Physical Fitness

COL Barbara Springer, PhD, PTDirector, Proponency Office for Rehabilitation and ReintegrationOffice of The Surgeon General

Outline

• Definitions • Metrics

Definitions

• Physical fitness-The US Dept of Health and Human Services separates it into 2 categories:– Health-related fitness-The amount of

physical activity required to reduce the risk of disease or injury

– Performance-related fitness-The amount of physical activity required to achieve a physical goal

• Military physical fitness-The ability to physically accomplish all aspects of the mission while remaining healthy/uninjured

Definitions (con’t)

• Physical Fitness Training-Consists of 4 major components: endurance, mobility, strength, and flexibility– Endurance-The body’s ability to continue to

accomplish a task over and over again– Mobility-The ability to move the body in

space with the precision necessary to negotiate an obstacle

– Strength-The ability to move an object in space

– Flexibility-Having the joint range of motion and muscle length required to move the body through space

Battle Focused Training

TaskMuscular Strength

Muscular Endurance

Aerobic Endurance

Anaerobic Endurance Flexibility Mobility

Foot March

X XXX XXX X   X

Climb XXX XX X XXX XXX XXX

Sprint to Cover

XX       X XX

High/Low Crawl

XX XXX X XXX XX XXX

Casualty Carry

XXX XX X XXX XX XXX

Digging XX XXX XX XX X XX

IMT XX XX X XXX XX XXX

Run   XX XX XX X X

TOTAL 15 17 11 17 12 18

Basics of Physical Fitness Training

• PROVRBS– Progression– Regularity– Overload– Variety– Recovery– Balance– Specificity

Building the Soldier Athlete

Leading Causes of Deployment Non-Battle InjuriesArmy OIF Medical Evacuations, 2003-

2008

Source: USACHPPM Deployment Injury Surveillance System

Sports/P

T

Falls/J

umps

Land transp

ort

Crush

/Blu

nt tra

uma

Lift/Push

/Pull

Twist/T

rip/S

lip

Boots/C

loth

ing/P

PE

Handling w

eapons/exp

losiv

es

Cut/Pie

rce

Environm

ental

0

5

10

15

20

25

20.9

16.8

14.6

8.87.8

6.7

4.43.1 2.9 2.4

Pe

rce

nt

(%)

of

All

Ca

us

es

Garrison Injuries

76%

12%9%3%

Running

PT (other)

Sports

Road Marching

Associated Activities

USACHPPM Top 10 Injury Prevention PrioritiesRank Injury Problem

Prioritization Score

1 Physical Training 34.0

2 Parachuting 31.8

3 Falls 30.6

4 Athletic Sports 28.4

5 Privately-owned vehicle accidents 27.2

6 Military vehicle accidents 26.2

7 Guns/explosives handling 26.2

8 Slip/twist/turn (near fall) 24.6

9 Tools/machinery 21.0

10 Non-traffic vehicle accidents 19.4

Results of a prioritization process conducted by Army members of the DoD Health Affairs Military Injury Prevention Priorities Working Group, 2006

What We Look Like Now

Strength

Endurance

Mobility

Battle Focused Training

• Injury rates: What the research tells us– Fewer miles run per week = fewer injuries

Strength EnduranceMobility

Where We Need To Go

Movement proficiency

Sustain activity

Overcome resistance

The Physical Training Program

• Endurance • Mobility• Strength• Flexibility

Reconditioning (Profile) PT

Group ApproachGROUP GROUP DESCRIPTION

RED: LOWER BODY

Most restrictive profile- Lower body severe injury- NO IMPACT allowed (must bike or swim ONLY for cardio)- Examples include fractures, acute sprains or strains

RED: LOW BACK

Most restrictive back profile- Moderate to severe low back pain- NO IMPACT allowed (must bike or Stairmaster ONLY for cardio)- Examples include severe sprains and strains or disc herniations

AMBER: LOWER

Less restrictive profile- Lower body mild - moderate injury- Mild - moderate low back pain- SOME IMPACT allowed (OK to walk, Stairmaster, or elliptical)

AMBER: UPPER

Upper body, upper back, or neck injury- Generally these individuals are on a run at own pace profile, but often running

is painful because of the jarring and arm swing. - If running is painful but the profile is marked “run at own pace,” running will not

only aggravate the injury, but it will waste time the Soldier could be using to get a beneficial cardiovascular workout.

- If so, this Soldier should do some other form of cardiovascular training.

GREEN: SELF PACED

Upper or lower body SELF PACED - SOME IMPACT allowed (i.e. walk, run, swim, and bike at own pace; sit ups and

push ups at own pace)

GREEN: RECOVERY

Recovery phase of an injury- Requires 2x length of profile, up to 90 days

MetricsIncluded in Physical Therapists in the BCT Manual

• Screening – Functional Movement Screen (FMS)– Y Balance

• Performance (in addition to the APFT)– Illinois Agility Test– Medicine Ball Put– Vertical Leap– 40 Yard Dash– Pull ups/Flexed Arm Hang

• Injury Surveillance

Functional Movement Screen

http://www.functionalmovementsolutions.com/

Y Balance

•Assess physical performance•Identify chronic ankle instability•Identify risk for LE injury•Screen for sports/activities•Those with asymmetrical movement 2.7x more likely to sustain LE injury•Those with decreased forward reach 2.6x more likely to sustain LE injury•Improves with training•Good reliability

http://www.kieselplisky.com/ybt

Illinois Agility Test

Medicine Ball Put

• This is a 2- handed upper body explosive power measure

• Sit in a chair placed against the wall with back firmly against the chair and feet flat on the floor

• Hold 2-kg medicine ball on chest and push ball forward with as much power as possible

• Final score: furthest distance of 3, measured from the front leg of the chair to where the middle of ball lands

• Best to put measuring tape on ground before the throws

Vertical Leap

•Lower body mobility measure

•Stands side on a wall and reaches up with the hand closest to wall

•Keeping the feet flat on the ground, the point of the fingertips is marked with chalk

•Steps slightly away from wall, and jumps vertically as high as possible using both arms and legs to assist in projecting the body upwards

•Attempts to touch the wall at the highest point of the jump

•Score: The difference in distance between reach height and jump height

•Record best of 3 attempts

40 Yard Dash

• A mobility measure • Begin at the start line in a 3 point

stance • On the command “Go” explode into a

straight sprint for 40 yards • Record best time of 3 trials

Pull ups (Males)

•Upper body strength measure

•Hang freely from bar with palms facing away and elbows completely extended before starting

•Pull body upwards until chin is above bar

•Then lower to the start position ensuring elbows have extended completely

•Count reps (at top)

Flexed Arm Hang (Females)•Upper Body endurance measure •Pull up bar: high enough to hang freely

•Soldier is lifted or steps up into position with elbows flexed and chin held above bar

•Palms should face away from her

•Time starts when support is removed and terminates when chin touches or falls below bar

Questions??