Bridging Total Force Fitness and Whole Health in Cardiovascular Disease Prevention.

INTRODUCTION: The Cardiovascular Disease (CVD) Prevention project is a VA-DoD initiative, supported by the Joint Incentive Fund. The goal of the project is to create an innovative, 3D virtual space within the VA-Virtual Medical Center (VA-VMC) platform that provides Veterans and Active Duty Service Members with educational resources on the prevention of CVD. MATERIALS AND METHODS: The Performance Health and Wellness Center is a new center within the VA-VMC. The space enables users to explore information and actionable resources on various risk factors related to CVD through independent and provider-led instruction, using a personalized 3D avatar. RESULTS: Partners of DoD and VA envision users engaging with the learning resources securely and with a sense of anonymity, which can foster self-directed learning and healthy behavior change. The DoD is particularly invested in promoting CVD prevention through the early adoption of positive health behaviors and the Total Force Fitness framework. The VA team is also committed to supporting users by providing professionally led classes and support groups on various CVD risk factors like tobacco, diabetes, nutrition, and exercise. CONCLUSIONS: This project is a unique and important collaboration during a time when telehealth and telemedicine services are in greater demand. The VA-VMC advances accessible, relevant, and evidence-based educational services for DoD and VA populations, and the Performance Health and Wellness Center, itself, presents Total Force Fitness concepts and a whole-person care approach while encouraging users to be actively involved in shared decision-making with their health care providers.

BMI and Physical Activity, Military-Aged U.S. Population 2015-2020.

INTRODUCTION: Obesity and physical inactivity are considered possible U.S. national security threats because of their impact on military recruitment. The objectives of this study were to estimate the prevalence of (1) BMI eligibility for military entrance, (2) adequate physical activity participation among the BMI-eligible population, and (3) combined BMI eligibility and adequate physical activity. METHODS: This cross-sectional study of nonpregnant, military-aged civilians (aged 17-42 years) used objectively measured weight and height data and self-reported aerobic physical activity data from the 2015-2020 National Health and Nutrition Examination Survey. BMI eligibility was defined as 19.0-27.5 kg/m2, per Department of Defense regulation. Adequate physical activity for entering initial military training was defined as ≥300 minutes/week of equivalent moderate-intensity aerobic physical activity from all domains, approximating U.S. Army guidance. Participants meeting both definitions were further classified as eligible and active. Analyses were conducted in 2021-2022. RESULTS: Of military-aged participants (unweighted n=5,964), 47.3% were eligible by BMI. Among BMI-eligible participants, 72.5% reported adequate physical activity. Taken together, 34.3% were both eligible and active. The prevalence of eligible and active status was higher among males, persons who were younger and non-Hispanic White, college graduates, and those with higher family income than among their counterparts. CONCLUSIONS: Among the military-aged U.S. population, slightly under half were eligible to enter the military on the basis of their BMI, and only 1 in 3 met BMI eligibility and were adequately physically active. Equitable promotion of healthy weight achievement and physical activity participation may improve military preparedness.

Rates of Lapidus Procedures in the US Military Before and After the Advent of and Advocacy for Tri-Plane Lapidus Corrective Surgery.

Tri-plane corrective Lapidus surgery has been described as advantageous with respect to its anatomic basis and outcomes. Because the procedure has been broadly publicized, changes in overall Lapidus procedure rates due to increased numbers of patients opting for the tri-plane approach could have occurred. Data supporting this possibility appears lacking. We employed official personnel and health records of the total active-duty US military to conduct a retrospective cohort study of Lapidus surgery rates before and after the advent of the tri-plane corrective Lapidus procedure. Least-squares and locally-weighted scatterplot smoother regression functions were used to confirm time trends. Sociodemographic and occupational traits of Lapidus patients were compared using 2-sided t tests and chi square tests. Lapidus surgery rates among hallux valgus patients decreased during 2014 to 2016 and increased during 2017 to 2021. While multiple factors might explain these trends, they coincide with the advent of and advocacy for tri-plane Lapidus surgery. The results support the possibility that its rise influenced overall Lapidus rates in this population. As these findings represent limited evidence of such an influence, further research is required to confirm a causal link. If such a link is found, and if the ongoing research suggests that superior outcomes are associated with tri-plane Lapidus surgery, substantial implications could exist for this population. Benefits might include enhanced medical readiness due to the importance of lower extremity function during military duties. Additional research is needed to confirm the impact of the procedure and to determine whether Lapidus surgery rate patterns in civilian populations mirror these findings.

