Physical Conditioning for Initial Military Training - NSCA · Physical Conditioning for Initial Military Training CPT Paul C. Henning, Ph.D., CSCS Research Physiologist, Military

Physical Conditioning for Initial Military Training

CPT Paul C. Henning, Ph.D., CSCS

Research Physiologist, Military Performance DivisionU.S. Army Research Institute of Environmental

Medicine Natick, MA

Overview• Basic military training

• Problems associated with basic military training

• Risk factors for training-related injuries

• Civilian and military fitness trends

• Physical fitness screening

• Practical guidelines for recruits

Initial Military Training• Initial Military Training (IMT) also known as

basic combat training, basic training, boot camp– Army: 10 weeks– Navy: 8 weeks– Air Force: 8 ½ weeks– Marines: 13 weeks

Initial Military Training

• Fundamentals of soldiering-spanning warrior tasks, physical training, combative tactics, and military customs and courtesies.

• Daily schedules are highly structured and are physically stressful

Component of BCT Physical Aspects

Phase I•Daily physical readiness training (PRT) (running, calisthenics) •Marching drills•Combat skills•Bayonet training•Personnel carrying methods

Phase II •Daily physical readiness training [PRT) (running, calisthenics)•Tactical foot march•Engagement skills•Situational training exercises (STX)

Phase III •Daily physical readiness training (PRT) (running, calisthenics)•10km and 15km foot marches•Field training exercises (FTX)

Army Physical Fitness Test

(APFT)

•2 minutes of sit-ups•2 minutes of push-ups•2 mile timed run

Physical aspects of U.S. Army basic combat training by phase (Henning 2011, SCJ)

Problems associated with IMT• IMT related musculoskeletal injuries significantly

impact Department of the Army.

– Evident in other countries (Israel, Finland, Australia)

- ~25% male and 50% female recruits sustain one or more injuries during basic combat training (BCT) (Technical Bulletin Medical 592, U.S. Army)

Problems associated with IMT• Cost during FY 2005 estimated at $57,500 per

discharged recruit. (Niebuhr, 2008)

• National Research Council Committee on the Youth Population and Military Recruitment highlighted entry-level training-related injuries as “the single most significant medical impediment to military readiness.”

• Overuse injuries account for 70 to 80% of IMT-related musculoskeletal injuries and thus more than half of all disability discharges among first-year recruits (Niebuhr, 2006)

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Physical Fitness and Training-Related Injury Risk

• Researchers identified multiple risk factors for training-related injury with physical fitness being a prominent risk factor.

Molloy et al 2012


• Each fitness component impacts risk to a varying degree

• Low aerobic fitness most strongly and consistently associated with increased injury risk (Jones & Knapik, 1991; Rauh et al 2006)

• Low aerobic fitness and low muscular endurance are risk factors for injuries in other countries, including Australia, Norway, England, and Israel (Pope et al 1999; Heir 1997; Rayson 2003)


• Strength asymmetries (left to right side differences) associated with increased risk (Kiesel et al 2007)

• Low BMI – lesser muscle or bone mass, underweight recruits may lack strength required for strenuous tasks (e.g. load carriage) (Blacker et al 2008)

Civilian and Military Fitness Trends

• Today’s youth appear less prepared for entry-level training than their predecessors given close relationship between timed running performance and IMT aerobic fitness requirements (Molloy et al 2012)

• Report shows low aerobic fitness levels among 1/3 of American youths aged 12-19 (Pate et al 2006)


• Physical fitness of young men in Norwegian, Finnish, and Swill Armies decreased over last 20 years (Dyrstad et al. 2005; Santtila, et al. 2006; Wyss, et al. 2009)

• Steadily increasing failure rates on Army’s 1-1-1 physical assessment test suggest decline in recruit fitness (2003-2009)




• CDC reported an increase in obesity (defined as BMI > 30) among Americans across past 2 decades .

• Excessive weight/body fat remains primary reason for recruit medical disqualifications (Accession Medical Standards Analysis & Research Activity, 2010)

Physical Fitness Screening

• Only Marines and Navy screen recruits pre-enlistment fitness levels.

