Physical Fitness: The Necessary Foundation

Chapter 20
PHYSICAL FITNESS: THE NECESSARY
FOUNDATION
BRIAN R. KUPCHAK, PhD*; DANA R. NGUYEN, MD†; and MARK B. STEPHENS, MD‡

INTRODUCTION

DEFINITIONS

HISTORY OF MILITARY PHYSICAL FITNESS

BENEFITS OF PHYSICAL FITNESS

KEY CONCEPTS
Components of Physical Fitness
Plyometrics
Physical Readiness/Fitness Tests
Overtraining

SPECIAL POPULATIONS
Pregnancy and Postpartum Physical Fitness
Aging
Wounded, Injured, and Ill Service Members

PHYSICAL FITNESS AND THE MILITARY MEDICAL OFFICER

Role of the Military Medical Officer
Guidance to the Commanding Officer

RESOURCES

SUMMARY

*Lieutenant, Medical Service Corps, US Navy; Assistant Professor, Department of Military and Emergency Medicine, Uniformed Services University
of the Health Sciences, Bethesda, Maryland
†
Lieutenant Colonel, Medical Corps, US Army; Assistant Professor, Department of Family Medicine, Uniformed Services University of the Health Sci-
ences, Bethesda, Maryland
‡
Captain (Retired), US Navy; Professor of Family and Community Medicine, Penn State University, State College, Pennsylvania

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“Physical fitness is the basis for all other forms of excellence.”1

—President John F. Kennedy

INTRODUCTION

Operating in today’s services requires exceptional ness and force preservation through eight domains
stamina and physical readiness. Service members (discussed in Chapter 19, The Evolution of Human
must be prepared to travel to a variety of environ- Performance Optimization and Total Force Fit-
ments on short notice and immediately conduct high- ness)—physical, nutritional, medical, environmental,
tempo and high-intensity operations. Success in this spiritual, psychological, social, and behavioral—all
arena requires constant vigilance among individual of which are critical for ensuring service members
units and commands to maintain the highest levels of have the requisite knowledge, skills, and abilities
physical fitness among service members to success- to perform optimally with maximal resilience.3 This
fully execute missions. Current military directives chapter will examine the physical domain by present-
emphasize total force fitness (TFF), a holistic approach ing definitions and a historical background, followed
encompassing all domains of the individual, as de- by the physiologic principles and benefits of exercise,
fined in the 2011 guidance issued by the chairman the foundational elements of physical fitness, and
of the Joint Chiefs of Staff (CJCSI 3405.01).2 The TFF the vulnerabilities faced in efforts to maintain a fit
instruction directs the services to approach readi- fighting force.

DEFINITIONS

• Balance. Ability to control or stabilize the • Maximal aerobic power. The highest level of
body when standing still or moving. oxygen that a person can utilize, called the
• Cardiorespiratory fitness. Efficiency with Vo2max, and reported as mL/kg/min. With im-
which the body delivers oxygen and nutrients proved levels of aerobic fitness, individuals
needed for muscular activity and transports can improve both their sustainable maximum
waste products from the cells. heart rate and their Vo2max.
Activities to build aerobic capacity: Jogging/run- • Overload. Setting the intensity of the exercise
ning, cycling, climbing, rowing, using the lateral higher than normal to produce physiological
trainer, using the upper-body ergometer, vigorous adaptations.
dance, kickboxing, aerobics, jumping rope, swim- • Periodization. Systematic planning of training
ming, cross country skiing, inline skating. to maximize/optimize performance of a mis-
• Coordination. Ability to move two or more sion or competition at a known point in the
body parts under control, smoothly and ef- future.
ficiently, to achieve a designated purpose. • Progression. Gradually and consistently es-
• Exercise prescription. Specific plans of fitness- calating a training stimulus to build aerobic
related activities designed for a specified capacity, strength, endurance, and mobility.
purpose. • Recovery. Providing adequate rest period
• Flexibility. Ability to move the joints (eg, between exercise sessions to achieve optimal
elbow, knee) or any group of joints through performance, particularly when working on
an entire normal range of motion. strength or endurance. Usually accomplished
Activities to build flexibility and mobility: stretch- by alternating fitness components or muscle
ing machines, freestyle stretches (or with straps), groups from one day to the next.
yoga and Pilates. • Specificity. Tailoring the training stimulus to
• Functional fitness. Exercises that train mus- achieve a desired outcome, such as training
cles to work together and prepare them for and practice for physical tasks that service
daily tasks by simulating common movements members will be required to perform as part
done at home, at work, or during combat. of their duties.
• Intensity. Level of effort during exercise, • Strength training. Incorporates muscular
from low to high. Increasing intensity allows strength and muscular endurance.
one to improve a particular component of ◦ Muscular strength. Amount of force a muscle
training. or muscle group can exert in a single effort.