Self-Reported Health Indicators in the US Army: Longitudinal Analysis From a Population Surveillance System, 2014‒2018.

Objectives. To describe health-related behaviors or indicators associated with overall health and well-being using the Global Assessment Tool (GAT), a health behavior and psychosocial questionnaire completed annually by US Army personnel. Methods. We analyzed GAT responses from 2014 to 2018, consisting of 367 000 to 449 000 respondents per year. We used generalized estimating equations to predict the presence of each health behavior or indicator, aggregated by year and stratified on various demographics. Results. Key findings included decreases from 2014 to 2018 in risky health behaviors such as hazardous drinking (7.5% decrease) and tobacco use (7.9% decrease), dietary supplement use (5.0% to 10.6% decrease, depending on type), self-reported musculoskeletal injury (5.1% decrease), and pain interference (3.6% decrease). Physical activity, sleep, and nutritional habits largely remained consistent over time. Conclusions. In the Army, tobacco, alcohol, and risky dietary supplement usage appears to be declining, whereas lifestyle health behaviors have been stable. Whether these trends reflect responses to health education is unknown. The GAT provides useful insights into the health of the Army, which can be leveraged when developing health-related educational programs and policies. Public Health Implications. Health behaviors that have changed less over time (e.g., nutrition, sleep) may require novel approaches compared with those that changed more (e.g., dietary supplement use, drinking). (Am J Public Health. 2021;111(11):2064-2074. https://doi.org/10.2105/AJPH.2021.306456).

A Threat to Military Combat Power: Dietary Supplements.

BACKGROUND: The use of dietary supplements by young warfighters is pervasive and comes with a readiness cost, especially in the deployed setting. Predatory targeting and marketing by various unscrupulous companies put this population at risk for a higher than baseline risk for adverse events. METHODS: We report on 6 serious adverse events experienced by warfighters while deployed in Kuwait and Afghanistan. Presented is a discussion of current practice gaps and solutions, as well as details regarding how polypharmacy contributes to the seriousness of the threat posed by problematic supplements. RESULTS: The morbidity associated with the 6 cases of dietary supplement adverse events compromised mission readiness and was costly in terms of health and health care expenditures. CONCLUSION: The military dietary supplement issue needs exposure, review, and action at the highest levels of government.

Summit on Exercise Collapse Associated with Sickle Cell Trait: Finding the "Way Ahead".

ABSTRACT: Although largely benign, sickle cell trait (SCT) has been associated with exertion-related events, to include sudden death. In 2011, a summit on SCT introduced the term exercise collapse associated with SCT (ECAST). A series of ECAST deaths in military personnel in 2019 prompted reevaluation of current efforts and led to a second summit in October 2019 hosted by the Consortium for Health and Military Performance of the Uniformed Services University in Bethesda, MD. The goals were to (1) review current service policies on SCT screening, (2) develop draft procedural instructions for executing current policy on SCT within the Department of Defense, (3) develop draft clinical practice guidelines for management of ECAST, (4) establish a framework for education on SCT and ECAST, and (5) prepare a research agenda to address identified gaps.

Caffeine and heat have additive but not interactive effects on physiologic strain: A factorial experiment.

