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Defining Total Fitness for the 21 st Century: Getting to Total Fitness Wayne B. Jonas, MD LTC (RET) USA Samueli Institute December 6-9, 2009.

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Presentation on theme: "Defining Total Fitness for the 21 st Century: Getting to Total Fitness Wayne B. Jonas, MD LTC (RET) USA Samueli Institute December 6-9, 2009."— Presentation transcript:

1 Defining Total Fitness for the 21 st Century: Getting to Total Fitness Wayne B. Jonas, MD LTC (RET) USA Samueli Institute December 6-9, 2009

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4 Capability Gaps (COL OConnor/RDML Miller) Alertness and sleep/rest management Stress/mental management – schedule pressure Endurance and Rapid recovery - short and long-term Fatigue and sustainment – add in the heat, cold, altitude Knee, leg, ankle and spine – premature OA, broken Fitness – quick ramp-up Not sustained during deployment Not mission specific to prevent injury Psychological trauma – 12% to 40% - even the tough are affected Rapid learning requirements and mental hardiness Drug and supplement side effects and interactions Pain, pain and pain – conscious and physiological NO PLACE TO GO AND NO PROCESS TO GET CREDIBLE, RELEVANT, TIMELY INFORMATION AND KNOWLEDGE ON TF

5 Whats a Warrior and Commander To Do? Demand analysis Lean 6 Team training Reset retreats Getting to Total Fitness ??? Adaptive leader courses COTS SMART Clinics Combines Load assist Psychological hardening E-stim Water Caffeine Tyrosine Biomonitoring PDAs and GPSThe -omics Ambien Amphetamines EEG Biofeedback Cultural conditioning Hypnosis Omega-3s Antioxidants Accelerated learning EM Machines Meditation Brain Stimulation PPE PTSD Tapes EKG Biofeedback Anabolic Steroids Acupuncture Carbs Quercitine FMS Yoga Finance$$$

6 Foundations of Total Fitness Readiness and Prevention HPO Resilience Health and Wellness Functional Excellence Stress Resistance System Balance Risk Reduction T o t a l F i t n e s s

7 Nothing works without it! money work and play science, art, culture, thought, action wars are won and lost on health Health arises from our inherent capacity to resist breakdown and rapidly heal/recover. Why is Health Important?

8 What is Health? Definition: the general condition of a person in all aspects. It is also a level of functional and/or metabolic efficiency of an organism, often implicitly human. WHO Definition: A state of complete physical, mental and social well-being, and not merely the absence of disease Military: Prevention– risk factor reduction Health - Well-being vs dis-ease Resilience – resistance and rebound from stress/injury Optimal Functioning – human performance Sustainability Throughout the deployment and military lifecycle Total – Mind, Body, Spirit and Social Holistic, Biopsychosocial

9 What Contributes to Human Health?PhysicalActivityRest DietDrugsSupplements MindSpirit LeadershipFriendsFamily Environment

10 What Contributes Most to Human Health and Performance?

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12 Total Fitness Request From Joint Chiefs

13 Total Fitness: The New Paradigm MIND BODY Spiritual Psychological Behavioral Social Physical Nutritional Medical Environmental

14 Slide 14 Integrated Whole: Dynamic Systems Theory Systems (persons) cannot be understood by studying fundamental constituents, the properties of the parts are not intrinsic but can be understood within the context of the whole Nature of life > interconnection, interdependent, multileveled Living systems are dynamic and highly nonlinear Patterns of self-organization are the key Patterns of organized complexity have emergent properties at various levels of organization The key to Total Fitness is to provide warriors, families and commanders with knowledge, skills and tools from which health, resistance and optimal performance can emerge.

15 Slide 15 Entire Correlation Network : Organized complexity ~3400 nodes ~17000 edges abs R > 0.8 Correlation Network in a Whole Organism - Courtesy of Jan van der Greef, TNO, Netherlands

16 Slide 16 Healthy and Fit Example – Effect of Reductionist Approach Correlation Network in a Whole Organism Network in Fat from Animal Model of T2DM

17 Slide 17 Disease Animal+Drug Unhealthy and Unfit Example – Effect of Reductionist Approach Correlation Network in a Whole Organism

18 Slide 18 Unhealthy + Single Treatment Example – Effect of Reductionist Approach Correlation Network in a Whole Organism

19 Slide 19 Unhealthy + Single Treatment Example – Effect of Reductionist Approach Correlation Network in a Whole Organism unmet biochemical need

20 Slide 20 Unhealthy + Single Treatment Example – Effect of Reductionist Approach Correlation Network in a Whole Organism unmet biochemical need biochemical side effect

21 Slide 21 How to design an intervention for a whole system? Current paradigm: Monotherapy 1 function– 1 target – 1 treatment fits all Reductionistic approach New paradigm : Integrated Intervention Medicine, nutrition, exercise, environment Behavior, Psychology, social, spiritual Systems Theory : The scale and complexity of the problem and solution should match - Yaneer Bar-Yam

22 Disease Healthy Are there opportunities to bring the system back in homeostasis? Stress Injury Aging Health Reversible Irreversible Total Fitness Maintain Health Reduce Risk Improve resilience Enhance performance Disease management Symptom and treatment focus Changes in behaviours to maintain performance Optimal - Adapted from Jan van der Greef, TNO, Netherlands

23 Slide 23 What Cannot Be Learnt from a Genome Creating a Total Fitness Environment One Animal One Genome Two States The Performance of a Person and Unit is Optimized with a Total Fitness Environment Understanding from a Systems Perspective?

