MILITARY MEDICINE, 175, 8:14, 2010

Physical Fitness
MAJ Tanja C. Roy, SP USA*; COL Barbara A. Springer, SP USA†;
MAJ Vancil McNulty, SP USA‡; LTC Nikki L. Butler, SP USA§

ABSTRACT “Total force fitness” is a state in which the individual, family, and organization can sustain optimal well-
being and performance under all conditions. Physical fitness, an important component of total force fitness, is the amount
of physical training required to achieve a physical work capacity. Due to the austere environments and high physical work
capacity required for mission tasks, military service members must sustain a more advanced level of physical fitness than

Downloaded from https://academic.oup.com/milmed/article/175/suppl_8/14/4344654 by guest on 01 February 2023

the civilian population. To meet these high demands, physical fitness training must be split into four components: endur-
ance, mobility, strength (including core strength), and flexibility. Both aerobic and anaerobic training need to be utilized.
The four components of physical fitness training plus performance testing and injury surveillance/prevention must be
well understood and included as part of all military physical fitness programs to ensure our service members are prepared
to meet the physical demands of the mission without incurring injury.

INTRODUCTION DEFINING PHYSICAL FITNESS

“Total force fitness” is a state in which the individual, fam- What is physical fitness? The U.S. Department of Health and
ily, and organization can sustain optimal well-being and Human Services separates physical fitness into two catego-
performance under all conditions. Physical fitness is one ries: health-related fitness and performance-related fitness.6
component of total force fitness, which also includes psy- The general public focuses on health-related fitness, which
chological, behavioral, medical, nutritional, spiritual, and is the amount of physical training required to reduce the risk
social health. Consistent regular exercise can have a positive of disease or injury. Military members focus on performance-
impact on social health, depression, generalized anxiety, and related fitness, which is the amount of physical training
sleep deprivation.1–5 With the interdependencies of the cat- required to achieve a physical goal, such as climbing a moun-
egories of total force fitness, it is very important that military tain or maneuver chalks and chains on an aircraft carrier.
service members be physically fit. The physical fitness level What exactly is military physical fitness? According to the
required by a military service member is higher than that Army Manual FM 21-20, Physical Training, “War places a
of the general population due to the diverse nature of mili- great premium upon the strength, stamina, agility, and coor-
tary missions and the large loads carried by service mem- dination of the soldier because victory and his life are so
bers. Currently, service members must perform missions in often dependent upon them. To march long distances with
austere environments over 6- to 15-month periods. Missions full pack, weapons, and ammunition through rugged country
executed in these diverse environments require a large vari- and to fight effectively upon arriving at the area of combat; to
ety of physical skills. The purpose of this article is to discuss drive fast-moving tanks and motor vehicles over rough terrain;
how to develop and maximize service members’ physical fit- to make assaults and to run and crawl for long distances; to
ness by aerobically and anaerobically training the four com- jump into and out of foxholes, craters, and trenches, and over
ponents that make up physical fitness: endurance, mobility, obstacles; to lift and carry heavy objects; to keep going for
strength (to include core strength), and flexibility; how to use many hours without sleep or rest—all these activities of war-
injury surveillance and prevention strategies to train without fare and many others require superbly conditioned troops.”7
incurring injury; and to outline current initiatives to improve To put it more succinctly, military physical fitness is the abil-
physical training. ity to physically accomplish all aspects of the mission while
remaining healthy/uninjured. Because there are variations in
military missions/tasks, it is important to adjust physical fit-
*15 Kansas Street, Bldg 42, Natick, MA 01760. ness training accordingly. Health-related fitness is therefore
†6301 Little River Turnpike, Suite 230, Alexandria, VA 22312.
‡5158 Blackhawk Road, E-4435, Aberdeen Proving Ground, MD 21010-
the same for all military members, but performance-related
5403. fitness differs depending on the mission. An Air Force load
§5109 Leesburg Pike, Suite 684, Falls Church, VA 22041. master who spends 10 hours a day loading planes needs to
Previous presentations: Total Force Fitness for the 21st Century meet- train differently than a scout who is tasked to patrol 15 miles
ing, December 6–9, 2009 at the Uniformed Services University of the Health through the mountains of Afghanistan. Military fitness train-
Sciences.
The opinions or assertions contained herein are the private views of the
ing needs to be designed to specifically complement the mis-
author(s) and are not to be construed as official or as reflecting the views of sion tasks required by the service members. This is referred to
the Army or the Department of Defense. as “specificity of training.”