This study tested the interactive effects of heat and caffeine on exercise-induced physiological strain by using a 2x2 within-subjects factorial design. Thirty-five physically fit Caucasians underwent a bout of exercise under four conditions wherein ambient conditions (heat vs no heat) and caffeine (placebo vs caffeine; double-blinded) were manipulated. Exercise consisted of a 60-min walk and 5-min step/squat test while wearing weighted backpack. Primary outcomes include measures of physiologic strain (Core temperature [Tr] and heart rate [HR]). Secondary measures included blood pressure, markers of sweat loss, and creatine kinase (CK). Repeated measures models were created to evaluate the individual and combined effects of heat and caffeine. Key results indicated that heat and caffeine significantly increased Tr and HR after walking and stair-stepping. No significant heat by caffeine interactions were detected, and caffeine's main effects were relatively low (≤0.17 °C for Tr and ≤6.6 bpm for HR). Of note, heat and caffeine exhibited opposite effects on blood pressure: caffeine increased both systolic and diastolic blood pressure (by 6-7 mmHg) and heat decreased them (by 4-6 mm Hg; ps < 0.05). In summary, heat and caffeine affected physiologic strain during exercise but exhibited no synergistic effects. In contrast, neither factor affected muscle damage. Clinical implications for heat illness risk in the military are discussed.

Health Behaviors and Psychosocial Attributes of US Soldiers.

BACKGROUND: Health trends, which promote performance enhancement and maintaining or increasing muscle strength, may appeal to soldiers looking to maintain health standards set by the US Army, but often these trends require further investigation to assess safety and efficacy. High-intensity interval training (HIIT) and use of weight loss and/or performance-enhancing/body-building dietary supplements (WL/PES DS) are two such trends that, if implemented inappropriately, can negatively impact soldier health and readiness. OBJECTIVE: Our aim was to establish health/psychosocial profiles of US Army soldiers who participate in HIIT and/or use WL/PES DS. DESIGN: This cross-sectional observational study used data from the 2016 US Army Global Assessment Tool. PARTICIPANTS: Data were analyzed from respondents to the 2016 US Army Global Assessment Tool (n=299,996) who consented to have their data used for research purposes. RESULTS: Soldiers were classified into four groups based on HIIT and/or WL/PES DS use. Thirty-five percent of soldiers participated in HIIT and 10% took WL/PES DS at least once per month in the last year. HIIT participation was associated with higher reported odds of healthy behaviors and higher emotional and social fitness. In contrast to HIIT, WL/PES DS use was associated with higher reported odds of risky behaviors (hazardous drinking and tobacco use) and lower psychosocial fitness. The group participating in HIIT but not using WL/PES DS reported fewer unhealthy behaviors compared to the HIIT+WL/PES DS and WL/PES DS-only groups. CONCLUSIONS: Engaging in HIIT is associated with higher reported odds of healthy behaviors and increased psychosocial fitness. However, soldiers who engaged in HIIT also have increased odds of WL/PES DS use, which is associated with greater reported risky behaviors and reduced fitness. Although HIIT and WL/PES DS use are related, they are associated with different reported health/risky behaviors and different psychosocial attributes.

Aviation-Modeled Investigation of Significant Obstetric Events.

INTRODUCTION: In this research, the authors attempted to ascertain whether or not the Root Cause Analysis Event Support and Engagement Team (RESET) investigates the use of U.S. Army aviation-based techniques by staff members or organizations in which serious obstetrical events have occurred. Root cause analysis (RCA), originating in the manufacturing and engineering sectors, attempts to elucidate an underlying cause of a problem. Most recently, this process has been applied to the investigation of medical error. RESET was established in order to perform centralized investigation of significant medical error within U.S. Army medical and dental treatment facilities based on request from a hospital commander or general officer. Significant obstetric events are high profile, discussed in multiple safety forums, and an area of close RESET focus. Yet it is unclear if RESET investigates the use of aviation-based techniques by staff and/or organizations involved in serious obstetrical events. Therefore the present survey study was conducted. MATERIALS AND METHODS: A structured, anonymous, voluntary survey was fielded to RESET staff in order to assess whether or not the RESET investigates the use of aviation-based techniques by staff members or organizations in which serious obstetrical events have occurred. RESULTS: Five of six members of this small team completed the survey. Prebriefs, debriefs, and checklist use were consistently investigated. The employment of a sterile cockpit, first-name introductions, annual check ride, and emergency procedure rehearsal were infrequently investigated. CONCLUSION: Obstetric RESET investigations inconsistently ascertain whether or not some of the aviation-based techniques are utilized by staff members or organizations in which serious obstetrical events have occurred. Standardization of investigative procedures and education directed at under-investigated practices may optimize medical investigation using proven tenets of an aviation-based approach.