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◦ Muscular endurance. Ability of a muscle machines, kettle bells, medicine balls, resis-
or muscle group to perform repeated tance bands/tubing, or suspension straps;
movements with a submaximal force for doing calisthenics with body weight resis-
extended periods of time. tance.
Activities to build strength and endurance: • Volume. Combination of the number of sets
working out with free weights, plate-loaded and repetitions performed in a workout.

HISTORY OF MILITARY PHYSICAL FITNESS

“Nations have passed away and left no trace, and history gives the naked cause of it—one single simple reason
in all cases; they fell because their people were not fit.”4
—Rudyard Kipling

Throughout the course of human history, leaders “readiness” for the US military. During World War I,
have recognized that physical fitness has paralleled the the United States undertook physical assessment of
rise and fall of empires. From individuals to societies, recruits using the standards of modern medicine for
physical fitness is a key predictor of the success of na- the first time. However, one-third of the men continued
tions. The Greeks (2,500–200 BCE) embraced physical to be rejected for service due to being physically unfit
perfection as an outward expression of health and throughout the war.6
fitness. The Romans (200 BCE–476 CE) required men As the United States prepared to enter World War
to participate in running, marching, jumping, and II, fitness standards intended to enhance screening for
throwing. In contrast, during the Middle Ages a rela- military service were introduced. The standards were
tive return to the agrarian lifestyle ensued. Physical used to identify individuals who needed remedial
work in the field was associated with general gains in fitness work. About half of the first 2 million service
fitness on a societal level, whereas traditional knightly members conscripted through the Selective Service
acts included shooting (bows), swimming, climbing, were deemed physically unfit. Over the course of
horsemanship, fighting (mounted and dismounted), the war, 30% percent of draftees were rejected, most
and socializing. From then on, a cyclical history of for medical issues related to poor physical fitness.
physical fitness and military success began—an onset Performance requirements and standards were estab-
of war inspired increased physical fitness efforts, which lished both for the individual services and for many
lapsed after the war ended. military operational specialties, including aviation
The role of physical fitness in the US military fol- programs (US Army Field Manual [FM] 21-20, Basic
lows an annual course cycle, with tests in the spring Field Manual, Physical Training [1941]; US Marine
and fall. Early colonial militias were typically selected Combat Conditioning [1942]; Physical Fitness Manual
based on their enthusiasm, strength, and reliability. In for the US Navy [1943]).7–9
general, colonial Americans were a largely agrarian Attention to civilian fitness levels also increased
society with an active physical lifestyle and commen- over the course of the war. The National Committee on
surate levels of fitness. However, by the early 20th Physical Fitness was created in 1943, and the US “Vic-
century, the urbanization of American society had tory Corps,” featuring a series of exercises specifically
shifted work from agriculture to factories and offices, designed to promote strength, stamina, endurance,
resulting in a population that had become significantly and physical skills, was incorporated into high-school
less active. In 1912, Woodrow Wilson recognized the curricula. The War Department pamphlet Physical
value of physical fitness in military performance, and Conditioning (PAM 21-9), published in 1944, defined
during his tenure as president, the US Army Manual total military fitness as a composite of:
of Physical Training was developed.5 The principles of
this first edition were to (a) develop general health and 1. Technical fitness, evidenced by tactical train-
vigor; (b) promote muscular strength and endurance; ing and a knowledge and skill in the use of
(c) enhance self-reliance; and (d) improve intellect, arms and equipment.
activity, and precision. 2. Mental and emotional fitness (more com-
In 1917, when the United States enacted the Selec- monly known as morale), characterized by:
tive Service Act, roughly one-third of all recruits were a. Habits of thinking and feeling which
found to be unfit to fight. Therefore, governmental will permit alertness with an economy
legislation was enacted to improve physical educa- of energy and rapid relaxation when
tion within public schools in an effort to improve opportunity is afforded to do so;

