1. German Armed Forces Health Promotion and Preventive Health Care Action
NATO Medical Conference Sep – 2 Oct 2009
German Armed Forces Health Promotion and Preventive Health Care Action
Dr. C. Holtherm, Bundeswehr Institute of Sports Medicine

2. Preventive Health Care– a Joint Scientific Effort
Three Bundeswehr institutes jointly are in charge of the development and provision of preventive health care under technical guidance by the Bundeswehr Medical Office.
The Bundeswehr Institute of Medical Occupational and Environmental Safety deals with the optimization of occupational and environmental conditions of soldiers at home and abroad, as well as, increasingly, with the problems of psychophysical stress reactions.
Laboratory Division IV collects biometric and military ergonomic data in different military work situations for the optimized harmonization of the soldiers‘ capabilities and duty requirements.
The Institute of Sports Medicine is the Bundeswehr‘s central facility for medical examinations, training and research in the fields of sports medicine, preventive health care and rehabilitation.
Bundeswehr Institute of Medical Occupational and Environ- mental Safety
Berlin
Central Bundeswehr Institute Medical Service Koblenz, Lab Division IV Military Ergonomics
Bundeswehr Institute of Sports Medicine, Warendorf

3. Preventive Health Care
Role 1 Medical Care
Medical Evacuation
Clinical Care Roles 2/3/4
Military Pharmacy and Med Service Mission Support
Preventive health care is an essential element of the Bundeswehr‘s chain of medical treatment. It is applied not only at home but also in deployments abroad – whose duration is increasing, together with the number of personnel employed – and it helps to improve mission conditions for the individual soldier.
Research,Development and Procurement Projects
Medical C4 I C² Support

4. Initial and Advance Training
The Bw Institute of Sports Medicine
Curative Medicine
Functional
Diagnostics
Expert opinion
Counseling
Orthopedics
Internal
Medicine
Performance
Diagnostics
My parent organization, the Institute of Sports Medicine in Warendorf near Münster, is a research establishment of the Federal Ministry of Defense and as such has primary responsibility for the concept development, the further development and the execution of several preventive health protection programs of the Bundeswehr. These activities are carried out in close coordination with the superior command, the Bundeswehr Medical Office, and with the Bundeswehr Sports School, which is also located in Warendorf.
Under “one roof“, the following interdisciplinary services are provided: medical treatment, counseling, instruction and scientific evaluation. Five medical officers (two internists, one medical specialist in general and nutritional medicine and two surgeons/orthopedic surgeons) as well as 15 other staff members take care of the soldiers‘ welfare in the best sense of the word.
General Medicine
Science Teaching
Initial and Advance Training

5. The Current Situation
Decreasing Physical Fitness throughout civil society
Decreasing Physical Fitness
new applicants/milit. personnel over 40
Armed Forces
Operational Readiness
In Germany, like in almost all industrialized nations, we have been observing a life style for many years which is characterized by physical inactivity, overweight and a resulting decrease in physical fitness. Of Germany‘s overall population, almost 60% of males and 40% of females are overweight according to the definition by the WHO.
This development also affects the German military. It must therefore be assumed that 25 to 30% of German soldiers – or even more in older age groups – are also over- weight, almost 10% of whom are obese and in need of treatment. An increase in cardiovascular diseases and degenerative skeletal damage must be expected, too.
Therefore, it is one of the tasks of the Medical Service to participate in efforts aimed at optimizing and – if required – restoring the operational readiness and stamina of military personnel with an increased risk profile.
Armed Forces Transformation 5

6. Dr. C. Holtherm, Bundeswehr Institute of Sports Medicine
Bundeswehr Projects with the Participation of the Bw Institute of Sports Medicine
Obesity Intervention Program
Workshop “Prevention for Medical Corps Officers“
PersonalHealthManagement for Military Leaders
Health Focused Sports Instructor/Supervisor
Services for the Special Forces Command
Regional Medical Command IV Health Initiative
In the following, I would like to present to you the programs that have been initiated. The Bundeswehr Institute of Sports Medicine either is one of the participants or has the overall responsibility, while technical supervision is carried out by the Bundeswehr Medical Office:
…(list projects)…
Dr. C. Holtherm, Bundeswehr Institute of Sports Medicine

7. OIP Body Weight Development - 5.4kg - 4.2kg
In the Bundeswehr‘s OIP, the Bundeswehr Institute of Sports Medicine has since 2001 treated about 600 soldiers per year as outpatients and in training courses. Treatment is evidence-based and includes motion, nutritional and behavior therapy. Both programs cover a period of two years, with regular physician-patient contacts at intervals of three to six months. This takes place parallel to duty, and the soldiers can still participate in deployments abroad. Training and nutritional recommendations are such that they can be put into practice also in the respective mission country. In addition to the statistically significant (Whitney U test, p =) and also clinically relevant weight reduction which we find in regular evaluations (here: the 1-year data), we also note a reduction in accompa- nying illnesses such as high blood pressure, lipoidosis and type II diabetes mellitus/glu- cose tolerance disturbance, as well a pronounced increase in endurance performance.
outpatients
patients in trg courses
Dr. C. Holtherm, Bundeswehr Institute of Sports Medicine

8. Dr. C. Holtherm, Bundeswehr Institute of Sports Medicine
OIP Performance Improvement (max. performance on the ergometer / body weight) % +11%
With an average weight loss of as much as 5%, the patients can improve relative physical fitness by up to 20% within 12 months. This means that “a noticeable optimization“ has been achieved with respect to the required fitness level and the Bundeswehr‘s transformation process.
ouptatients
patients in trg courses
Dr. C. Holtherm, Bundeswehr Institute of Sports Medicine

