Taking Care: Army Embraces a Personalized Approach to Training, Readiness
While future challenges to American interests are unpredictable, soldiers must maintain a ready and adaptive posture. The Holistic Health and Fitness System is the Army’s primary investment in soldier readiness and lethality, optimal physical and nonphysical performance, reduced injury rates, improved rehabilitation after injury and increased effectiveness of the Total Army. The system empowers and equips soldiers to take charge of their health, fitness and well-being in order to optimize individual performance while preventing injury and disease.
As of February 2019, approximately 56,000 soldiers were nondeployable (equivalent to 13 brigade combat teams), with about 21,000 having a temporary duty-limiting condition and an additional 15,500 with a permanent duty-limiting condition. In 2018, 56% of soldiers were injured annually. Of those injuries, 71% were lower-extremity musculoskeletal “overuse” injuries. A significant contributor to the Army’s health care burden, impacting medical readiness and soldier health, musculoskeletal injuries accounted for approximately $557 million in patient care costs among active-duty soldiers in 2018.
In addition, the “2018 Health of the Force” report categorized 17% of the active component as obese. These soldiers are 48% more likely to sustain an injury and have an 86% increased risk of being nonavailable.
The Army also is challenged by chronic sleep deprivation, fatigue and insomnia. A recent survey of drill sergeants by the Walter Reed Army Institute of Research found that more than 50% of drill sergeants sleep less than five hours per night. One in 20 active-duty soldiers requires prescription sleep aids and is consequently 16% less likely to be ready to deploy.
Focusing on Performance
Nested within the DoD Total Force Fitness program and the Army Campaign Plan, the Holistic Health and Fitness (H2F) System is an enterprisewide readiness “system” that combines aspects of physical and nonphysical human performance optimization under a single governance to enable commanders to improve soldier health and fitness. It is a capabilities-based, integrated system that spans the full spectrum of task- and environment-specific performance optimization, and injury prevention, treatment and rehabilitation strategies. The H2F System encompasses both the physical and nonphysical domains (mental readiness, sleep readiness, nutritional readiness and spiritual readiness) required for optimal performance.
In order to win on the battlefield, soldiers first must be able to deploy to the battlefield. The H2F System focuses on improving health- and fitness-related knowledge, attitudes and behaviors to increase medically available days and deployable rates currently degraded by obesity, musculoskeletal injuries, adverse sleep behaviors, suboptimal cognitive performance and other health-related problems.
By addressing and optimizing mental wellness and acuity, this system engenders the adaptability, mental agility and focus soldiers need to perform at their highest capacity, and not merely function. The H2F System encompasses education, coaching, mentoring, messaging and outreach to improve, restore and maintain readiness, resilience and performance of the Total Army. Immersing soldiers throughout their Army careers in a new Army readiness culture sustains and enables them to win our nation’s wars and return home healthy.
Leaders Set the Pace
Holistic Health and Fitness provides commanders with a comprehensive, immersive, integrated system that optimizes the physical and nonphysical performance of their soldiers and their units. Best practices, when applied to warfighter management and mission planning in tactical environments, bolster performance and enhance readiness.
However, for the H2F System to be successful, engaged leaders must set a personal example and foster an environment conducive to changing the culture of health and fitness in the Army. The Army’s numerous programs and initiatives (e.g., the Performance Triad, Army Resiliency Directorate programs, Soldier Fueling Initiative, Pregnancy and Postpartum Physical Training program) that seek to address these readiness issues will be enhanced by placing them under a single governance structure to enable commanders to improve soldier health and wellness. The H2F System represents a cultural and generational shift in the way commanders train, develop and care for our most important weapon system: our soldiers.
Holistic health is a multidimensional concept. Intrinsically, the H2F System centers on the whole soldier and how they interact with their environment. This process is best depicted with the Social-Ecological Model. This model, with its concepts and interplay of intrapersonal, interpersonal and environmental factors, has been widely used to understand the multifaceted and interactive effects of personal and environmental factors that determine behaviors.
The adapted Social-Ecological Model considers the following “spheres of influence” on the soldier: intrapersonal factors (individual soldier characteristics), interpersonal factors (social connections, relationships with family and friends) and environmental factors (institutional, community, policy and doctrine). In order to improve health outcomes, the Social-Ecological Model provides a representation of the numerous influential factors that greatly impact soldier health and fitness behavior throughout their lifespan.
For over 100 years, the Army has used an industrial-scale approach to physical training. Unit training was promoted without regard to individual soldiers’ needs. H2F doctrine changes that paradigm by directing the Army to train the whole soldier with an individualized program to ensure the readiness of the Army.
The H2F System supports this approach with expert performance personnel, far-forward medical care, performance training and testing equipment, and facilities. It uses the best exercise science, coaching and athletic training practices to assess each soldier and customize training to their specific needs. Each soldier, no matter their physical condition, trains to a tailored program.
The program will be “periodized,” with variation of exercise intensity and volume to improve soldier physical performance, mitigate injury and allow for proper recovery. Brigades will have the professionals, facilities and equipment consolidated at their level to execute this integrated process while receiving support from their garrison resources. A purposeful and integrative comprehensive training program, standardized across the enterprise, allows soldiers to move from one duty station to another without disrupting their readiness training progression.
H2F training facilities will be exclusively dedicated to holistic physical and nonphysical training and programming for soldiers. H2F doctrine will be nested with the U.S. Army Futures Command’s Multi-Domain Operations concept, as the centerpiece of warfighting is the soldier. Doctrine will define how to design, build, deliver and examine individual soldier and unit H2F physical and nonphysical programming and accomplishments. It will describe the basics of human anatomy and performance physiology that are the foundation for program design.
It also will include detailed guidance on performance nutrition and sleep strategies for all soldiers in garrison, living and working in community settings, and while deployed. Special programs will be included for water survival training, running skill development, free-weight training, and training for pregnant and postpartum soldiers. Multiple stakeholders align their programs, funding, personnel and support under the governance of the H2F System, and stop disparate individual efforts.
Holistic Health and Fitness Human Performance Team professionals, including physical therapists, registered dietitians, occupational therapists, cognitive enhancement specialists, athletic trainers and strength and conditioning specialists, in close coordination with the chain of command, will execute a team approach to preventing injuries before they happen and holistically enhance soldier readiness.
Mental readiness will be addressed through tailored education and training on strategies and mental skills (e.g., individual goal-setting, energy management, mental toughness, character development, emotion management, cultivation of the Warrior Ethos) that bolster soldier performance. Spiritual readiness will be addressed through the lens of personal, philosophical, psychological, and/or religious teachings or beliefs. These elements help define the essence of a person, enable one to build inner strength, behave ethically, persevere through challenges, and be resilient when faced with adversity.
H2F enables commanders to deliver the chief of staff of the Army’s No. 1 priority of taking care of people. The H2F System provides an opportunity to obtain a “return on readiness.” For example, a 10% reduction in musculoskeletal injury could add a full brigade combat team to the battlefield. A 1% reduction in the medically nonavailable rate adds a battalion-sized ready force and $30 million in cost avoidance in nonmission capable assets.
Programming and implementation of the H2F System will achieve an unparalleled return on readiness and is the Army’s primary investment in soldier readiness and lethality, optimal physical and nonphysical performance, reduced injury rates, improved rehabilitation after injury and increased overall effectiveness of the Total Army.