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b. A sense of mission, or identification with grams.14 FM 21-20 was revised again in 1973 to define
a cause of great significance shared with fitness as a “healthy body with the capacity for skill-
others; and ful, sustained performance, ability to recover quickly
c. A will to fight. after exertion, a desire to complete the mission, and
3. Physical fitness, evidenced by a body which confidence to face any eventuality.”15
can retain normal responses to stimuli in the FM 21-20 was again revised again in the 1980s
face of fatigue and exhaustion, and continue to introduce the three-activity physical fitness test:
to function effectively under the physical a 2-mile run (aerobic endurance), plus sit-ups and
stresses placed upon it by the routine and push-ups (muscular endurance).16 In 1981, Department
emergency tasks of war.10 of Defense (DoD) Directive 1308.1 was published,17
stipulating further that physical fitness training activi-
Colonel Leonard G. Rowntree, medical director of ties should enhance both combat readiness and unit
the Selective Service during World War II, defined cohesion, and that personnel trained in fitness meth-
combat-related fitness as the ability to combine power ods must plan and supervise the programs according
and efficiency with minimal recovery periods in activi- to uniform methods and standards for performance
ties that required strength, stamina, agility, endurance, and weight control. As the United States shifted to an
emotional stability, leadership, and a refusal to lose.11 all-volunteer force after the end of the Vietnam War,
In 1946, War Department PAM 21-910 was revised civilian fitness experts began to take military metrics
and became Army FM 21-20.12 It defined the principles as their model. In 1998, an American College of Sports
of exercise training in terms of progression and over- Medicine position statement used military readiness
load, and also identified functional exercises to develop standards to establish exercise minimums for health
strength, muscular endurance, anaerobic and aerobic and fitness in the civilian population.18
capacity, agility, and coordination (Exhibit 20-1), as The eighth revision of FM 21-20 (1985) had shifted
well as attainment of “proficiency in certain military focus from combat readiness to health-related fitness,
physical skills which are essential to personal safety and troops began to focus on fitness test scores rather
and effective combat performance.”13 The Army gener- than combat performance.16 However, once active
ally enacted these official fitness initiatives. Although military engagement increased in the early 1990s,
the other services often followed suit, they tended to Army Regulation 350-41, published in 1993, shifted
make duty-specific modifications and only rarely for- the focus back to combat readiness, emphasizing nine
mulated written policies for the entire service. elements of fitness: (1) cardiorespiratory endurance,
The entry of the United States into the wars in Ko- (2) muscular strength and endurance, (3) anaerobic
rea and Vietnam shifted the focus of military fitness conditioning, (4) flexibility, (5) body composition, (6)
requirements yet again. In 1958 the Army Physical competitive spirit, (7) self-discipline, (8) ability to cope
Fitness Service opened at Fort Benning, Georgia, to with psychological stressors, and (9) healthy lifestyle
give physical fitness the same level of importance as choices.19 In summary, although the components of
technical skill development. In 1962, the principles of military physical fitness have changed over time,
balance, variety, and regularity were introduced into battlefield conditions have always imposed strenuous
military physical training. A 1970 physical fitness demands even on physically fit, resilient combatants.
symposium at Fort Benning added aerobic activity as As conditions of future engagements unfold, physical
a central component and recommended that trained fitness will remain a significant factor in individual,
fitness personnel implement physical training pro- unit, and force readiness.