9. “Prevention for Med. Corps Officers“ 6 Dec - 12 Dec 2009 in WARENDORF
2nd Workshop
“Prevention for Med. Corps Officers“
6 Dec - 12 Dec 2009 in WARENDORF
In order to establish a standardized therapy of obesity and accompanying diseases throughout the Bundeswehr on a nation-wide basis, the Bundeswehr Institute of Sports Medicine in cooperation with Section IV 1.2 of the Bundeswehr Medical Office started a prevention initiative and in November conducted the workshop “Prevention for Med. Corps Officers” as a pilot project in WARENDORF.
The participants were about 20 Medical Corps officers and unit physicians interested in health promotion and preventive medical care.
Dr. C. Holtherm, Bundeswehr Institute of Sports Medicine 9

10. Dr. C. Holtherm, Bundeswehr Institute of Sports Medicine
Bundeswehr Institute of Sports Medicine Workshop “Prevention for Med. Corps Officers“
Up to 25 participants from major medical clinics, Bw hospitals, Medical Corps Officers
Aim:
motivate, provide tools
spread OIP for outpatients across Germany
evidence-based therapy
Also in 2009 this workshop will take place in Warendorf. Within the one-week program, the participants are presented tools, contents, evidence-based guidelines and current developments, and the input they provide is collected.
Participation in the workshop is certified not only by the Bundeswehr Institute of Sports Medicine and Section IV 1.2. of the Bundeswehr Medical Office, but also by the responsible medical association. This means that officers who have completed this workshop are certified to offer the programs on an “area-wide” basis, that is, at the regional medical treatment facilities.
Dr. C. Holtherm, Bundeswehr Institute of Sports Medicine

11. Personal Health Management for Military Leaders
Since 2006, the PHM program for military leaders has been conducted in Warendorf, another project jointly developed by the Bundeswehr Medical Office, the Bundeswehr Institute of Sports Medicine and the Bundeswehr Sports School.
All under one roof – saving a lot of time

12. Personal Health Management for Military Leaders
Diagnosis
Information
Identification of risk factors
Time Management
Nutrition Counseling
Therapy
Training
The program is organized as a seminar where up to ten leading officers with the ranks of colonel and general, as well as with comparable ranks, are taken care of as a group, being offered briefings, medical examinations, counseling, performance diagnosis and personal training at the Institute for three days. In addition to a personal medical exami- nation, personal training management and the optimization of their own risk constella- tion, possibilities and measures of prevention are presented and discussed. Thus, the seminar not only focuses on personal preventive health care but also aims to make military leaders identify with the ideas of preventive health protection, and we hope for positive effects in the participants‘ subordinate commands.
Functional Capacity
Improvement
Risk Reduction
Adopt Preventive Health Care
Implementation in Subordinate Command

13. Start Gesundheitsinitiative Süddeutschland 01.04.2009
One of the outcomes of the PHM seminar is an initiative by Regional Medical Command IV under the heading: “Fit for duty – fit for life“. The idea for this project originated in the participation of the commander, Brigadier General Dr. Schindelhauer, in a PHM seminar. Promotion by top athletes made it possible to establish the project at unit level. Medical, predeployment and physical fitness programs at the garrisons in Southern Germany are the contents of the initiative.
Start Gesundheitsinitiative Süddeutschland
Start of the Health Initiative for Southern Germany April 2009

14. Health Focused Sport Instructor
Obesity
Metabolic Syndrome
Chronic Diseases
Lack of Exercise
Lack of Physical Stamina
Anatomy, Physiology,
Sports Medicine, Nutrition
Training Management; Practice
Field Test; Selection of Type, Scope,
Intensity of Physical Exercise
Training Methods/Didactics
A further element – which is of particular importance for the training therapy at the garrisons for soldiers lacking in physical fitness – is the training course “Health Focused Sport Instructor“ at the Bundeswehr Sports School in Warendorf. This 3-week training course is the result of close cooperation between the Bundeswehr Sports School and the Institute of Sports Medicine and serves to familiarize 100 soldiers per year with the contents of health sports in order to enable them to establish and manage physical fit- ness training teams at their home garrisons. In this training course, as many as 42 lessons in sports medicine are taught by the Institue of Sports Medicine.
Together with the disciplinary superior and the local unit physician, the Health Focused Sport Instructor is to complete the cycle of evidence-based and standardized therapy for soldiers with reduced physical fitness. Also in this case, the aim is physical fitness restoration / improvement of operational readiness.
Instructor Training:
Physical Fitness Restoration / Improvement of
Operational Readiness

15. Bw Institute Support to the Special Forces Command
Performance Diagnosis
Training Counseling
Workshop
Soldiers Performance
and Fitness for
Special Forces Command
Last but not least, and again in cooperation with the Bundeswehr Sports School, the Bundeswehr Institute of Sports Medicine offers various possibilities of regeneration, diagnosis, therapy and training managment, and even intensive rehabilitation for soldiers whose special task areas involve increased stress levels. The Institute of Sports Medicine provides equipment for performance diagnosis to facilitate the selection of candidates, and it is in charge of the reintegration of Special Forces Command soldiers after severe and very severe wounds.
Interdisciplinary outpatient consulting hours
Intensive orth. rehabilitation
Dr. C. Holtherm, Bundeswehr Institute of Sports Medicine

16. Dr. C. Holtherm, Bundeswehr Institute of Sports Medicine
Preventive Medicine
Field Medicine
Now my briefing ends right where it started: The cycle of medical care in the Bundeswehr is completed by preventive health protection, which is one of its integral elements. Thank you very much for your attention!
Dr. C. Holtherm, Bundeswehr Institute of Sports Medicine