• Marine recruits must pass standardized Initial Strength Test (IST) before proceeding to basic training

PCH1

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PCH1 see if can get data on attrition/injuries in Marine basicPaul Clifford Henning, 1/11/2013



• Recruits must again pass IST upon arrival at basic training.

• IST failures assigned to Physical Conditioning Platoon (PCP) to improve fitness before beginning basic training.

Physical Fitness Screening• 1999 – Army’s TRADOC administered 1-1-1 test

to all recruits before beginning IMT. • Recruits that failed assigned to Fitness Training

Unit (FTU).• Recruits remained within FTU until passing the

1-1-1 test and progressing to BCT.• FTU reduced injury risk and attrition, this

enabling Army to retain ~516 recruits and save over $14 million annually in early 2000s (Knapik et al 2004, Knapik et al 2006)

Physical Fitness Screening• Army eventually discontinued 1-1-1- testing and

automatic assignment to FTU.• Currently, FTU assignment limited to recruits

who repeatedly fail the APFT despite completing all other BCT requirements

• As of July 2011, ~93% of recruits in FTU at Fort Jackson achieved BCT standards for APFT (50 points per event) after performing Physical Readiness Training (PRT) for 2-4 weeks (M. Reed, personal communication, 2011

Physical Fitness Screening• Army conducted an Assessment of Recruit

Motivation and Strength (ARMS) (2005-2009).– Consisted of modified Harvard step test and 1-minute

push-up test

• Attrition rates significantly higher among ARMS failures (Niebuhr et al 2008).

• Recruits who passes ARMS test received body composition enlistment waivers.– Increased risk of injury but not attrition (Cowan

et al 2011)

Physical Fitness Screening• RAND reported ARMS program accessed an

additional 3690 recruits in FY 2007 at an estimated per-recruit cost of $163 (Loughran and Orvis)

• Army discontinued ARMS testing in September 2009 due to improved recruiting environment.

Physical Fitness assessment Australian Defence Force

Summary of studies on basic training

• Inadequate preparatory physical conditioning results in poor fitness test performance and increased risk of musculoskeletal injuries, thus contributing to attrition rates in basic training

Practical guidelines for recruits

• Medical attrition rates of 4 cohorts of recruits undergoing basic military training (BMT)

• Group A (n=3475)-mixture of fit and unfit recruits– Trained under standard combat BMT program

• Group B (n=2081)-only fit recruits– Passed pre-BMT fitness minimum criteria

• Group C (n=940)-unfit recruits – Underwent pre-training conditioning program from 4-6

weeks prior to a similar 3-month BMT

• Group D (n=2613)-unfit recruits– Underwent extended 4-month BMT which allowed

more gradual pace

• A formal pre-training conditioning program resulted in lower attrition during BMT and this reduction was more effective than training the recruits at a slower pace by extending the BMT by one month

• Three groups of recruits at Fort Jackson, SC– PC : failed entry level PT test and entered

FTU. Trained until pass test and entered BCT.– NPC: failed entry level PT test; allowed to

enter BCT without preconditioning in FTU– NNPC: passed the entry level PT test and

went directly to BCT

• The proportions of NPC, PC, and NNPC recruits who completed the 9-week BCT cycle were 59%, 83%, and 87% for men (p < 0.01) and 52%, 69%, and 78% for women (p < 0.01) respectively.

• Compared with NNPC men, injury risk was 1.5 and 1.7 times higher for PC and NPC men, respectively.

• Compared with NNPC women, injury risk was 1.2 and 1.5 times higher for PC and NPC women, respectively.

• Conclusion:– Low-fit recruits who are preconditioned have

reduced BCT attrition and tend to have lower injury risks compared with low-fit recruits who do not precondition.