BENEFITS OF PHYSICAL FITNESS

The demands of modern warfare require physically efits.18 Physically fit service members have been shown
fit combatants: they must be able to train consistently to have better mental health, more positive outlooks,
even when not actively engaged in warfighting; dem- greater happiness, and greater ability to withstand
onstrate reliable performance in missions; manage the stressful environments.21,22
stressors presented during conflict; and endure the Evidence strongly suggests that both all-cause
longer-term consequences for mental and physical mortality and many chronic disease rates decrease
health.20 Meeting these standards has important ben- as physical activity increases.23–26 The psychological
efits beyond the immediate. The fit service member is benefits of fitness and exercise in decreasing stress
less likely to miss days due to musculoskeletal injury and modifying the symptoms of stress-related ill-
or illness and will reap significant psychological ben- nesses are also well established.27 A Cochrane review

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 Physical Fitness: The Necessary Foundation

EXHIBIT 20-1
ARMY TRAINING PRINCIPLES DURING THE 1950s

• Running. Distance and sprint running on road and cross country.

• Jumping. Broad jumping and vertical jumping downward from a height.
• Dodging. Change of body direction rapidly while running.
• Climbing and traversing. Vertical climbing of rope, poles, walls, and cargo nets. Traversing
horizontal objects such as ropes, pipes, and ladders.
• Crawling. High crawl and low crawl for speed and stealth.
• Throwing. Propelling objects such as grenades for distance and accuracy.
• Vaulting. Surmounting low objects such as fences and barriers by use of hand assists.
• Carrying. Carrying objects and employment of man carries.
• Balancing. Maintaining proper body balance on narrow walkways and at heights above normal.
• Falling. Contact with the ground from standing, running, and jumping postures.
• Swimming (in specialized situations). Employment of water survival techniques.
Data source: US Department of the Army. Physical Training. Washington, DC: DA; 1950. Field Manual 21-20.

of research on depression shows that exercise is mod- for longer periods of time than those less fit. This
erately more effective than a control intervention for type of fitness is especially beneficial during long
reducing symptoms of the disease.28 There has also tactical marches, loading and unloading trucks,
been strong evidence regarding the benefits of low- preparing fighting positions, maneuvering at high
ering anxiety levels via exercise.29,30 Perhaps of most altitudes (>15,000 ft), and land navigation over
significance to healthy military individuals, attaining a prolonged time period. Thus, individuals with
higher levels of physical fitness confers higher levels greater aerobic fitness can perform tasks at a higher
of well-being and decreases reactivity to psychosocial intensity levels and are less likely to succumb to
stressors.31,32 fatigue. They are also able to recover faster and to
Recent research suggests that physical fitness has move more quickly to the next task at hand. Specific
important consequences for resilience—a key charac- physiologic benefits of endurance/aerobic training
teristic of the effective combatant. Resilience reinforces are listed in Exhibit 20-2.
higher levels of both mental and physical function in Strength and power are critical components for the
stressful situations, and supports more effective re- functional fitness of service members. Most military
covery after the initial stressors are removed. Several occupational specialties require heavy physical lift-
literature reviews have demonstrated that aerobic ex- ing. Many service members repetitively lift heavy
ercise has positive effects on self-efficacy, self-esteem, machine parts, weapons, or combat gear while per-
and mental toughness—physically fit individuals forming their daily duties. The US Department of
demonstrate higher levels of resilience than those who Labor rates over half of Army military occupational
are unfit.33–35 specialties as entailing “very heavy” lifting, which
Because higher levels of physical and mental resil- means that they require the capacity to lift 50 pounds
ience contribute to improved unit cohesion as well as frequently and 100 pounds occasionally (Technical
higher levels of individual and unit confidence, these Bulletin 592).36 The demands these tasks impose on
relationships have significance for military units as today’s soldiers warrant careful attention to both
well as individuals. Unit fitness schedules should strength and power training to optimize both safety
alternate endurance-activity days with strength- or and performance in performing combat-specific tasks.
mobility-training days to ensure a training frequency Load-bearing tasks in particular can put significant
that enables units to improve and sustain individual physical stress on the individuals who perform them.
aerobic capacity without increasing the risk of over- Fortunately, resistance training has been shown
use injuries. to improve both physical-readiness testing and
The service member who exhibits a high level of performance of load-bearing maneuvers.37 Specific
aerobic fitness can also perform activities at inten- physiologic benefits of resistance training are listed
sity levels lower than his or her maximum ability in Exhibit 20-3.

