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Proposal for
Revised AFT requirements in the IGR
A Final Revised Position Paper for Consideration For SGAUS MEDICAL ACADEMY
AUG 23RD 2017
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PREAMBLE The INDIANA GUARD RESERVE (IGR) fitness test currently matches the US ARMY fitness standards for sit-ups, push-ups and a 2-mile run. (Soldiers are scored based on their performance in three events consisting of the push-up, sit-up, and a two-mile run, ranging from 0 to 100 points in each event. A minimum score of 60 in each event is required to pass the test. The soldier's overall score is the sum of the points from the three events. If a soldier passes all three events, the total may range from 180 to 300.) The IGR has two methods of assessing physical fitness. One uses the U.S. Army fitness standards. The other is the completion of a two-and-a-half mile walk in NUMBER OF MINUTES or less. The latter method takes into account, that the many of the IGR soldiers may not be able to or may not desire to maintain the more rigorous fitness life styles required of the active and reserve military forces. However, many of the IGR soldiers wish to maintain a lifestyle that supports a balance upper body, core, lower body and cardiovascular fitness. These soldiers elect to be tested according to the Army standards, with sit ups, push-ups and a timed two-mile run. Election of this fitness standard is exemplary and should be encouraged. However, the evaluation standards must be both safe and fair. Because nearly all regular and reserve army soldiers separate from the service after age 62, the Army fitness standards are calculated by professional exercise physiology and medical staff for age levels up to and including 62-years-old. The standards take into account the effects of advancing age on physiological performance, and base exercise repetition numbers and completion times on the soldiers' ages. The IGR allows soldiers to continue to serve until the age of 75. Unfortunately, because official Army fitness standards are not currently available beyond age 62, all soldiers above the age of 62 are required to perform at the fitness level required of 62-year-olds. The assumption that this is a safe or fair procedure is contrary to the established Army policy of accounting for incrementally decreasing performance levels for soldiers advancing in age from 18 to 62. This paper proffers that, to continue to encourage whole-body fitness of IGR members over the age of 62, without endangering their health with unreasonable performance demands, IGR should develop performance standards adjusted to include levels appropriate for this group. The standards should be developed by qualified professionals.
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The Army's over-40 cardiovascular screening program (CVSP) does the following:
▪ Identifies soldiers with a risk of coronary heart disease. ▪ Provides guidelines for safe, regular CR exercise. ▪ Gives advice and help in controlling heart-disease risk factors. ▪ Uses treadmill testing only for high-risk soldiers who need it.
Soldiers who reached age 40 before 1 January 1989 must be cleared through the cardiovascular screening program before taking a record APFT. Prior to their CVSP evaluation, however, they may still take part in physical training to include diagnostic APFTs unless profiled or contraindications to exercise exist. All soldiers must undergo periodic physical examinations in accordance with AR 40-501 and NGR 40-501. These include screening for cardiovascular risk factors. The IGR has no mechanism for such risk aversion procedures. The upper age limit for the sliding scale in the US Army is 62 years of age.
Since the IGR allows service beyond that age soldiers are nevertheless expected to meet the 62-year-old standard for the fitness requirements. This applies to sit ups push-ups and a 2-mile run.
CURRENT RISK It is the opinion of MEDCOM that holding soldiers for 13 years to the 62-year-old fitness test might be contra-indicated from a safety standpoint1 including cardiac risk and maximal heart rate demands. Below we will provide data from the cardiac literature including the longitudinal study from the classic Framingham Study (Brigham and Women’s Hospital, Harvard Medical School). These will show the aging heart parallels the maximal heart rate and cardiac output suggesting support for our fear of cardiac stress in those subjected to fitness tests applicable to soldiers ten years younger. The recommendation will therefore
1 In fact, I pulled out 4 IGR soldiers this AT due to BP and irregular heart rhythms, EKG and HR issues prior to the run, even though they had been considered “green” at the MEDCOM intake medical a day before.
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include a progressive lengthening of the run times along an exact regression along the army trajectory from 62 to 75 years of age. Over a third of IGR soldiers have cardiac issues including hypertension, and over half are overweight according to current BMI standards.2
These issues make the revision of the standards more imperative so that IGR soldiers will not be put at risk. It is the primary mission of MEDCOM to provide a safe environment for all IGR soldiers by ensuring health and wellness while on training exercises and especially during the fitness test which is the most challenging drill they will endure on a non-emergency basis. The recommendations below therefore take into account the current state of health of the IGR as well as act in preventing possible cardiac related events.