Program design for potential recruits

• Physical fitness – ability to perform sustained physical work characterized by an effective integration of cardiorespiratory endurance, strength, flexibility, coordination, and body composition (Miller et al. 1991)

Program design for potential recruits

• ACSM – well-rounded training program should include aerobic and strength training for the major muscle groups. – Frequency of 3-5 and 2-3 training sessions

per week recommended for improving aerobic fitness and muscular strength, respectively.

– When recommendations met, improvements in task performance in military settings have been observed in as little as 4-8 weeks (Frykman et al. 2006; Harman et al. 2006; Sharp et al 2006)

Effects of Concurrent Resistance and Aerobic Training on Load-Bearing Performance and the Army Physical Fitness Test

(Kraemer et al. 2004)

• Purpose - Examine how concurrent RT and ET would impact a loaded 2-mile run in male Army personnel.

• Subjects – 35 active duty men (ages 18-29) • 4 training groups: 1) RT + ET, 2) UB + ET, 3) RT only, 4)

ET only• Training – 12 weeks, 4 sessions/week (Mon, Tues, Thurs, Fri)

• Resistance training program • varied workouts within each week (i.e,. nonlinear

periodization) designed to enhance muscle hypertrophy and strength.

• Endurance training program• Long distance runs (Mondays and Thursdays)• Sprint intervals (Tuesdays and Fridays)

• Load Carriage Tasks• A maximal effort 2-mile loaded run (44.7 kg = 98lbs) • Performance measure – Time to complete

Hypertrophy Training Regimen (Mon & Thurs)

Body Area Sets RM Rest(mins)

Bench press + flys

3 10 1

Shoulder press + upright row

2 10 1

Lat pulldown + seated row

3 10 1

Bicep curls 3 10 1

Leg ext + Leg curl

3 10 1

Split squats 3 10 1

Calf raises 3 15 1

Sit-ups 2 25 1

Strength Training Regimen (Tues & Fri)

Body Area Sets RM Rest(mins)

Bench Press

5 5 2-3

Shoulder Press

5 5 2-3

Bicep curls

5 5 2-3

Lat pulldown

5 5 2-3

Dead lift 4 6 2-3

Leg press 5 5 2-3

Leg extension

5 5 2-3

Calf raises 3 10 2-3

Obliques 5 10

Sit-ups 5 10

Combined resistance and endurance training improves physical capacity and performance on tactical occupational tasks

(Hendrickson et al. 2010)

• Purpose – evaluate the effectiveness of endurance, strength, and the additive effect of strength and endurance training for improving the performance of common tactical occupational tasks among recreationally active women

• Subjects – 56 recreationally active women, 18–26 years old• Groups

• Combined (n=15)• Resistance (n=18)• Endurance (n=13)• Control (n=10)

• Training – 12 weeks, 3 sessions/week (Mon, Wed, Fri)• Load Carriage Tasks

• A maximal effort 2-mile loaded run (32.7 kg = 72lbs) • Performance measure – Time to complete

Program variables for the endurance exercise training program (Hendrickson et al. 2010)

Week Monday (easy SS, longer)

Wed (interval and TT)

Fri (SS, threshold)

1 Pre-testing & familiarization

2 Pre-testing & familiarization (3.2 km TT)

3 20-30 min SS or jog/walk (100 m jog/100 m walk)

20-30 min SS 20-30 min SS

4 30 min total SS ,75% HR max

30 min total (1.6 km alternating straights fast, jog/walk corners)

30 min SS, 80-85% HR max

5 30 min total SS, 75% HR max

1 x 800m, 1 x 400m, 2 x 200m)



3 x 800 m) 30 min SS, 80-85% HRmax

7 Mid testing


(8 x 400 m ) 30 min SS, 80-85% HR max


(1 x 1.6 km, 1 x 800m, 2 x 400m)



2 x 1.6km (5 min rest in between)

30 min SS, 80-85% HRmax


4.8km SS 3.2km TT

12 Post-testing

Program variables within periodized resistance training program (Hendrickson et al. 2010)