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EXHIBIT 20-2
BENEFITS OF ENDURANCE TRAINING

• Increased stamina due to central and peripheral adaptions.

• Lower respiration (minute ventilation) at a given submaximal intensity.
• Lower heart oxygen cost for a given absolute submaximal intensity.
• Lower heart rate and blood pressure at a given submaximal intensity.
• Lower risk of injury.
• Increased blood supply (capillary density) in skeletal muscle.
• Increased maximum work capacity and power output.
• Increased capacity for prolonged work.
• Increased serum high-density lipoprotein cholesterol and decreased serum triglycerides.
• Reduced total body and intraabdominal fat.
• Reduced insulin needs; improved glucose tolerance.
• Heat acclimation.
Data sources: (1) Franklin B, ed. ACSM’s Guidelines for Exercise Testing and Prescription. 6th ed. Philadelphia, PA: Lippincott Williams
& Wilkins; 2000. (2) American College of Sports Medicine. ACSM Fitness Book. 3rd ed. Champaign, IL: Human Kinetics; 2003. (3)
Myers J. Exercise and cardiovascular health. Circulation. 2003;107(1):e2–e5.

EXHIBIT 20-3
BENEFITS OF RESISTANCE TRAINING

• Increased muscle strength.

• Increased size of muscle fibers.
• Increased speed with movement.
• Improved anaerobic capacity.
• Increased bone strength.
• Increased bone mass and mineral density.
• Increased size and strength of tendons, ligaments, and fascia.
• Increased work capacity and power output.
• Decreased muscle soreness from heavy work.
Data sources: (1) Baechle TR, Earle RW. Essentials of Strength Training and Conditioning. Champaign, IL: Human Kinetics; 2000. (2)
Conroy BP, Kraemer WJ, Maresh CM, Dalsky GP. Adaptive responses of bone to physical activity. Med Exerc Nutr Health. 1992;1:64–74.
(3) Hather BM, Tesch PA, Buchanan P, Dudley GA. Influence of eccentric actions on skeletal muscle adaptations to resistance train-
ing. Acta Physiol Scand. 1991;143(2):177–185. (4) Kraemer WJ, Mazzetti SA, Nindl BC, et al. Effect of resistance training on women’s
strength/power and occupational performances. Med Sci Sports Exerc. 2001;33(6):1011–1025. (5) Sale DG. Neural adaptation to re-
sistance training. Med Sci Sports Exerc. 1988;20(5 Suppl):S135–S145. (6) Staron RS, Leonardi MJ, Karapondo DL, et al. Strength and
skeletal muscle adaptations in heavy-resistance trained women after detraining and retraining. J Appl Physiol. 1991;70(2):631–640.
(7) Wilmore JH, Costill DL. Physiology of Sport and Exercise. Champaign, IL: Human Kinetics; 1994.