2 Col. Agley provided the BMI statistics for each brigade as well which can be provided on request.
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3 The latest recommendations from a US Government body for the older corps members includes the following:
1. Reduce run to 1.5 miles
3 I am grateful to LtCol Richard Friedman for providing me this study
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2. Scores for 1.5 mile run: Men
3. Scores for Push Ups: Men
4. Scores for Sit ups: Men
5. 1.5 mile run: Scores for Women
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6. Push Ups: Scores for Women
7. Sit ups: Scores for Women
Based on these 2016 recommendations we are proposing a reduction in running distance to 1.5 miles for all IGR soldiers over 55 years of age.
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Recommendation Based on the above government changes and medical evidence we are recommending a “sliding scale” to continue beyond the age of 62 until age 75 which reflects the capability of the aging heart WITHOUT RISK TO IGR SOLDIERS, and nevertheless in keeping with the tradition for physical fitness.
Current US Army 2-mile run sliding scale:
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5 https://www.marist.edu/studentlife/rotc/pdfs/apft.pdf
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Current Cardiac Recommended Rates
From American Heart Association guidelines to running appropriately6
6http://www.heart.org/HEARTORG/HealthyLiving/PhysicalActivity/FitnessBasics/Target-Heart-Rates_UCM_434341_Article.jsp#.WDBBY6IrIcg
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Cardiological Studies:7 All conclude the aging heart maximum rate declines in a steady state linear trajectory. We can therefore be safe in providing a progressive reduced target times by extending a regression curve for the 13 years after 62 for the IGR.
Maximal Heart Rate Regression Curve
7 http://content.onlinejacc.org/article.aspx?articleid=1126908
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Since the regression is so linear we felt it appropriate and safe to apply the same decrease with age to the fitness test. *From a recent study8 by Tanaka, Monahan and Seals. “Age-predicted maximal heart rate revisited”
Cardiac competence and age
In the classical NIH study age, related heart incompetence rises dramatically as is seen in the Brubaker and Kitzman paper.9
8 American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription. 6th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2000. 9 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3065291/
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(see references at end of the proposal)
RECOMMENDATIONS for REVISED AFT TIMES FOR IGR
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1.5-Mile Run: Recommendations: MEN
We are proposing a sliding scale linear increase in running times for the 13 years until IGR retirement age, using a simple linear regression/extrapolation curve from 62 years of age until mandatory retirement age of 75 (based on statistical analysis and regression analysis). For men: minimum target rates for 1.5-mile run to score the basic passing standard of 100:
Age Range
Middle of the range Target (s) Target mm:ss
62-64 63 1200 20:00 64-66 65 1239.1915 20:39 66-68 67 1250.9537 20:51 68-70 69 1262.7159 21:03 70-72 71 1274.4781 21:14 72-74 73 1286.2403 21:26 74-76 75 1298.0025 21:38
Below is the regression analysis we based these figures on:
Min
Middle of the range
Bottom of range
Top of range min sec sec total
17-21 19 17 21 15 54 954 #VALUE! 22-26 24 22 26 16 36 996 42
27-31 29 27 31 17 0 1020 24 32-36 34 32 36 17 42 1062 42 37-41 39 37 41 18 18 1098 36 42-46 44 42 46 18 42 1122 24 47-51 49 47 51 19 30 1170 48 52-56 54 52 56 19 48 1188 18 57-61 59 57 61 19 54 1194 6 62-64 63 62 64 20 0 1200 6 64-66 65 64 66
1239.1915 66-68 67 66 68
1250.9537 68-70 69 68 70
1262.7159 70-72 71 70 72
1274.4781 72-74 73 72 74
1286.2403 74-76 75 74 76
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y = 5.8811x + 856.92 R² = 0.9704
y = 5.8811x + 856.92R² = 0.9704
900
950
1000
1050
1100
1150
1200
1250
1300
1350
1400
0 10 20 30 40 50 60 70 80 90
Max
se
con
ds
allo
we
d t
o p
ass
test
Middle of age range
Men - Maximum time, in seconds, allowed for runners in different age ranges.