14 MILITARY MEDICINE, Vol. 175, August Supplement 2010

 Physical Fitness

Physical fitness training can be split into four major com-

ponents allowing for the diversity of training necessary to
accomplish mission tasks: endurance, mobility, strength,
and flexibility. Endurance is the body’s ability to continu-
ally accomplish the same task in a repetitive fashion, such as
loading supplies onto a ship. Mobility is the ability to move
the body in space with the precision necessary to negotiate
an obstacle. An example of this is climbing a wall. Strength
is the ability to generate force attempting to overcome resis-
tance such as lifting an ammunition can. Finally, flexibility is
possessing the optimal joint range of motion such as required

Downloaded from https://academic.oup.com/milmed/article/175/suppl_8/14/4344654 by guest on 01 February 2023

to reach overhead. All four aspects of physical fitness are
important and essential in creating a physically well-balanced,
injury-resistant, and mission-fit service member.
Military fitness programs need to be based on the mission
task-oriented fitness philosophy. In fact the most recent physi-
cal fitness guidance from the Army and Marine Corps places
an emphasis on this philosophy.8,9 It isolates individual tasks
performed by the service member during a mission and breaks FIGURE 1. Mission tasks can be separated into the four different compo-
them down into their physical components. An example of nents. Training these components while using injury prevention strategies can
result in well-balanced, uninjured, physically fit service members.
this task breakdown is when a squad has to patrol through
Baghdad, sprint through the market, kick down a door, and
steady their weapons to fire. Many aspects of fitness are being tive tasks at a lower relative work load; patrolling 10 miles
utilized to accomplish this mission. The service member must will become easier. Endurance is aerobic training which is
possess the aerobic endurance to walk the distance of the dependent on the body’s ability to take in and utilize oxygen,
patrol while wearing combat gear. Sprinting through the mar- VO2max. The American College of Sports Medicine (ACSM)
ket place and jumping through the window require not only and the American Heart Association recommend a minimum
the anaerobic ability to sprint but also the ability to change of 30 minutes of moderately vigorous aerobic activity for a
directions quickly to negotiate obstacles. Kicking down the minimum of 5 days a week for adults under the age of 65.10
door requires strength. The service member’s overall VO2max However, participation in physical activity above the minimum
must be high enough to allow him or her to accomplish all of and within the guidelines will increase the health benefits.10,11
these tasks without fatiguing. Failure to accomplish any task Since the military requires service members to perform chal-
in the sequence puts the service member in danger and could lenging physical tasks, they should perform more than the min-
result in death. Therefore, suboptimal or poor physical fitness imum duration and frequency of aerobic training. Examples of
in service members is much more serious than in an athlete endurance training are long-distance running, swimming, foot
and training should reflect this. marching, cycling, low-weight, high-repetition strength train-
An absolute work load is the amount of work required to ing, and stairmaster. Distance, duration, repetition number,
accomplish a task. A task may require 3 L/min of oxygen con- and speed need to be increased gradually to reduce the risk
sumption. If the service member’s VO2max is 4 L/min, then he of injury and increase performance. A very general example
or she is working at 75% of his or her maximal capacity. By would be increasing the distance run only 10% per week.
improving the service member’s physical fitness, or maximal
capacity, any given task will represent a lower relative work Mobility
load, i.e., it will be easier. The main purpose of physical train- Mobility is the ability to move the body in space with the
ing in a service member is to decrease the relative work load precision necessary to negotiate an obstacle, such as enter-
required to complete mission tasks. The secondary purpose of ing a window. Mobility training is designed to increase the
military physical training is to increase the service member’s service member’s speed, balance, jumping, and ability to
overall medical fitness, psychological fitness, and resistance change direction. Anaerobic training can improve mobil-
to injury (Fig. 1). ity. This involves training with tasks that take no more than
5 minutes. Examples of mobility training include jumping,
COMPONENTS OF PHYSICAL FITNESS sprinting, and climbing. Plyometrics (jumping exercises) have
been shown to be effective in increasing vertical jump height
Endurance more than strength training alone.12–14 Speed (sprint) training
Endurance is the body’s ability to continually accomplish the over 11 weeks with 3–4 sets of 3 sprints of 10 m increasing to
same task in a repetitive fashion. Proper endurance training 50 m has been shown to increase jump height, jump power,
will increase the service member’s ability to perform repeti- jump length, squat strength, sprint speed, and agility.15

MILITARY MEDICINE, Vol. 175, August Supplement 2010 15

 Physical Fitness

It is important that speed training incorporate changes in to remember that this does not mean that each muscle group
direction as well. If a service member is training to accom- is stressed every day. When performing a whole body routine,
plish running tasks that require quick directional changes, the the service member should lift a maximum of three times a
principle of specificity of training should be applied; namely, week or, when using an upper and lower body split workout,
train by sprinting in a straight line as well as with multiple the service member should lift 4 days a week: upper body
directional changes. Using only straight sprint training results 2 days and lower body 2 days.18
in increases in straight speed but not change-of-direction Core strength is the endurance strength of the abdominal
speed and vice versa.16 Therefore, a combination of the two and back muscles and should be included as the foundation of
training techniques is needed.17 any physical fitness program. Low muscular forces applied at
specific areas along the spine during core strengthening will
Strength drastically increase the load carriage capability of the spine

Downloaded from https://academic.oup.com/milmed/article/175/suppl_8/14/4344654 by guest on 01 February 2023