Functional Movement Assessments Are Not Associated with Risk of Injury During Military Basic Training.

INTRODUCTION: Musculoskeletal injuries (MSK-I) in the U.S. military accounted for more than four million medical encounters in 2017. The Military Entrance Processing Screen to Assess Risk of Training (MEPSTART) was created to identify MSK-I risk during the first 180 days of military service. METHODS: Active duty applicants to the United States Army, Navy, Air Force, and Marine Corps between February 2013 and December 2014 who consented completed a behavioral and injury history questionnaire and the MEPSTART screen [Functional Movement Screen (FMS), Y-Balance Test (YBT), Landing Error Scoring System (LESS), and Overhead Squat assessment (OHS)] the day they shipped to basic training. Male (n = 1,433) and Female (n = 281) applicants were enrolled and MSK-I were tracked for 180 days. Binomial logistic regression and multivariate Cox proportional hazards modeling were used to assess relationships among MEPSTART screens and MSK-I independent of age, BMI, sex, Service, injury history, and smoking status. Analyses were finalized and performed in 2017. RESULTS: The only functional screen related to injury was the LESS score. Compared to those with good LESS scores, applicants with poor LESS scores had lower odds of MSK-I (OR = 0.54, 95% CI = 0.30-0.97, p = 0.04), and a lower instantaneous risk of MSK-I during the first 180 d (HR = 0.58, 95%CI = 0.34-0.96, p = 0.04). However, secondary receiver operator characteristic (ROC) analyses revealed poor discriminative value (AUC = 0.49, 95%CI = 0.43-0.54). CONCLUSIONS: Functional performance did not predict future injury risk during the first 180 days of service. Poor LESS scores were associated with lower injury risk, but ROC analyses revealed little predictive value and limited clinical usefulness. Comprehensive risk reduction strategies may be preferable for mitigating MSK-I in military training populations.

Dietary Ingredients as an Alternative Approach for Mitigating Chronic Musculoskeletal Pain: Evidence-Based Recommendations for Practice and Research in the Military.

OBJECTIVE: Approximately 55-76% of Service members use dietary supplements for various reasons, including pain and related outcomes. This work evaluates current research on dietary ingredients for chronic musculoskeletal pain to inform decisions for practice and self-care, specifically for Special Operations Forces personnel. METHODS: A steering committee convened to develop research questions and factors required for decision-making. Key databases were searched through August 2016. Eligible systematic reviews and randomized controlled trials were assessed for methodological quality. Meta-analysis was applied where feasible. GRADE was used to determine confidence in the effect estimates. The committee made evidence-informed judgments and recommendations for practice and self-care use. RESULTS: Nineteen eligible dietary ingredients were assessed for quality, efficacy, and safety. Avocado soybean unsaponifiables, capsaicin, curcuma, ginger (as a food source), glucosamine, melatonin, polyunsaturated fatty acids, and vitamin D were conditionally recommended as their benefits outweighed risks, but there was still some uncertainty about the trade-offs. No recommendations were made for boswellia, ginger (as a dietary supplement), rose hip, or s-adenosyl-L-methionine. Recommendations were made against the use of collagen, creatine, devil's claw, l-carnitine, methylsulfonylmethane, pycnogenol, willow bark extract, and vitamin E. Research priorities were developed to address gaps precluding stronger recommendations. CONCLUSIONS: Currently the scientific evidence is insufficiently robust to establish definitive clinical practice guidelines, but processes could be established to track the impact of these ingredients. Until then, providers have the evidence needed to make informed decisions about the safe use of these dietary ingredients, and future research can address existing gaps.

Dietary Ingredients Requiring Further Research Before Evidence-Based Recommendations Can Be Made for Their Use as an Approach to Mitigating Pain.

