Military human performance optimization and injury prevention: Strategies for the 21st century warfighter

Universal Training Precautions: A Review of Evidence and Recommendations for Prevention of Exercise-Related Injury, Illness, and Death in Warfighters and Athletes

Facing pressure to train for victory, warfighters and athletes encounter numerous health risks that are directly related to their regular physical training. The concept of universal training precautions (UTPs) signifies universal processes designed to prevent unnecessary bodily harm, including injury, illness, and death, during physical training programs. Although no formal guidelines exist for collectively implementing a defined set of UTPs to address a broad scope of exercise-related health risks, recommendations and guidelines have been published relating to preventing sudden death during high school sports and collegiate conditioning sessions. A long list of critical topics must be considered as UTPs, including physical fitness factors, transition-period accommodation, hydration, environmental factors and acclimatization, appropriate recovery, use of medications and dietary supplements, and importantly, leadership. In this article, we outline in detail, with corresponding Strength of Recommendation Taxonomy ratings, what should be considered universal recommendations to minimize the risk of warfighters and athletes coming to harm when participating in group physical activities.

Low Back Biomechanics during Repetitive Deadlifts: A Narrative Review

OCCUPATIONAL APPLICATIONSHeavy deadlifting is used as a screening tool or training protocol for recruitment and retention in physically-demanding occupations, especially in the military. Spinal loads experienced during heavy deadlifts, particularly shearing forces, are well above recommended thresholds for lumbar spine injury in occupational settings. Although members of the noted occupation likely have stronger musculoskeletal systems compared to the general population, experiencing shearing forces that are 2 to 4 times larger than the threshold of injury, particularly under repetitive deadlift, may transform a screening tool or training protocol to an occupationally-harmful physical activity.

The Effect of a Surface Combat Swimming Training Program on Swimming Performance

In this study the effect of a surface combat swimming (sCS) training program on performance in freestyle swimming and sCS was examined. Forty-five officer cadets were divided into three equivalent groups: a control group (CG), a group that was trained only with a swimsuit and fins (SF), and a group that was trained with combat uniform and equipment (UE). Groups SF and UE followed a 60-min training program with sCS for 4 weeks, 4 times per week. Before and after the training program all groups performed 4×50 and 400-m freestyle swimming, 250-m sCS with a uniform and equipment, 350-m with a swimsuit and fins, and 300-m with a swimsuit. The UE group showed improved performance in 4×50-m (mean±SD 14±9 s) and in 250-m sCS (24±14 s) (p<0.01). Both the SF group and the UE group improved in 300-m sCS, in 350-m sCS and in 400-m freestyle (p<0.05). We conclude that the training adaptations seemed to be specific, not only with regard to the activity performed, but also in terms of the actual conditions of an operation, which also include equipment.

EEG Theta Power Activity Reflects Workload among Army Combat Drivers: An Experimental Study

We aimed to evaluate the effects of mental workload variations, as a function of the road environment, on the brain activity of army drivers performing combat and non-combat scenarios in a light multirole vehicle dynamic simulator. Forty-one non-commissioned officers completed three standardized driving exercises with different terrain complexities (low, medium, and high) while we recorded their electroencephalographic (EEG) activity. We focused on variations in the theta EEG power spectrum, a well-known index of mental workload. We also assessed performance and subjective ratings of task load. The theta EEG power spectrum in the frontal, temporal, and occipital areas were higher during the most complex scenarios. Performance (number of engine stops) and subjective data supported these findings. Our findings strengthen previous results found in civilians on the relationship between driver mental workload and the theta EEG power spectrum. This suggests that EEG activity can give relevant insight into mental workload variations in an objective, unbiased fashion, even during real training and/or operations. The continuous monitoring of the warfighter not only allows instantaneous detection of over/underload but also might provide online feedback to the system (either automated equipment or the crew) to take countermeasures and prevent fatal errors.

Does Health Care Utilization Before Hip Arthroscopy Predict Health Care Utilization After Surgery in the US Military Health System? An Investigation Into Health-Seeking Behavior

BACKGROUND

The influence of prior patterns of health care utilization on future health care utilization has had minimal investigation in populations with musculoskeletal disorders.

OBJECTIVES

The purpose of this study was to explore the relationship between presurgical health care utilization and postsurgical health care utilization in a population of patients undergoing hip surgery in the US Military Health System.

METHODS

In this observational cohort study, person-level data were collected for patients undergoing hip arthroscopy in the Military Health System from 2003 to 2015, capturing all encounters 12 months before and 24 months after surgery for every individual. Cluster analysis was used to categorize individuals with high and low health care utilization, based on preoperative health care visits. Unadjusted and adjusted Poisson and generalized linear models were generated. Health care utilization outcomes were targeted, including costs, visits, and medication use.

RESULTS

There were 1850 individuals in the final cohort (mean age, 32.18 years; 55.4% male). The high health care utilization group averaged 57.69 ± 25.87 visits, compared to 20.43 ± 8.36 visits in the low utilization group. There were significant differences between groups for total health care visits (58.17; 95% confidence interval [CI]: 57.39, 58.58), total health care costs ($11 539.71; 95% CI: $10 557.26, $12 595.04), hip-related visits (12.77; 95% CI: 12.59, 12.96), hip-related costs ($3325.07; 95% CI: $2886.43, $3804.51), days' supply of pain medications (752.67; 95% CI: 751.24, 754.11), opioid prescriptions (48.83; 95% CI: 48.47, 49.21), and cost of pain medications ($1074.80; 95% CI: $1011.91, $1137.68).

CONCLUSION

Presurgical patterns of health care utilization were associated with postsurgical patterns of health care utilization, indicating that those patients who used more care before surgery also used more care after surgery. Clinicians should consider prior patterns of health care utilization, including utilization unrelated to the index condition, when determining care plans and prognosis. J Orthop Sports Phys Ther 2018;48(11):878-886. Epub22 Jul 2018. doi:10.2519/jospt.2018.8259.

International consensus on military research priorities and gaps - Survey results from the 4th International Congress on Soldiers' Physical Performance

OBJECTIVES

The objectives of this study were to identify perceived priorities related to military personnel's health and physical performance, among attendees at the 4th International Congress on Soldiers' Physical Performance (ICSPP), and to determine if perceived priorities had changed between the 3rd ICSPP survey held in 2014 and the 4th ICSPP survey held in 2017.

DESIGN

Electronic survey.

METHODS

Respondents were asked to grade priority areas on a Likert scale, and average ratings were used to rank priority areas. Responses to free text questions were analyzed qualitatively. Responses to the 4th ICSPP survey were described and compared to responses to the 3rd ICSPP survey.

RESULTS

The 4th ICSPP survey respondents were a diverse group (40.6% military, 58.9% civilian). The two most important priority areas identified were physical demands in operational environments (mean score=4.41/5) and measuring physical performance/fitness (4.38/5), which were also the top two areas in the 3rd ICSPP survey. There was remarkable overlap in the rankings of priority areas between the two surveys. Sleep and nutrition were emerging priority areas and were perceived as relatively more important in the 4th ICSPP survey compared to the 3rd ICSPP survey. The greatest perceived emerging threat was resilience/psychological fitness of recruits (4.16/5). Physiological status monitoring (2.79/4) was identified as the most important technology.

CONCLUSIONS

Despite the diverse backgrounds of the respondents, there was a clear continuing consensus about perceived important priority areas influencing military personnel's health and physical performance. Soldier resiliency and assessment of physiological status were research topics identified as top priorities.