The purpose of strength training is to increase the service (combat gear or lifting loads).24 Since this submaximal coact-
member’s ability to generate force and power, thus lowering ivation must be maintained regardless of which component
the relative work required to complete mission tasks. Muscle is being trained (endurance, mobility, strength, or flexibility),
strength is the maximum force created by a muscle, muscle endurance is much more important than overall strength for
endurance is the ability to create a force repetitively or sus- maintaining and increasing load carriage capability.25 Core
tain it, and power is the ability to create force quickly across stability is the biomechanical building block upon which all
distance. Hence, strength is required to lift a 40-lb box, while other training rests. Core stability is also important because
power is the ability to move the box 4 feet in 1 second. low core strength is associated with a high prevalence of low
Many weight training regimes are based on a one-repeti- back pain (LBP) and higher core strength is associated with
tion maximum (1 RM). This is simply the most weight that less reoccurrence of LBP; patients were 12 times less likely to
the service member can lift once. Novice individuals should have recurrence in LBP for 1 year after receiving core stability
begin with 60–70% of their 1 RM for 8–12 repetitions and training.26–29 The core muscles must be conditioned to increase
2–3 sets.18 However, once a service member has been strength the load carriage capability of the spine, reduce the risk of
training for 6 months or more, 80% of 1 RM is needed to injury, and keep the body biomechanically efficient.
continue to increase one’s strength and 85% has been shown
to be most effective in athletes.18 It is important to remem- Flexibility
ber that even though 80% is stated to be the most successful, Flexibility is the fourth physical fitness component. The pur-
this effectiveness is maximized when incorporated into a peri- pose of flexibility training is to maintain or achieve optimal
odized weight training program.19 Periodization is a phased muscle length–tension relationships across joints that enable
training program using a variety of sets, repetitions, weights, a service member to perform military-specific tasks with less
and exercises. likelihood of injury or undue difficulty. Hypo- or hyperflex-
The strength program goal always needs to be consid- ibility can be detrimental. Poor flexibility is related to injury
ered. For maximum strength to increase, one of three things in the Achilles tendon, hamstrings, patellar tendon, plantar
must happen: (1) the load must increase, (2) repetitions must fascia, and iliotibial band.30–34 For individuals who require
increase, or (3) rest periods must be lengthened.18 For muscle increased flexibility, static stretching (motionless stretches
endurance to increase, repetition speed should be increased held for 15–30 seconds) should be done at the end of the fit-
and rest time reduced.18 If the goal is to increase power, light ness session.35 If static stretching is performed before the main
loads (0–60% 1 RM for lower body and 30–60% 1 RM for exercises, there is often a decrease in performance.36–41 In fact,
upper body) are used with fast repetitions.18 The amount of one study shows that maximum voluntary muscle contraction
rest time between sets varies, depending on the goal of the was still reduced 9% an hour after stretching.42 Hence, to avoid
weight lifting program.19 If the goal is for maximum one-time performance decrements, stretching is best done at the end of
strength, such as lifting a heavy casualty, then the rest periods a work out. It is important to note that it is possible to be too
between sets need to be longer, at least 2–3 minutes and often flexible.43,44 Those who are hyperflexible do not need to stretch
up to 5.20,21 If the goal of the program is to increase endur- these muscles, as it will not reduce their likelihood of injury.
ance, such as lifting more boxes, then the rest period should
be shorter, less than 1 minute for sets of 10–15 repetitions and
1–2 minutes for 15–20 repetition sets.22,23 For power, such as NON-PERFORMANCE-BASED BENEFITS
pushing up out of the prone, rest periods should be 3–5 min- OF PHYSICAL FITNESS
utes between sets.18 Ballistic exercises use very fast explosive There are many non-performance-based benefits to being
movements and are most effective when training power.18 It is physically fit besides accomplishing the mission. The risk of
important to remember that maximum strength, muscle endur- cardiovascular disease, thromboembolic stroke, hypertension,
ance, and power are all inter-related and a general program type 2 diabetes mellitus, osteoporosis, obesity, colon cancer,
should include aspects of each one. ACSM recommends that breast cancer, anxiety, and depression all decrease with an
weight lifting be performed 3–4 days a week.18 It is important increase in physical activity.11 Endurance training increases

16 MILITARY MEDICINE, Vol. 175, August Supplement 2010

 Physical Fitness

capillary density in working muscle, raises blood volume, bat fitness test (CFT) to complement their standard physical
and decreases heart rate during exercise.45 Mechanical load- fitness test (PFT). The Marine Corps is currently the only
ing of the skeletal system through impact or weight lifting military service evaluating the components of mobility and
will help increase bone formation in young adults and slow strength (Table II). The CFT is designed to test tasks similar
the rate of bone loss in older adults.10 Fitness programs that to those found in a combat environment.
include resistance training improve dynamic stability and pre- Since service members tend to design their physical train-
serve functional capacity.46–49 Fitness training also improves ing around the fitness test, the ideal fitness test would reflect
psychological well-being as well as work performance.46,50–52 all components required for mission task accomplishment.
The end result is that fit service members are physically and The performance measures in Table III provide a possible set
psychologically healthier and more productive. of tests to assess all four components. This set is only one
example; many combinations of tasks could be used. A com-