OBJECTIVE: Approximately 55-76% of Service members use dietary supplements for various reasons; although such use has become popular, decisions are often driven by information that is not evidence-based. This work evaluates whether current research on dietary ingredients for chronic musculoskeletal pain provides sufficient evidence to inform decisions for practice and self-care, specifically for Special Operations Forces personnel. METHODS: A steering committee convened to develop research questions and factors required for decision-making. Key databases were searched through August 2016. Eligible systematic reviews and randomized controlled trials were assessed for methodological quality. Meta-analysis was applied where feasible. Grading of Recommendations, Assessment, Development and Evaluation was used to determine confidence in the effect estimates. The committee used a decision table to make evidence-informed judgments across decision-making factors and recommendations for practice and self-care use. RESULTS: Nineteen dietary ingredients were assessed. No recommendations were given for boswellia, ginger, rose hip, or s-adenosyl-L-methionine (SAMe); specifically, although ginger can be obtained via food, no recommendation is provided for use as a supplement due to unclear research. Further, there were insufficient strong research on boswellia and SAMe and possible compliance issues (i.e., high number of capsules required daily) associated with rose hip. CONCLUSIONS: No recommendations were made when the evidence was low quality or trade-offs were so closely balanced that any recommendation would be too speculative. Research recommendations are provided to enhance the quality and body of evidence for the most promising ingredients. Clinicians and those with chronic pain can rely on evidence-based recommendations to inform their decisions.

Curcumin induces concentration-dependent alterations in mitochondrial function through ROS in C2C12 mouse myoblasts.

Curcumin exhibits antioxidant properties in normal cells where the uptake is low, unlike in tumor cells where uptake is high and curcumin increases reactive oxygen species (ROS) production and cell death. Mitochondria are the main source and primary target of cellular ROS. We hypothesized that curcumin would regulate cellular redox status and mitochondrial function, depending on cell sensitivity and/or curcumin concentration in normal cells. We examined the differences between low and high concentrations of curcumin, with specific attention focused on ROS levels, mitochondrial function, and cell viability in mouse C2C12 myoblast under normal and simulated conditions of diabetes. Cells incubated with high concentrations of curcumin (10-50 µM) resulted in decreased cell viability and sustained robust increases in ROS levels. Mechanistic studies showed that increased ROS levels in cells incubated with 20 µM curcumin induced opening of mitochondrial permeability transition pores and subsequent release of cytochrome c, activation of caspases 9 and 3/7, and apoptotic cell death. Low concentrations of curcumin (1-5 µM) did not affect cell viability, but induced a mild increase in ROS levels, which peaked at 2 hr after the treatment. Incubation with 5 µM curcumin also induced ROS-dependent increases in mitochondrial mass and membrane potential. Finally, pretreatment with 5 µM curcumin prevented high glucose-induced oxidative cell injury. Our study suggests that mitochondria respond differentially depending on curcumin concentration-dependent induction of ROS. The end result is either cell protection or death. Curcumin may be an effective therapeutic target for diabetes and other mitochondrial diseases when used in low concentrations.

Timing and Predictors of Mild and Severe Heat Illness among New Military Enlistees.

PURPOSE: Heat illnesses are important and potentially fatal conditions among physically active individuals. We determined predictors of heat illness among enlistees in a large military population experiencing common physical activity patterns. METHODS: We estimated the adjusted odds of mild (MHI) and severe (SHI) heat illness associated with demographic, health-related, and geographic factors among active-duty, US Army soldiers enlisting between January 2011 and December 2014 (N = 238,168) using discrete-time multivariable logistic regression analyses. RESULTS: We observed 2612 incident cases of MHI and 732 incident cases of SHI during 427,922 person-years of follow-up, with a mean and median of 21.6 and 21 months per subject. During the first 6 duty months, 71.3% of the MHIs and 60.2% of the SHIs occurred, peaking at month 2. The odds of MHI quadrupled among those with prior SHI (odds ratio [OR], 4.02; 95% confidence interval [CI], 2.67-6.03). Body mass index (BMI) extremes increased the odds substantially (OR at BMI ≥30 kg·m: for MHI, 1.41 (CI, 1.19-1.67); for SHI, 1.94 (CI, 1.47-2.56); OR at BMI <18.5 kg·m: for MHI, 1.50 (CI, 1.01-2.21); for SHI, 2.26 (CI, 1.16-4.39)). Tobacco use was associated with a 55% increase (CI, 1.37-1.77) in MHI odds. The odds of MHI increased if taking nonsteroidal anti-inflammatory drugs, opioids, or methylphenidate stimulants. Lower age and lower entry aptitude scores were associated with progressively increased MHI odds. CONCLUSIONS: Most heat illnesses occurred at the outset of service, indicating the need for focused prevention methods at the initiation of military duty. Prior heat illness, BMI extremes, medications, and tobacco use represent potentially actionable risk factors to address by education, policy, and/or clinician intervention.

