1. Physical Fitness COL Barbara Springer, PhD, PT Director, Proponency Office for Rehabilitation and Reintegration Office of The Surgeon General

2. Outline Definitions Metrics

3. 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

4. Definitions (cont) Physical Fitness Training-Consists of 4 major components: endurance, mobility, strength, and flexibility –Endurance-The bodys 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

5. Battle Focused Training Task Muscular Strength Muscular Endurance Aerobic Endurance Anaerobic Endurance FlexibilityMobility Foot March XXXX X X ClimbXXXXXXXXX Sprint to Cover XX X High/Low Crawl XXXXXX XXXXX Casualty Carry XXXXXXXXXXXXXX DiggingXXXXXXX X IMTXX XXXXXXXXX Run XX XX TOTAL151711171218

6. Basics of Physical Fitness Training PROVRBS –Progression –Regularity –Overload –Variety –Recovery –Balance –Specificity

7. Building the Soldier Athlete

8. Leading Causes of Deployment Non-Battle Injuries Army OIF Medical Evacuations, 2003-2008 Source: USACHPPM Deployment Injury Surveillance System

9. Garrison Injuries 76% 12% 9% 3% Running PT (other) Sports Road Marching Associated Activities

10. USACHPPM Top 10 Injury Prevention Priorities RankInjury Problem Prioritization Score 1Physical Training34.0 2Parachuting31.8 3Falls30.6 4Athletic Sports28.4 5Privately-owned vehicle accidents27.2 6Military vehicle accidents26.2 7Guns/explosives handling26.2 8Slip/twist/turn (near fall)24.6 9Tools/machinery21.0 10Non-traffic vehicle accidents19.4 Results of a prioritization process conducted by Army members of the DoD Health Affairs Military Injury Prevention Priorities Working Group, 2006

11. What We Look Like Now Strength Endurance Mobility

12. Battle Focused Training Injury rates: What the research tells us –Fewer miles run per week = fewer injuries

13. Strength EnduranceMobility Where We Need To Go Movement proficiency Sustain activity Overcome resistance

14. The Physical Training Program Endurance Mobility Strength Flexibility

15. Reconditioning (Profile) PT

16. Group Approach GROUPGROUP 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

17. Metrics Included 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

18. Functional Movement Screen http://www.functionalmovementsolutions.com/

19. 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

20. Illinois Agility Test

21. 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

22. 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

23. 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

24. 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)

25. 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

26. Questions??