Downloaded from https://academic.oup.com/milmed/article/175/suppl_8/14/4344654 by guest on 01 February 2023

MEASURING PHYSICAL FITNESS plete fitness test could be achieved with several single events
Once unit physical fitness trainers understand the four com- or events could be combined into an obstacle course, simi-
ponents of physical fitness and how to create and implement lar to the CFT. The goal is to measure mobility, strength, and
a fitness program, there needs to be a method to measure the endurance in the entire body and monitor how they change
service member’s and unit’s physical fitness. Physical fitness over time. The Marine Corps administers the PFT once a year
needs to be measured and monitored to ensure that service and separately administers the CFT later in the year. The Air
members are improving or maintaining the required level of Force, Army, and Navy currently administer their single fit-
fitness to perform their mission tasks with a reduced relative ness tests twice a year.
work load. There exist numerous validated tests to measure
each component individually. Military fitness tests are not INJURY SURVEILLANCE AND PREVENTION
currently designed to measure each component. However, the It is essential that units, commanders, and other oversee-
military physical fitness test design is constrained by ease of ing agencies have the ability to monitor injuries and ensure
administration, minimal requirement for equipment, field set- that specific training techniques are not disproportionately
tings, and time required to administer. Currently, each military increasing injuries. An adequate surveillance system monitors
service is using its respective physical fitness test composed of injury incidence and allows injury to be tied to mechanisms of
some variation of a distance run, push ups/pull ups/flexed arm
hang, and sit ups (Table I). Note that only endurance and flex- TABLE II. Marine Corps Combat Fitness Test
ibility are currently being measured on standard fitness tests.
However, current tests are easy to administer and roughly cor- Event Time/Distance Component
relate to endurance and strength performance. In the majority Run 880 yds Endurance
of studies, the 2- and 3-mile run have shown good or excellent Overhead Lift 2 min Endurance
Sprint 25 yds Mobility
correlation to VO2max in subjects.53,54 A 1-mile run has shown
Crawl 25 yds Mobility
poor to good correlation with VO2max.54 Previous studies on Sprint 25 yds Mobility
push ups indicate a good correlation with total upper body Casualty Drag 10 yds Strength
strength and endurance.54 The Marine Corps has added a com- Casualty Carry 65 yds Strength
Ammo Can Carry 75 yds Endurance
Grenade Throw Mobility
TABLE I. Standard Physical Fitness Tests of Each Service Ammo Can Carry 75 yds Endurance

Service Event Time/Distance Component

TABLE III. Suggested Performance Metrics to Include All
Air Force Push Ups 1 minute Endurance
Components in Military Fitness Tests
Sit Ups 1 minute Endurance
Run 1.5 miles Endurance
Metric Measured Component
Waist Circumference None
Army Push Ups 2 minutes Endurance Push Ups55 Endurance
Sit Ups 2 minutes Endurance Sit Ups55 Endurance
Run 2 miles Endurance 2-Mile Run55 Endurance
Marine Corps Abdominal Crunch 2 minutes Endurance Illinois Agility Test56,57 Mobility
Pull Ups/ Flexed To exhaustion Endurance Medicine Ball Put58,59 Strength
Arm Hang Broad Jump60 Mobility
Run 3 miles Endurance Repetitive Squats61 Endurance
Navy Push Ups 2 minutes Endurance Pull Ups62,63/Flexed Arm Hang64,65 Endurance
Curl Ups 2 minutes Endurance Functional Movement Screen66 Flexibilitya
Runa 1.5 miles Endurance
a
Sit and Reach Flexibility The Functional Movement Screen is currently undergoing validation in
a military population. It has been shown to correlate with injuries in NFL
a
A swim or elliptical event can be substituted for the Navy run. players.66

MILITARY MEDICINE, Vol. 175, August Supplement 2010 17

 Physical Fitness

injury. Ideally, injury data should be linked to readiness reduc- dental services, and synthetic blend socks are issued. All four
tion due to injury. From this information, medical providers branches of the military have issued new physical fitness guid-
and commanders can identify and modify injury promoting ance with the Army and Marine Corps offering the most in-
activities, taking steps to decrease injuries and increase unit depth instruction.
fitness, productivity, and readiness. The previous Army Fitness Manual, FM 21-20, was pub-
For injury surveillance to be optimally successful, the lished in 1998. Since then, there has been further exercise and
Department of Defense (DoD) needs to create a standard DoD- injury research as well as a drastic change in the military’s
wide injury surveillance database. Currently, injury surveil- operational tempo. This resulted in implementation of several
lance databases are not uniform either in metrics collected or local fitness programs. In addition, Army physical therapists
data entered. In general, it is recommended that a minimum of recognized the need for well-rounded fitness programs and
four data points be collected on all new patients (mechanism created them for several divisions and the Rangers. In these