sec total
Linear (sec total)
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1.5-Mile Run: Recommendations : WOMEN For women: minimum target rates for 1.5-mile run to score the basic passing standard of 100:
Age Range Middle of the range Target (s) Ttarget mm:ss
62-64 63 1200 20:00 64-66 65 1579.73 26:20 66-68 67 1598.53 26:39 68-70 69 1617.33 26:57 70-72 71 1636.13 27:16 72-74 73 1654.93 27:35 74-76 75 1673.73 27:54
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And the regression analysis below we based the women’s scores on:
Middle of the range
Bottom of range
Top of range min sec sec total
17-21 19 17 21 18 54 1134
22-26 24 22 26 19 36 1176
27-31 29 27 31 20 30 1230
32-36 34 32 36 21 42 1302
37-41 39 37 41 22 42 1362
42-46 44 42 46 23 42 1422
47-51 49 47 51 24 0 1440
52-56 54 52 56 24 24 1464
57-61 59 57 61 24 48 1488
62-64 63 62 64
1560.93
64-66 65 64 66
1579.73
66-68 67 66 68
1598.53
68-70 69 68 70
1617.33
70-72 71 70 72
1636.13
72-74 73 72 74
1654.93
y = 9.4x + 968.73R² = 0.9747
900
1000
1100
1200
1300
1400
1500
1600
-10 10 30 50 70 90
Max
se
con
ds
allo
we
d t
o p
ass
test
Middle of age range
Women - Maximum time, in seconds, allowed for runners in different age ranges.
sec total
Linear (sec total)
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74-76 75 74 76
1673.73
y = 9.4x + 968.73 R² = 0.9663
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Revised Push Ups recommendation:MEN
Middle of the range
Bottom of range
Top of range min
17-21 19 17 21 35 22-26 24 22 26 31 27-31 29 27 31 30 32-36 34 32 36 26 37-41 39 37 41 24 42-46 44 42 46
47-51 49 47 51 52-56 54 52 56 57-61 59 57 61 62-64 63 62 64 64-66 65 64 66 66-68 67 66 68 68-70 69 68 70 70-72 71 70 72 72-74 73 72 74 74-76 75 74 76
y = -0.54x + 44.86
R² = 0.9746
Age Range
Middle of the range
Target - Line fit Target - Log fit
64-66 65 6 9 66-68 67 5 8 68-70 69 3 7 70-72 71 2 7 72-74 73 1 6 74-76 75 -1 5
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Revised Push Ups recommendation:WOMEN
Middle of the range
Bottom of range
Top of range min
17-21 19 17 21 13
22-26 24 22 26 11
27-31 29 27 31 10
32-36 34 32 36 9
37-41 39 37 41 6
42-46 44 42 46 6
47-51 49 47 51 52-56 54 52 56 57-61 59 57 61 62-64 63 62 64 64-66 65 64 66 66-68 67 66 68 68-70 69 68 70 70-72 71 70 72 72-74 73 72 74 74-76 75 74 76
y = -15ln(x) + 79.25R² = 0.9714
y = -0.54x + 44.86R² = 0.9746
0
5
10
15
20
25
30
35
40
0 20 40 60 80 100
Minimum Push Ups Men
min
Log. (min)
Linear (min)
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Age Range
Middle of the range
Target - Line fit Target - Log fit
47-51 49 4 5 52-56 54 3 4 57-61 59 1 3 62-64 63 0 3 64-66 65 -1 3 66-68 67 -1 2 68-70 69 -2 2 70-72 71 -2 2 72-74 73 -3 2 74-76 75 -4 1
y = -8.675ln(x) + 38.755R² = 0.95
y = -0.2914x + 18.347R² = 0.9568
-10
-5
0
5
10
15
0 20 40 60 80 100
Minimum Push Ups Women
min
Log. (min)
Linear (min)
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REVISED Sit Ups: Men and Women
Middle of the range
Bottom of range
Top of range min
17-21 19 17 21 47 22-26 24 22 26 43 27-31 29 27 31 36 32-36 34 32 36 34 37-41 39 37 41 29 42-46 44 42 46 22 47-51 49 47 51 21 52-56 54 52 56
57-61 59 57 61 62-64 63 62 64 64-66 65 64 66 66-68 67 66 68 68-70 69 68 70 70-72 71 70 72 72-74 73 72 74 74-76 75 74 76
Age Range
Middle of the range
Target - Line fit Target - Log fit
52-56 54 15 18 57-61 59 10 16 62-64 63 7 14 64-66 65 5 13 66-68 67 3 12 68-70 69 1 11 70-72 71 0 11 72-74 73 -2 10 74-76 75 -4 9
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This paper assumes that a linear extrapolation of the decrease in cardiac performance with age accurately reflects the decrease to age 75 and may, at least partially, underlie an expected depression of physical performance at the older age range. It is understood that factors such as the age-related decline in mitochondrial function, that affect all ATP-dependent systems, may well underlie this decreased cardiac affect with age. The present paper suggests that, while the linear extrapolation of the age-related decrease in cardiovascular performance may not be accurate, especially at the higher ages closer to 75, it strongly suggests that safer and more fair fitness goals should be established for soldiers older than the age of 62. The present premise seems wiser than assuming a stable, constant level of cardiovascular function beyond the age of 62 and fixing the required fitness level at that point.10