Acute program variables

Light Moderate Heavy

Weeks 1-2 Pre-testing & familiarization

Weeks 3-6Sets 3 3 3

Reps 12 8-10 6-7

Rest (s) 90 120 120

Total time (min) 40 48 47

Week 7 Mid-testing

Weeks 8-11Sets 3 3 3

Reps 12 6-8 3-5

Rest (s) 90 150 180

Total time (min) 40 57 63

Week 12 Post-testing

Resistance Exercises (Hendrickson et al. 2010)

Monday Wednesday Friday

Exercises Squat

Stiff-leg deadlift

Bench press

Lat pull down

Upright row

Calf exercises

Abdominal work

Leg press

Stiff-leg deadlift

Incline bench press

Seated row

Shoulder press

Calf exercises

Abdominal work

Squat

Stiff-leg deadlift

Bench

Lat pull down

Upright row

Calf exercises

Abdominal work

Preparatory 12-week strength training (ST) and endurance training (ET) guidelines for Basic Combat Training (Henning, 2011)

Mesocycle Week ST Prescription ET Prescription

- 1Familiarization period; Establish initial training loads

1 2-5

Frequency2x/weekSets/Reps/RestDay 1: 3x12RM, 90sDay 2: 3x8-10RM, 120s

Frequency2x/weekMode/Intensity/DurationDay 1: LSD, 70-75% APMHR, 20-30 minDay 2: Intervals (4 x 100m, 2 x 200m)

-6

Active recovery; Adjust loading as needed for next mesocycle



2 7-10

Frequency3x/weekSets/Reps/RestDay 1: 3x12RM, 90sDay 2: 3x8-10RM, 120sDay 3: 3x6-7RM, 150-180s

Frequency3x/weekMode/Intensity/DurationDay 1: Intervals (4 x 400 m)*Day 2: LSD, 75-80% APMHR, 20-30 minDay 3: Intervals (4 x 200m, 4 x 400m, 2 x 800m)

-11

Active recovery; Adjust loading as needed for next mesocycle

*Perform 5-kilometer unloaded marching twice per mesocycle instead of prescribed activity.



3 12-15

Frequency3x/weekSets/Reps/RestDay 1: 3x12RM, 90sDay 2: 3x6-8RM, 150sDay 3: 3x4-5RM, 180s

Frequency3x/weekMode/Intensity/DurationDay 1: Intervals (6 x 400m)^Day 2: LSD, 80-85% APMHR, 20-30 minDay 3: Intervals (6 x 200m, 6 x 400m, 4 x 800m)

- 16 Rest and recovery prior to Basic Combat Training

^Perform 5-kilometer marching with standard load (15.87kg) twice per mesocycle instead of prescribed activity.

Sample strength and endurance exercises for mesocycle 2 of pre-Basic Combat Training conditioning program (Henning, 2011)

Strength Exercises Endurance ExercisesDay 1High PullSquatBench PressLat Pull DownShoulder PressIncline Sit-ups (20-30 reps)Leg raises (20-30 reps)

Day 1Interval training

Can be performed on track at various distances:

•Sprint straights, walk corners•4 x 400m (assignments depending on training status of individual)•Performed at maximal to near-maximal intensity•1:2 work to rest ratio, decrease rest as tolerated

Twice during mesocycle, perform 5-kilometer unloaded marching instead


Strength Exercises Endurance ExercisesDay 2Push PressLeg PressStraight Leg DeadliftIncline Dumbbell PressBarbell RowUpright RowSit-ups (with holding the feet down) (20-30 reps)Leg raises (20-30 reps)

Day 2Long-Slow Distance (LSD)

Intensity: 75-80% APMHR,

Duration: 20-30 min


Strength Exercises Endurance ExercisesDay 3High PullSquatStraight Leg DeadliftFlat Dumbbell PressBarbell RowShoulder PressIncline Sit-ups (20-30 reps)Leg raises (20-30 reps)

Day 3Interval training

Can be performed on track at various distances:

•Sprint straights, walk corners•4 x 200m, 4 x 400m, 2 x 800m (assignments depending on training status of individual)•Performed at maximal to near-maximal intensity•1:2 work to rest ratio, decrease rest as tolerated

Recommended Interventions (Molloy et al 2012

• Basic training is an “expensive screening function” • NRC recommends pre-accession testing for all services • Resume 1-1-1 testing at recruiting stations for all recruits

and ARMS testing at MEPS for recruits exceeding body composition accession standards.