Downloaded from https://academic.oup.com/milmed/article/175/suppl_8/14/4344654 by guest on 01 February 2023

of injury, body region, deployability, and unit). Additionally, programs, more emphasis has been placed on strength train-
fitness scores should be included as part of the medical record. ing, core strengthening, mobility drills, and foot marching
The information that is collected must be available for analysis than found in FM 21-20.
by local medical staff to provide commanders with accurate The Army recently created a new doctrine for physical fit-
injury trends and options to correct the likely cause of injury. ness training using the injury prevention approach guidance.
Using surveillance, the Army identified that the majority TC 3-22.20 Army Physical Readiness Training (PRT) was pub-
of injuries occur during training. Data collected Army-wide lished in March of 2010. The emphasis is on a well-rounded
indicated that physical training is the leading cause of outpa- mission task-oriented approach to physical fitness and includes
tient injury visits, accounting for 25 to 40% of all injuries.67,68 detailed explanations of proper methods for mobility, strength,
In Marine Corps basic training, 78% of the injuries were due endurance, and flexibility training. Soldiers participating in
to overuse and significantly correlated to running and physi- PRT were 46–52% less likely to suffer an injury when com-
cal training.69 Thirty-six percent of female Navy recruits suf- pared to units using traditional physical training while scoring
fered overuse injuries in basic training.70 Musculoskeletal the same on the Army physical fitness test (APFT).76
injuries resulted in the most lost duty days at the U.S. Air The Marine Corps has also been making huge strides in
Force Academy.71 Of the limited duty days received by sol- enhancing its physical fitness program and issued new guid-
diers, 80–90% are from training-related injuries.72 In a study ance in 2008. Along with creating the CFT the Marine Corps
of 15,000 deployed soldiers, the majority of soldiers claimed is shifting the focus of its physical fitness training to mission-
that physical training was responsible for their musculoskel- oriented tasks as well. The Marine Corps has been develop-
etal injuries.73 Research has identified risk factors for these ing a comprehensive combat fitness program that promotes
injuries in service members. Smoking, greater age, lower musle health and fitness.8 The Marine Corps’ most recent guidance
endurance, lower fitness level, hyper- and hypo-flexibiity, lower recommends that aerobic and muscle-strengthening activities
VO2max, and higher running mileage increase the chance that be conducted more often, at higher intensity, and for shorter
a service member will sustain an injury.44,72,74,75 duration as well as points out the need to gradually increase
Once injury surveillance has identified injuries, steps must the difficulty of training.8
be taken to reduce them through prevention. The Joint Services The Air Force has issued its latest physical fitness guid-
Physical Training Injury Prevention Work Group in 2008 sys- ance in 2010.77 This guide instructs airmen to train endurance,
tematically reviewed 34 potential injury prevention strate- strength, mobility, and flexibility. The Air Force has increased
gies. Six interventions had strong enough evidence to become its fitness testing to twice a year, is making the standards on
recommendations for implementation in all four services: their fitness test more difficult this year, and is certifying phys-
(1) prevent overtraining; (2) perform multiaxial, neuromuscu- ical training leaders.
lar, proprioceptive, and agility training; (3) wear mouth guards The Navy published new guidance on physical fitness
during high-risk activities; (4) wear semirigid ankle braces for training in 2005, emphasizing its importance for mission
high-risk activities (such as airborne training); (5) consume accomplishment.78 Sailors are instructed to train endurance,
nutrients to restore energy balance within 1 hour following flexibility, and strength. The Navy has started a command fit-
high-intensity activity; and (6) wear synthetic blend socks to ness leaders course to create fitness leaders capable of design-
prevent blisters. The first two interventions speak to the wide- ing fitness programs.
spread overuse injuries caused by an over-reliance on endur-
ance running in the military’s physical training programs. CONCLUSIONS
Physical fitness is composed of the four components: endur-
CURRENT PHYSICAL FITNESS INITIATIVES ance, mobility, strength, and flexibility. Training should
The military has attempted to initiate the six interventions men- include all four components supported by a foundation of
tioned above as well as several others geared toward mitigat- core strength and be based on mission tasks the service mem-
ing additional risk factors. Service members are given counsel ber is required to perform. Proper physical training should
on smoking sensation, custom mouth guards are offered by (1) break down mission tasks into physical components,

18 MILITARY MEDICINE, Vol. 175, August Supplement 2010

 Physical Fitness

(2) ensure that all four components are part of physical training 16. Young WB, McDowell MH, Scarlett BJ: Specificity of sprint and agility
in a manner specific to the mission tasks required, (3) moni- training methods. J Strength Cond Res 2001; 15(3): 315–9.
17. Walklate BM, O’Brien BJ, Paton CD, Young W: Supplementing regular
tor physical fitness levels and improvement to ensure perfor- training with short-duration sprint-agility training leads to a substantial
mance is increasing and relative work load is decreasing, and increase in repeated sprint-agility performance with national level bad-
(4) prevent improper training through injury surveillance and minton players. J Strength Cond Res 2009; 23(5): 1477–81.
prevention. The four components of physical fitness train- 18. ACSM: American College of Sports Medicine Position Stand. Progres-
ing plus performance monitoring and injury surveillance/ sion models in resistance training for healthy adults. Med Sci Sports
Exerc 2009; 41(3): 687–708.
prevention must be well understood and included as part of 19. Kraemer WJ, Ratamess NA: Fundamentals of resistance training: pro-
all military physical fitness programs to ensure our men and gression and exercise prescription. Med Sci Sports Exerc 2004; 36(4):
women in uniform are properly prepared to accomplish any 674–88.
mission safely and effectively. 20. Ahtiainen JP, Pakarinen A, Alen M, Kraemer WJ, Häkkinen H: Short