10 I acknowledge the work of LCol Richard Friedman for these caveats.
y = -28.8ln(x) + 133.33R² = 0.973
y = -0.9071x + 63.986R² = 0.9816
-30
-20
-10
0
10
20
30
40
50
60
0 20 40 60 80 100
Minimum Sit Ups Men and Women
min
Log. (min)
Linear (min)
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ALTERNATE AEROBIC EVENTS Alternate aerobic events assess the cardio respiratory and muscular endurance of Soldiers with permanent medical profiles, or long-term temporary profiles that cannot perform the 2-mile run. The alternate aerobic APFT events are the following:
• 800-Yard-Swim Test. • 6.2-Mile Bicycle Test. • 2.5-Mile Walk Test.
Revised Men’s Alternate 800 Yard Swim
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Revised Women’s Alternate 800 Yard Swim
Min
Middle of the range
Bottom of range
Top of range Min
17-21 19 17 21 21
22-26 24 22 26 21
27-31 29 27 31 22
32-36 34 32 36 22
37-41 39 37 41 23
42-46 44 42 46 23
47-51 49 47 51 24
52-56 54 52 56
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57-61 59 57 61 62-64 63 62 64 64-66 65 64 66 66-68 67 66 68 68-70 69 68 70 70-72 71 70 72 72-74 73 72 74 74-76 75 74 76
6x + 1146 R² = 1
Age Range Time target (s)
Time target mm Target time ss
52-56 1470 24 30 57-61 1500 25 0 62-64 1524 25 24 64-66 1536 25 36 66-68 1548 25 48 68-70 1560 26 0 70-72 1572 26 12 72-74 1584 26 24 74-76 1596 26 36
52-56 24:30 57-61 25:00 62-64 25:24 64-66 25:36 66-68 25:48 68-70 26:00 70-72 26:12 72-74 26:24 74-76 26:36
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Women’s 800 yard swim graph
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Alternate MEN’s 6.2 mile Bicycle Test
Min
Middle of the range
Bottom of range
Top of range min Sec sec total
17-21 19 17 21 24 0 1440 #VALUE
! 22-26 24 22 26 24 30 1470 30
27-31 29 27 31 25 0 1500 30 32-36 34 32 36 25 30 1530 30 37-41 39 37 41 26 0 1560 30 42-46 44 42 46 27 0 1620 60 47-51 49 47 51 28 0 1680 60
52-56 54 52 56
1740.0964 60.0964
57-61 59 57 61
1810.8349 70.7385
62-64 63 62 64
1872.5701 61.7352
64-66 65 64 66
1905.1525 32.5824
66-68 67 66 68
1938.8781 33.7256
68-70 69 68 70
1973.7469 34.8688
70-72 71 70 72
2009.7589 36.012
72-74 73 72 74
2046.9141 37.1552
74-76 75 74 76
2085.2125 38.2984
= 0.1429x2 - 2x + 1431.4
Age Range Time target (s)
Time target mm Target time ss
52-56 1740.0964 29 0.0964 57-61 1810.8349 30 10.8349 62-64 1872.5701 31 12.5701 64-66 1905.1525 31 45.1525 66-68 1938.8781 32 18.8781 68-70 1973.7469 32 53.7469 70-72 2009.7589 33 29.7589 72-74 2046.9141 34 6.9141 74-76 2085.2125 34 45.2125
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52-56 29:10 57-61 30:11 62-64 31:13 64-66 31:45 66-68 32:19 68-70 32:54 70-72 33:30 72-74 34:07 74-76 34:45
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Alternate Women’s 6.2 mile Bicycle Test
Min
Middle of the range
Bottom of range
Top of range Min sec sec total