Round Table on Malignant Hyperthermia in Physically Active Populations: Meeting Proceedings.

CONTEXT: Recent case reports on malignant hyperthermia (MH)-like syndrome in physically active populations indicate potential associations among MH, exertional heat stroke (EHS), and exertional rhabdomyolysis (ER). However, an expert consensus for clinicians working with these populations is lacking. OBJECTIVE: To provide current expert consensus on the (1) definition of MH; (2) history, etiology, and pathophysiology of MH; (3) epidemiology of MH; (4) association of MH with EHS and ER; (5) identification of an MH-like syndrome; (6) recommendations for acute management of an MH-like syndrome; (7) special considerations for physically active populations; and (8) future directions for research. SETTING: An interassociation task force was formed by experts in athletic training, exercise science, anesthesiology, and emergency medicine. The "Round Table on Malignant Hyperthermia in Physically Active Populations" was convened at the University of Connecticut, Storrs, September 17-18, 2015. CONCLUSIONS: Clinicians should consider an MH-like syndrome when a diagnosis of EHS or ER cannot be fully explained by clinical signs and symptoms presented by a patient or when recurrent episodes of EHS or ER (or both) are unexplained. Further research is required to elucidate the genetic and pathophysiological links among MH, EHS, and ER.

The Interrelationship of Common Clinical Movement Screens: Establishing Population-Specific Norms in a Large Cohort of Military Applicants.

CONTEXT: Musculoskeletal injuries (MSK-Is) are a leading cause of missed duty time and morbidity in the military. Modifiable risk factors for MSK-Is, such as inadequate core stability, poor movement patterns, and dynamic balance deficits, have not been identified in military applicants on entering service. OBJECTIVE: To establish normative functional movement data using a series of screens in military applicants entering basic training and explore relationships among several movement tests. DESIGN: Cross-sectional study. SETTING: Military Entrance Processing Station. PATIENTS OR OTHER PARTICIPANTS: A total of 1714 (1434 male, 280 female) military applicants entering the US Army (n = 546), Navy (n = 414), Air Force (n = 229), or Marine Corps (n = 525). INTERVENTION(S): We conducted the Functional Movement Screen (FMS), Y-Balance Test (YBT), overhead squat (OHS), and Landing Error Scoring System (LESS). Movements were assessed using the scoring convention for each screen. MAIN OUTCOME MEASURE(S): The FMS, YBT, OHS, and LESS scores and associations among the movement screens as well as clinical meaningfulness. RESULTS: A total of 1037 of the 1714 enrolled applicants were screened on the day they left for basic training. Normative means for this population were established: FMS = 14.7 ± 1.8, YBT anterior-reach difference = 3.1 ± 3.0 cm, mean YBT composite differences = 8.0 ± 6.8 cm, mean YBT composite percentage = 90.9% ± 8.3%, OHS errors = 5.0 ± 2.8, and LESS score = 5.7 ± 2.1. Backward regression results revealed that the YBT composite percentage was related to the FMS and OHS scores in males and to the FMS and LESS results in females. However, clinically meaningful relationships between the tests varied for both males and females. CONCLUSIONS: Sex-normative values for the FMS, YBT, OHS, and LESS screens were established for US military applicants, and some of the assessments overlapped. Overall, males performed better on the OHS and LESS and achieved a greater YBT composite percentage than females. The regression results revealed movement screen performance relationships that varied by sex and clinical meaningfulness. In future studies, we will determine if performance on any of the screens is associated with MSK-Is in basic trainees.