Downloaded from https://academic.oup.com/milmed/article/175/suppl_8/14/4344654 by guest on 01 February 2023

vs. long rest period between the sets in hypertrophic resistance training:
influence on muscle strength, size, and hormonal adaptations in trained
ACKNOWLEDGMENTS men. J Strength Cond Res 2005; 19: 572–82.
21. Pincivero DM, Lephart SM, Karunakara RG: Effects of rest interval on
The authors acknowledge the assistance of the members of the Chairman’s
isokinetic strength and functional performance after short-term high
Total Fitness Conference 2009 members as well as that of Col Brian McGuire,
intensity training. Br J Sports Med 1997; 31(3): 229–34.
USMC (Ret.) in creating this article.
22. Marcinik EJ, Hodgdon JA, Mittleman K, O’Brien JJ: Aerobic/calisthenic
and aerobic/circuit weight training programs for Navy men: a compara-
tive study. Med Sci Sports Exerc 1985; 17(4): 482–7.
REFERENCES 23. Wilmore JH, Parr RB, Girandola RN, et al: Physiological alterations
1. Cramer SR, Nieman DC, Lee JW: The effects of moderate exercise train- consequent to circuit weight training. Med Sci Sports 1978; 10(2):
ing on psychological well-being and mood state in women. J Psychosom 79–84.
Res 1991; 35(4–5): 437–49. 24. Kiefer A, Shirazi-Adl A, Parnianpour M: Stability of the human spine in
2. Hassmen P, Koivula N, Uutela A: Physical exercise and psychologi- neutral postures. Eur Spine J 1997; 6(1): 45–53.
cal well-being: a population study in Finland. Prev Med 2000; 30(1): 25. Barr KP, Griggs M, Cadby T: Lumbar stabilization: core concepts
17–25. and current literature, Part 1. Am J Phys Med Rehabil 2005; 84(6):
3. De Moor MH, Beem AL, Stubbe JH, Boomsma DI, De Geus EJ: Regular 473–80.
exercise, anxiety, depression and personality: a population-based study. 26. Mannion AF, Muntener M, Taimela S, Dvorak J: Comparison of three
Prev Med 2006; 42(4): 273–9. active therapies for chronic low back pain: results of a randomized clini-
4. Barbour KA, Blumenthal JA: Exercise training and depression in older cal trial with one-year follow-up. Rheumatology (Oxford) 2001; 40(7):
adults. Neurobiol Aging 2005; 26(Suppl 1): 119–23. 772–8.
5. Driver HS, Taylor SR: Exercise and sleep. Sleep Med Rev 2000; 4(4): 27. Bayramoglu M, Akman MN, Kilinc S, Cetin N, Yavuz N, Ozker R:
387–402. Isokinetic measurement of trunk muscle strength in women with chronic
6. U.S. Department of Health and Human Services: 2008 Physical Activity low-back pain. Am J Phys Med Rehabil 2001; 80(9): 650–5.
Guidelines for Americans, Washington, DC, DHHS, 2008. 28. Greene HS, Cholewicki J, Galloway MT, Nguyen CV, Radebold A: A
7. Department of War: FM 21-20, Physical Fitness. Washington, DC, history of low back injury is a risk factor for recurrent back injuries in
Government Printing Office, 1946. varsity athletes. Am J Sports Med 2001; 29(6): 795–800.
8. Department of the Navy: Marine Corps Order 6100.13. Washington, DC, 29. Hides JA, Jull GA, Richardson CA: Long-term effects of specific sta-
DoD, 2008. bilizing exercises for first-episode low back pain. Spine 2001; 26(11):
9. Department of the Army: Army Physical Readiness Training. Washington, E243–8.
DC, DoD, 2010. 30. Puniello MS: Iliotibial band tightness and medial patellar glide in patients
10. Haskell WL, Lee IM, Pate RR, et al: Physical activity and public health: with patellofemoral dysfunction. J Orthop Sports Phys Ther 1993; 17(3):
updated recommendation for adults from the American College of Sports 144–8.
Medicine and the American Heart Association. Med Sci Sports Exerc 31. Garrett WE Jr, Califf JC, Bassett FH 3rd: Histochemical correlates of
2007; 39(8): 1423–34. hamstring injuries. Am J Sports Med 1984; 12(2): 98–103.
11. Kesaniemi YK, Danforth E Jr, Jensen MD, Kopelman PG, Lefebvre P, 32. Kibler WB, Goldberg C, Chandler TJ: Functional biomechanical deficits
Reeder BA: Dose-response issues concerning physical activity and in running athletes with plantar fasciitis. Am J Sports Med 1991; 19(1):
health: an evidence-based symposium. Med Sci Sports Exerc 2001; 33(6, 66–71.
Suppl): S351–8. 33. Leach RE, James S, Wasilewski S: Achilles tendinitis. Am J Sports Med
12. Luebbers PE, Potteiger JA, Hulver MW, Thyfault JP, Carper MJ, 1981; 9(2): 93–8.
Lockwood RH: Effects of plyometric training and recovery on verti- 34. Worrell TW: Factors associated with hamstring injuries. An approach to
cal jump performance and anaerobic power. J Strength Cond Res 2003; treatment and preventative measures. Sports Med 1994; 17(5): 338–45.
17(4): 704–9. 35. LaRoche DP, Connolly DA: Effects of stretching on passive muscle ten-
13. Fatouros IG, Jamurtas AZ, Leontsini D, et al: Evaluation of plyomet- sion and response to eccentric exercise. Am J Sports Med 2006; 34(6):
ric exercise training, weight training, and their combination on vertical 1000–7.
jumping performance and leg strength. J Strength Cond Res 2000; 14: 36. Rubini EC, Costa AL, Gomes PS: The effects of stretching on strength
470–6. performance. Sports Med 2007; 37(3): 213–24.
14. Newton RU, Kraemer WJ, Hakkinen K: Effects of ballistic training on 37. Yamaguchi T, Ishii K: Effects of static stretching for 30 seconds and
preseason preparation of elite volleyball players. Med Sci Sports Exerc dynamic stretching on leg extension power. J Strength Cond Res 2005;
1999; 31(2): 323–30. 19(3): 677–83.
15. Markovic G, Jukic I, Milanovic D, Metikos D: Effects of sprint and plyo- 38. McMillian DJ, Moore JH, Hatler BS, Taylor DC: Dynamic vs. static-
metric training on muscle function and athletic performance. J Strength stretching warm up: the effect on power and agility performance.
Cond Res 2007; 21(2): 543–9. J Strength Cond Res 2006; 20(3): 492–9.