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KEY CONCEPTS

Below are a variety of key concepts relating to overall up with one’s own service, but the chart is useful
physical fitness. This list is not complete but provides for service members and healthcare providers.38
an overview of key ideas.
Power
Components of Physical Fitness
Power is a very important concept for military
Components of physical fitness include both health- readiness and performance. Simply stated, power
and skill-related attributes. The health-related compo- is the ability to perform muscular work per unit of
nents include: time (power = work/time). If strength is defined as the
ability to exert force, power is the ability to exert force
• body composition quickly: being able to move a heavy weight quickly,
• cardiovascular fitness being able to move quickly when carrying a heavy
• muscular endurance load, or being able to quickly carry an injured service
member from one place to another. Power is related
• muscular strength to strength, aerobic capacity, and speed.
• flexibility
Mobility
In contrast, the skill-related components include:
Mobility is the ability to perform functional
• agility movement patterns with no restrictions in range
• power of motion: it involves multiple elements that influ-
• balance ence performance. Warm-up mobility exercises
(eg, posterior hip mobilization, shoulder extension,
• reaction time
external rotation, anterior hip mobilization, ankle
• coordination dorsiflexion, deep squats, couch stretch) allow the
• speed service member to prepare for performing jumping,
climbing, and sprinting activities and maneuvering
Each of these components is important for the around obstacles more efficiently. These exercises
physical fitness of service members and mission also limit the risk of injury as they reinforce proper
performance. Some of the components have been de- technique. Strength in the extremities directly relates
fined above and others require no real definition. For to the ability to perform mobility tasks, which means
example, although flexibility has been defined above, that mobility overlaps with the strength component
it is important to note that exercises to maintain of fitness. Optimized mobility training can increase a
flexibility should be incorporated into any standard service member’s capacity for strength and endurance
program to help ensure all muscles maintain their and minimize the possibility for injury.39
proper length and movements are performed with
proper mechanics. This is key to preventing injury. Plyometrics
Incorporating flexibility training can also improve
muscle imbalances by maintaining the appropriate Plyometrics are exercises performed so that muscles
length-tension relationship. exert maximum force in short intervals of time to
The US armed forces use body composition (a achieve increasing power (speed-strength). Designed
measure of a person’s body fat) as one component to improve lower-body mobility and power, these
to determine a service member’s physical fitness. exercises include jumping up onto a higher surface
If a service member is “overfat,” it can adversely and back down. Data suggest that plyometric training
affect his or her career, including the ability to be benefits service members in terms of increased maxi-
promoted and even stay in the military. Each service mal strength, power output, coordination, and overall
branch has its own standards within DoD Instruc- performance. Combining plyometrics with lower-body
tion 1308.1. 17 The Human Performance Resource strength training appears to greatly improve strength
Center (see Resources, below) provides a chart that performance.40,41 Thus, current evidence supports
compares one service’s standards to another. Be- incorporating several types of plyometrics with other
cause the standards change, it is important to keep types of training into fitness programs.

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Physical Readiness/Fitness Tests ball throw, standing long jump, deadlift, and interval
run. It will eventually be used to determine which jobs
All of the services require some type of physical fit- recruits are qualified to perform.
ness assessment. Table 20-1 presents each of the tests
service members must pass (unless they are on a physi- Overtraining
cal profile). Currently they all include a run and sit-ups,
plus either push-ups or pull-ups, and all of the services Overtraining is the end result of excessive training.
have body composition standards. The Marine Corps The most common signs are a decline in physical per-
was the first service to develop a functional test designed formance with continued training, pronounced fatigue,
to evaluate combat fitness. Thus, Marines perform two and changes in mood. The condition involves a com-
semi-annual fitness tests, a physical readiness test and plex interplay among the neuroendocrine, immune,
a combat fitness test. The other services are developing and central nervous systems, as well as psychological
functional tests to assess operational/combat fitness, and and social stressors in response to prolonged strenuous
in 2017, the Army rolled out the Occupational Physical training without sufficient recovery.42 Military training
Assessment Test (OPAT) for all recruits and soldiers. can be intense, and overtraining can occur particularly
This requirement resulted from the Army’s effort to in the absence of adequate sleep and nutrition. The
integrate women into its previously closed combat spe- mechanisms of overtraining have not been adequately
cialties. The OPAT consists of four events: a medicine- elucidated.