17-21 19 17 21 25 0 1500 22-26 24 22 26 25 30 1530 27-31 29 27 31 26 0 1560 32-36 34 32 36 26 30 1590 37-41 39 37 41 27 0 1620 42-46 44 42 46 28 0 1680 47-51 49 47 51 30 0 1800 52-56 54 52 56
1877.0352 57-61 59 57 61
1986.3107 62-64 63 62 64
2084.0163 64-66 65 64 66
2136.2975 66-68 67 66 68
2190.8643 68-70 69 68 70
2247.7167 70-72 71 70 72
2306.8547 72-74 73 72 74
2368.2783 74-76 75 74 76
2431.9875
0.2857x2 - 10.429x + 1607.1
Age Range Time target (s)
Time target mm Target time ss
52-56 1877.0352 31 17.0352 57-61 1986.3107 33 6.3107 62-64 2084.0163 34 44.0163 64-66 2136.2975 35 36.2975 66-68 2190.8643 36 30.8643 68-70 2247.7167 37 27.7167 70-72 2306.8547 38 26.8547 72-74 2368.2783 39 28.2783 74-76 2431.9875 40 31.9875
52-56 31:17 57-61 33:06 62-64 34:44 64-66 35:36 66-68 36:31 68-70 37:28 70-72 38:27 72-74 39:28
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74-76 40:32
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Alternate Men’s 2.5 mile Walk Test
Min
Middle of the range
Bottom of range
Top of range min Sec
sec total
17-21 19 17 21 34 0 2040 #VALUE! 22-26 24 22 26 34 30 2070 30
27-31 29 27 31 35 0 2100 30 32-36 34 32 36 35 30 2130 30 37-41 39 37 41 36 0 2160 30 42-46 44 42 46 36 30 2190 30 47-51 49 47 51 37 0 2220 30 52-56 54 52 56
2250 30 57-61 59 57 61
2280 30 62-64 63 62 64
2304 24 64-66 65 64 66
2316 12 66-68 67 66 68
2328 12 68-70 69 68 70
2340 12 70-72 71 70 72
2352 12 72-74 73 72 74
2364 12 74-76 75 74 76
2376 12
y = 6x + 1926
Age Range Time target (s)
Time target mm Target time ss
52-56 2250 37 30 57-61 2280 38 0 62-64 2304 38 24 64-66 2316 38 36 66-68 2328 38 48 68-70 2340 39 0 70-72 2352 39 12 72-74 2364 39 24 74-76 2376 39 36
52-56 37:30 57-61 38:00 62-64 38:24 64-66 38:36 66-68 38:48 68-70 39:00 70-72 39:12 72-74 39:24 74-76 39:36
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Alternate Women’s 2.5 Mile Walk Test
Min
Middle of the range
Bottom of range
Top of range min sec
sec total
17-21 19 17 21 37 0 2220 22-26 24 22 26 37 30 2250 27-31 29 27 31 38 0 2280 32-36 34 32 36 38 30 2310 37-41 39 37 41 39 0 2340 42-46 44 42 46 39 30 2370 47-51 49 47 51 40 0 2400 52-56 54 52 56
2430 57-61 59 57 61
2460 62-64 63 62 64
2484 64-66 65 64 66
2496 66-68 67 66 68
2508 68-70 69 68 70
2520 70-72 71 70 72
2532 72-74 73 72 74
2544 74-76 75 74 76
2556
y = 6x + 2106
Age Range Time target (s)
Time target mm Target time ss
52-56 2430 40 30 57-61 2460 41 0 62-64 2484 41 24 64-66 2496 41 36 66-68 2508 41 48 68-70 2520 42 0 70-72 2532 42 12 72-74 2544 42 24 74-76 2556 42 36
52-56 31:17 57-61 33:06 62-64 34:44 64-66 35:36 66-68 36:31 68-70 37:28 70-72 38:27 72-74 39:28 74-76 40:32
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For further questions, comments or suggestions please contact:
MAJ Julian Ungar-Sargon MD PhD Medical Director MEDCOM [email protected] On behalf of BG Philip Eskew and Col. Mark Griffith I acknowledge the contribution of: LtC Richard Friedman PhD And LtC Daniel Agley PhD
References
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