• Meeting minimum pre-enlistment fitness standards could screen out individuals who fail to respond or lack motivation to adhere to an exercise program.

• Screening could positively influence injury and attrition rates

• A pre-IMT fitness program and standardized fitness guide address this need (Rieger & Scott, 2006)

Conclusion and summary• Training-related injuries negatively impact the military

services• Low (particularly aerobic) fitness levels among recruits

associated with increased risk for injury and attrition.• Recommend that pre-enlistment fitness screening be

conducted whenever possible – would likely decrease attrition and injuries.

• Preparatory physical conditioning program conducted by recruits has been research-proven to attenuate attrition and injuries during IMT.

Disclaimer

• The views, opinions, and/or findings contained in this presentation are those of the author and should not be construed as an official Department of the Army position, policy, or decision unless so designated by other documentation.

• CPT Paul C. Henning• U.S. Army Research Institute of Environmental Medicine• Kansas Street, Bldg 42• Natick, MA 01760• [email protected]

Suggested Readings

• Technical Bulletin Medical 592. U.S. Department of the Army, Prevention and control of musculoskeletal injuries associated with physical training. Washington, DC, 2011. Available at http://armypubs.army.mil/med/dr_pubs/dr_a/pdf/tbmed592.pdf; accessed January 12, 2012.

• Niebuhr DW, Scott CT, Powers TE, et al: Assessment of recruit motivation and strength study: preaccession physical fitness assessment predicts early attrition. Mil Med 2008; 173(6): 555– 62

• National Research Council. Physical fitness and musculoskeletal injury. In: Assessing Fitness for Military Enlistment: Physical, Medical, and Mental Health Standards, pp 66 –108. Edited by Sackett PR, Mavor AS. Washington, DC, National Academies Press, 2006.

Suggested Readings

• Almeida SA, Williams KM, Shaffer RA, Brodine SK: Epidemiological patterns of musculoskeletal injuries and physical training. Med Sci Sports Exerc 1999; 31(8): 1176–82.

• Jones BH, Shaffer RA, Snedecor MR: Chapter 6. Injuries treated in outpatient clinics: surveys and research data. Mil Med 1999; 164(8 Suppl): 1–89.

• Kiesel K, Plisky PJ, Voight ML: Can serious injury in professional football be predicted by a preseason functional movement screen? N Am J Sports Phys Ther 2007; 2(3): 147–58.

• Jones BH, Darakjy S, Knapik JJ: Aerobic fitness, body mass index and risk of injury during Army Basic Combat Training. Med Sci Exer 2004; 36(5): S308.

• Blacker SD, Wilkinson DM, Bilzon JL, Rayson MP: Risk factors for training injuries among British Army recruits. Mil Med 2008; 173(3): 278–86.

Suggested Readings

• Pate RR, Wang CY, Dowda M, Farrell SW, O’Neill JR: Cardiorespiratory fitness levels among US youth 12 to 19 years of age: findings from the 1999–2002 national health and nutrition examination survey. Arch Pediatr Adolesc Med. 2006; 160(10): 1005–12.

• Knapik JJ, Darakjy S, Hauret KG, et al: Increasing the physical fitness of low-fit recruits before basic combat training: an evaluation of fitness, injuries, and training outcomes. Mil Med 2006; 171(1): 45–54.

• National Research Council. Physical fitness and musculoskeletal injury. In: Assessing Fitness for Military Enlistment: Physical, Medical, and Mental Health Standards, pp 66 –108. Edited by Sackett PR, Mavor AS. Washington, DC, National Academies Press, 2006

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Physical Conditioning for Initial Military Training - NSCA · Physical Conditioning for Initial Military Training CPT Paul C. Henning, Ph.D., CSCS Research Physiologist, Military