SPECIAL POPULATIONS

Within the military, physical fitness standards may is recognized that some women may not be able to
vary depending on the population. Brief discussions maintain fitness due to a variety of complications, but
about pregnancy and postpartum physical fitness; ag- in general, physical fitness can and should be main-
ing; and the wounded, ill, and injured are provided. tained during pregnancy across the services. Service
members who participate in a pregnancy wellness
Pregnancy and Postpartum Physical Fitness program (see the American College of Sports Medi-
cine, Army Pregnancy Postpartum Physical Training,
Pregnant service members constitute an important and the Human Performance Resource Center web-
subgroup of the military population, and fitness sites, under Resources, below) have been shown to
requirements must be tailored to this condition. have shorter labor durations and a lower incidence
The American College of Obstetricians and Gyne- of premature delivery.45 Likewise, physical fitness in
cologists recommends that pregnant women perform the postpartum period remains a challenge for a large
moderate-intensity exercise for a total of 150 minutes, percentage of service members. Service-led physical
spread over the course of a week.43 Despite these rec- fitness programs for postpartum service members
ommendations, many service members do not main- have been shown to improve participants’ overall
tain optimal physical training during pregnancy.44 It physical capacity.46

TABLE 20-1
PHYSICAL READINESS TESTS, BY SERVICE

Service Task 1 Task 2 Task 3

Air Force Sit-ups (1 min) Push-ups (1 min) 1.5-Mile run

Army Sit-ups (2 min) Push-ups (2 min) 2.0-Mile run
Marines* Crunches (2 min) Pull-ups (males); flex-arm hang (females) 3.0-Mile run
Marines† 880-Yard run Ammo lifts–30 lb (2 min) Maneuver under fire (300 m)
Navy Curl-ups (2 min) Push-ups (2 min) 1.5-Mile run

*Marine Corps Performance Fitness Test

†
Marine Corps Combat Fitness Test

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 Physical Fitness: The Necessary Foundation

Aging nel.”48 Medical treatment and rehabilitation should

be aimed at restoring these service members to a suit-
Service members 40 years and older typically serve as able level of physical fitness. Such treatment should
senior military leaders. Leaders must set good examples use appropriate, progressive physical activities with
and serve as positive role models for those under their medical or unit supervision (see the American College
command; this includes maintaining and demonstrating of Sports Medicine, Building the Soldier Athlete–Re-
a high level of physical fitness. Even if their normal du- conditioning [Profile] Physical Training Supplement,
ties are stressful (but nonphysical), these service mem- the Human Performance Resource Center, National
bers must regularly partake in physical exercise so their Strength and Conditioning Association, and US Army
fitness is maintained and does not degrade with age. Physical Readiness Training Information websites,
Service members who are fit at age 40 and continue under Resources, below). The activity levels of service
to exercise show smaller decreases in many fitness- members usually decrease while they are recovering
related physiological functions compared to those who from sickness or injury. With medical supervision,
exercise less often.47 Those who have been exercising proper diet, and the right physical training programs,
regularly can continue to exercise at the same level. service members should be able to overcome their
Those aged 40 and over who have not been exercising physical profiles more quickly and return to their
regularly should start at a lower level of intensity and normal routines and fitness levels.
progress slowly. Long periods of inactivity cannot be All profiled service members should complete as
corrected in a few weeks or even months. much of the unit’s regular fitness program as pos-
sible. The Office of the Surgeon General of the Army
Wounded, Injured, and Ill Service Members developed DA Form 3349 to facilitate the exchange
of information between healthcare personnel and
DoD Directive 1308.1 requires that “those person- their units.49 On this form, healthcare personnel list
nel identified with medically limiting defects shall be the service member’s physical limitations along with
placed in a physical fitness program consistent with activities the individual can perform to maintain his
their limitations as advised by medical authorities.”17 or her fitness level. Based on this information, the unit
AR 350-15 states, “For individuals with limiting should direct profiled service members to participate
profiles, commanders will develop physical fitness in appropriate activities to replace those they cannot
programs in cooperation with health care person- participate in.