MILITARY MEDICINE, Vol. 175, August Supplement 2010 19

 Physical Fitness

39. Amako M, Oda T, Masuoka K, Yokoi H, Campisi P: Effect of static 60. Harman EA, Gutekunst DJ, Frykman PN, et al: Effects of two differ-
stretching on prevention of injuries for military recruits. Mil Med 2003; ent eight-week training programs on military physical performance.
168(6): 442–6. J Strength Cond Res 2008; 22(2): 524–34.
40. Jones AM: Running economy is negatively related to sit-and-reach test 61. Kraemer WJ, Nindl BC, Gotshalk LA, et al: Prediction of military rel-
performance in international-standard distance runners. Int J Sports Med evant occupational tasks in women from physical performance compo-
2002; 23(1): 40–3. nents. In: Advances in Occupational Ergonomics and Safety, pp 719–722.
41. Brandenburg JP: Duration of stretch does not influence the degree of Edited by Kumar S. Burke, VA, IOS Press, 1998.
force loss following static stretching. J Sports Med Phys Fitness 2006; 62. Department of the Army: Physical Training, Vol FM 21-20. Washington,
46(4): 526–34. DC, Government Printing Office, 1950.
42. Fowles JR, Sale DG, MacDougall JD: Reduced strength after pas- 63. Department of the Navy: Headquarters United States Marine Corps:
sive stretch of the human plantarflexors. J Appl Physiol 2000; 89(3): Marine Corps Order P6100.12. Washington, DC, DoD, 2002.
1179–88. 64. President’s Council on Physical Fitness and Sport: The President’s
43. Stewart DR, Burden SB: Does generalised ligamentous laxity increase Challenge, 2009. Bloomington, IN. Available at http://www.presidentschal

Downloaded from https://academic.oup.com/milmed/article/175/suppl_8/14/4344654 by guest on 01 February 2023

