immediately after the course, serum concentrations of inflammatory and endocrine markers were taken along with anthropometric measures prior to and immediately after the Army Ranger course. In addition, nine soldiers were assessed between 2 and 6 weeks after the course. SETTING: This research occurred in a field setting during an intensive 8-week military training course characterized by high-energy expenditure, energy restriction, and sleep deprivation (U.S. Army Ranger School). PARTICIPANTS: Twenty-three male soldiers (23.0 ± 2.8 y; 177.6 ± 7.9 cm; 81.0 ± 9.6 kg, 16.8 ± 3.9% body fat) participated in this study. INTERVENTIONS: There were no interventions used in this research. OUTCOME MEASURES AND RESULTS: Significant changes occurred in circulating total testosterone (-70%), brain-derived neurotrophic factor (-33%), total IGF-1 (-38.7%), free IGF-1 (-41%), IGF binding protein (IGFBP-6; -23.4%), sex-hormone binding globulin (+46%), thyroid stimulating hormone (+85%), IGFBP-1 (+534.4%), IGFBP-2 (+98.3%), IGFBP-3 (+14.7%), IL-4 (+135%), IL-6 (+217%), and IL-8 (+101%). Significant changes in body mass (-8%), bicep (-14%), forearm (-5%), thigh (-7%), and calf (-2%) circumferences, sum of skinfolds (-52%), and percentage body fat (-54%). All anthropometric, inflammatory, and hormonal values, except T3, were restored to baseline levels within 2-6 weeks after the course. CONCLUSIONS: Endocrine markers and anthropometric measures were degraded, and inflammatory mediators increased after an extended energy deficit. A short-term recovery of 2-6 weeks was sufficient to restore these mediators.

Diet, physical activity, and bone density in soldiers before and after deployment.

PURPOSE: To investigate diet, physical activity, and bone mineral density (BMD) in combat service support Soldiers before and after deployment, and to determine if any components of diet or physical activity impacted BMD. DESIGN: Fifty-three Soldiers participated in the study. The BMD of the femoral neck and lumbar spine were measured using dual-energy x-ray absorptiometry. Diet was assessed using the Block Food Frequency Questionnaire. Physical activity was assessed using the Baecke Habitual Physical Activity Questionnaire. RESULTS: The BMD of the spine (0.79%; P=.03) increased significantly during deployment. Reported physical activity at work (-10.76%; P=.01) decreased and vitamin K intake increased (37.21%; P=.01). Soldiers did not meet the dietary reference intake for vitamin D and exceeded the dietary reference intakes for all other nutrients. No significant relationships were observed between change in diet or physical activity and change in BMD. CONCLUSION: Due to the small sample size, we could not determine if deployment impacted BMD, diet, or physical activity in combat service support Soldiers. Future research should focus on investigating the association between lower levels of physical activity, inadequate diet, and decreased BMD in larger military populations.