PHYSICAL FITNESS AND THE MILITARY MEDICAL OFFICER

Role of the Military Medical Officer can contact to obtain additional reliable information
when necessary.
Military medical officers (MMOs) serve critical
roles in supporting achievement and maintenance Guidance to the Commanding Officer
of physical fitness and readiness considerations
at the unit level. They are responsible for being a The MMO serves as the primary consultant to the
role model, but must first build relationships with commander regarding the overall health status of the
their unit. The MMO should support human perfor- unit. As such, the MMO is responsible for:
mance optimization and provide the highest level
of preventive healthcare. The MMO must be able to • Monitoring physical fitness levels and advis-
effectively communicate with and translate medical ing the unit commander on profiling those
and scientific knowledge into actionable plans that who are ill, injured, or wounded. The MMO
support ongoing physical training activities and must also ensure that standard physical fit-
military operations. The MMO should be familiar ness programs are consistent with their ser-
with concepts related to physical fitness and com- vice’s requirements and understand both the
petent in key topics such as functional movement, commander’s intent and the mission goals.
strength and resistance training, overtraining, and This information will allow the MMO to
exercise prescription. Additionally, knowledge correctly identify the unit’s physical training
about service-specific and DoD regulations and and fitness needs.
guidance regarding body composition and physical • Monitoring musculoskeletal injuries and
fitness are critical. Lastly, the MMO must identify physical profiling of service members. This
physical fitness subject matter experts (SMEs) they task requires a full understanding of the

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physical requirements of service members’ est level of fitness for their specific specialty.
jobs, the physical fitness guidelines for the • Ensuring the physical training program is
service, and the current health status of each safe and limits the risk of injuries.
service member. Physical limitations should • Keeping the commander updated about the
protect service members from further injury physical readiness of individual service mem-
while encouraging alternative activities that bers and reviewing training plans for those
sustain their overall fitness level. with special fitness considerations such as
• Working closely with physical fitness SMEs to pregnancy, illness, or injury. These tailored
review the training program intended to de- plans should draw on advice from fitness
velop individual service members at the high- SMEs.

RESOURCES

• American College of Sports Medicine: http://acsm.org/

• Building the Soldier Athlete—Reconditioning (Profile) Physical Training Supplement: http://army-
medicine.mil/Documents/R2D-Building_the_Soldier_Athlete_Reconditioning_profile_Supplement_-_7_
Oct_09.pdf
• Air Force Fitness Program: http://www.afpc.af.mil/affitnessprogram/
• Army Comprehensive Soldier and Family Fitness: http://csf2.army.mil/
• ARMYFIT—Comprehensive Soldier and Family Fitness: https://armyfit.army.mil/
• Army Pregnancy Postpartum Physical Training: https://phc.amedd.army.mil/topics/healthyliving/al/
Pages/ArmyPregnancyPostpartumPhysicalTrainingProgram.aspx
• Commander, Navy Installations Command—Fitness, Sports and Deployed Forces Support: http://www.
navyfitness.org/fitness/
• Human Performance Resource Center: http://hprc-online.org/
• National Strength and Conditioning Association: https://www.nsca.com/
• US Army Public Health Center—Army Physical Fitness: https://phc.amedd.army.mil/TOPICS/
HEALTHYLIVING/AL/Pages/ArmyPhysicalFitness.aspx
• US Army Physical Readiness Training Information: http://www.armyprt.com/
• US Coast Guard Office of Work-Life Programs—Physical Fitness Program: http://www.uscg.mil/worklife/
physical_fitness_program.asp
• US Marine Corps Physical Fitness Program: http://www.fitness.marines.mil/

SUMMARY

Accurate assessment of strengths and vulnerabilities can help an MMO make better decisions and recom-
in the quest for optimal fitness is essential in guiding both mendations to the unit commander. Appreciation of the
individuals and units to peak military performance. Un- interrelatedness of the components of physical fitness
derstanding the physiologic construct of fitness and how can help the MMO tailor better individual fitness plans
the factors of military fitness requirements may change and ensure optimal fitness for every member of the unit.

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