seasonal incidence of injuries in male first division club rugby players? lenge.org/pdf/2009_PC_Brochure.pdf; accessed October 1, 2009.
Br J Sports Med 2004; 38(4): 457–60. 65. Eisenmann JC, Malina RM: Age- and sex-associated variation in neuro-
44. Knapik JJ, Sharp MA, Canham-Chervak M, Hauret K, Patton JF, Jones muscular capacities of adolscent distance runners. J Sports Sci 2003; 21:
BH: Risk factors for training-related injuries among men and women in 551–7.
basic combat training. Med Sci Sports Exerc 2001; 33(6): 946–54. 66. Kiesel K, Plisky PJ, Voight M: Can serious injury in professional football
45. Kubukeli ZN, Noakes TD, Dennis SC: Training techniques to improve be predicted by a preseason Functional Movement Screen? North Am
endurance exercise performances. Sports Med 2002; 32(8): 489–509. J Sports Phys Ther 2007; 2(3): 76–81.
46. Stewart KJ, Mason JM, Keleman M: Three-year participation in circuit 67. Knapik J, Darakjy S, Jones S, et al: Injuries and physical fitness before
weight-training improves strength and self-efficacy in cardiac patients. and after deployment by the 10th Mountain Division to Afghanistan for
J Cardiopulm Rehabil 1988; 8: 292–6. Operation Enduring Freedom 2007: Report Number 12-MA-05SD-07.
47. Keleman MH, Stewart KJ, Gillian RE, et al: Circuit weight training in U.S. Army Center for Health Promotion and Preventive Medicine,
cardiac patients. J Am Coll Cardiol 1986; 7: 38–42. Edgewood, MD.
48. Ghilarducci LE, Holly RG, Amsterdam EA: Effects of high resis- 68. Knapik JJ, Jones SB, Darakjy S, et al: Injury rates and injury risk fac-
tance training in coronary artery disease. Am J Cardiol 1989; 64(14): tors among U.S. Army wheel vehicle mechanics. Mil Med 2007; 172(9):
866–70. 988–96.
49. Evans WJ: Exercise training guidelines for the elderly. Med Sci Sports 69. Almeida SA, Williams KM, Shaffer RA, Brodine SK: Epidemiological
Exerc 1999; 31(1): 12–7. patterns of musculoskeletal injuries and physical training. Med Sci Sports
50. Ewart CK: Psychological effects of resistive weight training: implica- Exerc 1999; 31(8): 1176–82.
tions for cardiac patients. Med Sci Sports Exerc 1989; 21(6): 683–8. 70. Shaffer RA, Brodine SK, Ito SI, Le AT: Epidemiology of illness and
51. Norris R, Carroll D, Cochrane R: The effects of aerobic and anaerobic injury among U.S. Navy and Marine Corps female training populations.
training on fitness, blood pressure, and psychological stress and well- Mil Med 1999; 164(1): 17–21.
being. J Psychosom Res 1990; 34(4): 367–75. 71. Billings CE: Epidemiology of injuries and illnesses during the United
52. Pronk NP, Martinson B, Kessler RC, Beck AL, Simon GE, Wang P: The States Air Force Academy 2002 Basic Cadet Training program: docu-
association between work performance and physical activity, cardiorespi- menting the need for prevention. Mil Med 2004; 169(8): 664–70.
ratory fitness, and obesity. J Occup Environ Med 2004; 46(1): 19–25. 72. Jones BH, Knapik JJ: Physical training and exercise-related injuries.
53. Mello RP, Murphy MM, Vogel JA: Relationship between a two mile run Surveillance, research and injury prevention in military populations.
for time and maximal oxygen uptake. J Appl Sport Sci Res 1988; 2(1): Sports Med 1999; 27(2): 111–25.
9–12. 73. Sanders JWPS, Frankart C, Frenck RW, et al: Impact of illness and non-
54. Knapik J: The Army Physical Fitness Test (APFT): a review of the litera- combat injury during Operations Iraqi Freedom and Enduring Freedom
ture. Mil Med 1989; 154(6): 326–9. (Afghanistan). Am J Trop Med Hyg 2005; 73(4): 713–9.
55. Department of the Army: Physical Fitness Training. Washington, DC, 74. Bell NS, Mangione TW, Hemenway D, Amoroso PJ, Jones BH: High
DoD, 1998. injury rates among female army trainees: a function of gender? Am J
56. Roozen M: Illinois Agility Test. NSCA’s Perform Train J 2004; 3(5): 5–6. Prev Med 2000; 18(3, Suppl): 141–6.
57. Miller MG, Herniman JJ, Ricard MD, Cheatham CC, Michael TJ: The 75. Jones BH, Bovee MW, Harris JM 3rd, Cowan DN: Intrinsic risk factors
effects of a 6-week plyometric training program on agility. J Sports Sci for exercise-related injuries among male and female army trainees. Am J
Med 2006; 5: 459–65. Sports Med 1993; 21(5): 705–10.
58. Wyss T, Hubner K, Mader U: Seated shot put as a measurement of explo- 76. Knapik JJ, Hauret KG, Arnold S, et al: Injury and fitness outcomes dur-
sive upper body power. In: International Congress on Soldiers’ Physical ing implementation of physical readiness training. Int J Sports Med 2003;
Performance. Edited by Häkkinen K, Kyolainen H; Jyvaskyla, Findland, 24(5): 372–81.
University of Jyvaskyla, 2005. 77. Secretary of the Air Force: Air Force Instruction 36-2905 Personnel
59. Sharp MA, Knapik JJ, Walker LA, et al: Physical fitness and body com- Fitness Program. Washington, DC, DoD, 2010.
position after a 9-month deployment to Afghanistan. Med Sci Sports 78. Department of the Navy: OPNAV Instruction 6110.1H: Office of the
Exerc 2008; 40(9): 1687–92. Chief of Naval Operations, Washington, DC; 2005.

20 MILITARY MEDICINE, Vol. 175, August Supplement 2010