24 Total Fitness Medical & Behavioral Fitness Physical Environmental Fitness Nutritional Fitness Psychological Fitness Spiritual Fitness Social Fitness Definitions Descriptions Outcomes Evidence Metrics Integration Application Delivery The Domains of Total Fitness

25 Slide 25 Physical Fitness

26 StrengthEnduranceFlexibilityMobility Injury Prevention Rest & Recovery Outcomes/Metrics

27 Average Lap Time for Each 200 m of the 5 km Runs for Each Trial Ace Sponsored Study. Mind Over Body. May/June 2006. ACE FitnessMatters. 12-13

28 People frequently use mushrooms as tonics, such as the Chinese caterpillar fungus (Cordyceps sinensis) for improving athletic performance and increasing energy, and species like reishi (Ganoderma lucidum), shitake (Lentinella edodes), and maitake (Grifola frondosa) to boost immunity. Research on medicinal mushrooms suggests that taking more than one at the same time gives better results. 2nd Wind, a unique, all-natural formulation of standardized herbal extracts, has been clinically proven to accelerate clearance of lactic acid from the bloodstream following exercise by over 100%. Faster utilization of lactate by the muscle after exercise indicates enhanced energy production, enabling speedier recovery of muscle strength and reaction time. Improved lactate clearance can also lead to a reduction in post-workout muscle soreness and fatigue.* There is a combination mushroom extract called ESP, which is essentially the second generation of Second Wind product. All ingredients have a long history of safe use. Research involving ESP is currently ongoing and so far is showing a significant increase in physical stamina as indicated by a more than 800% increase in the maximum swim time of mice. Mushroom Supplements to Improve Physical Performance http://www.personalbestnutrition.com/cgi-bin/pbn/415.html

29 Slide 29 Psychological Fitness

30 Psychological Fitness Attitudes, Beliefs, Expectations Mindfulness, Awareness, Intention, Insights Emotional Flexibility, Emotional Choice Self: Other Focus: 1:1 Outcomes/Metrics Positivity 3:1

31 Meta-analysis of omega-3s on depressive symptoms, randomized placebo controlled trials, effect size = 0.54, p<0.008 Freeman M, Hibbeln JR, Davis JM et al. American Psychiatric Associations treatment recommendations for omega-3 fatty acids in psychiatric disorders. J Clin Psychiatry 2006; 67 12: 1954-1967.

32 0 Time to First Suicide Attempt (days) 0 200 400 600800 Survival Probability 0.2 0.4 0.6 0.8 1.0 High DHA (n=16) Low DHA (n=17) (median split of plasma phospholipid % fatty acids) Low Plasma DHA at Baseline Predicts Greater Risk of Future Suicide Attempts Cox proportional hazard ratio=0.29, p<0.002 Sublette, Hibbeln et al Am J Psychiatry 2006;163: 1100-1102 Inpatient Discharge

33 Slide 33 Medical & Behavioral Fitness

34 Immunizations Disease Screening Drug Prophylaxis Risk Factors Environmental (see environmental figure) Behavioral/ Occupational (see behavioral figure) Outcomes/Metrics

35 Example of Extra-ordinary Pain and Healing Control

36 Integrative Neural Immune Program http://neuralimmune.nih.gov/index.html Brain~Mind Body Connections

37 Train the Brain Mind-body approaches can reduce pain, improve immune function and wound healing

38 Family Conflict and Wound Healing: Time to healing was 1 day later following the conflict visit than after the social support visit (day 6 vs. day 5) Kiecolt-Glaser JK, Loving TJ, Stowell JR, Malarkey WB, Lemeshow S, Dickinson SL & Glaser R (2005). Hostile marital interactions, proinflammatory cytokine production, and wound healing. Archives of General Psychiatry.

39 Slide 39 Social Fitness

40 Stressful events and depression slow local cytokine production at the wound site which is important for wound healing while promoting maladaptive systemic proinflammatory cytokine production Kiecolt-Glaser JK, Loving TJ, Stowell JR, Malarkey WB, Lemeshow S, Dickinson SL & Glaser R (2005). Hostile marital interactions, proinflammatory cytokine production, and wound healing. Archives of General Psychiatry.

41 Social Fitness Peer Support/ Relationships Family Support/ Relationships Economic Relationships Quality of Unit Leadership Outcomes/Metrics Unit Cohesion

42 High Performance Teams vs. Low Performance Teams Losada M. Mathematical and Computer Modeling 30 (1999): 179-192. The personal connectivity of a team is highly correlated with its performance.

43 Slide 43 Total Fitness Medical & Behavioral Fitness Physical Fitness Nutritional Fitness Psychological Fitness Spiritual Fitness Social Fitness

44 The Challenge for The Total Fitness Group Science and Evidence Utility and Application Isolated Domains Whole Systems Translation to Military Mission

45 A Total Fitness UPS for the Warrior and Commander

46 Fitness Facilitators An Integrated Total Fitness System Fitness Metrics and Monitoring Evidence Based Training

47 Creating Total Fitness in Military Operations

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