Sickle Cell Trait, Rhabdomyolysis, and Mortality among U.S. Army Soldiers.

BACKGROUND: Studies have suggested that sickle cell trait elevates the risks of exertional rhabdomyolysis and death. We conducted a study of sickle cell trait in relation to these outcomes, controlling for known risk factors for exertional rhabdomyolysis, in a large population of active persons who had undergone laboratory tests for hemoglobin AS (HbAS) and who were subject to exertional-injury precautions. METHODS: We used Cox proportional-hazards models to test whether the risks of exertional rhabdomyolysis and death varied according to sickle cell trait status among 47,944 black soldiers who had undergone testing for HbAS and who were on active duty in the U.S. Army between January 2011 and December 2014. We used the Stanford Military Data Repository, which contains comprehensive medical and administrative data on all active-duty soldiers. RESULTS: There was no significant difference in the risk of death among soldiers with sickle cell trait, as compared with those without the trait (hazard ratio, 0.99; 95% confidence interval [CI], 0.46 to 2.13; P=0.97), but the trait was associated with a significantly higher adjusted risk of exertional rhabdomyolysis (hazard ratio, 1.54; 95% CI, 1.12 to 2.12; P=0.008). This effect was similar in magnitude to that associated with tobacco use, as compared with no use (hazard ratio, 1.54; 95% CI, 1.23 to 1.94; P<0.001), and to that associated with having a body-mass index (BMI; the weight in kilograms divided by the square of the height in meters) of 30.0 or more, as compared with a BMI of less than 25.0 (hazard ratio, 1.39; 95% CI, 1.04 to 1.86; P=0.03). The effect was less than that associated with recent use of a statin, as compared with no use (hazard ratio, 2.89; 95% CI, 1.51 to 5.55; P=0.001), or an antipsychotic agent (hazard ratio, 3.02; 95% CI, 1.34 to 6.82; P=0.008). CONCLUSIONS: Sickle cell trait was not associated with a higher risk of death than absence of the trait, but it was associated with a significantly higher risk of exertional rhabdomyolysis. (Funded by the National Heart, Lung, and Blood Institute and the Uniformed Services University of the Health Sciences.).

Physical fitness and injury reporting among active duty and National Guard/Reserve women: associations with risk and lifestyle factors.

OBJECTIVE: As more women enter the military, it is important to understand how different risks and lifestyle factors influence physical fitness and injury among women in both active duty (AD) and National Guard/Reserve (NG/R). Women in military service are less fit and more likely to suffer musculoskeletal injuries during physical training than men. They also use more medical care during deployment than men. Using data from the Comprehensive Soldier and Family Fitness Global Assessment Tool 2.0 (GAT 2.0), self-reported health and lifestyle and behavioral risk factors were analyzed in nondeployed Army personnel, with the goals of examining (1) service-component differences across traditional risk and lifestyle factors, and (2) correlates of physical performance and physical activity-related injury. METHODS: Self-report GAT 2.0 data included health risk factors (overall perceived health, sleep, diet, tobacco and alcohol use), self-reported health metrics (height, weight, Army Physical Fitness Test (APFT) scores), and history of physical activity-related injury. The GAT 2.0 was completed by 1,322 AD and 1,033 NG/R women, and APFT data were available for a subsample of 605 AD and 582 NG/R women. RESULTS: Initial analyses of GAT 2.0 data indicated that AD had higher rates of fair/poor perceived health, poor sleep, and unhealthy diet compared to NG/R women. However, AD women had a lower APFT fail rate (8%) than NG (27%) and R (28%). Active duty women were more likely to experience a physical injury in the past 6 months (38%) than NG (19%) and R (22%) women, and more likely to seek medical care than NG/R women. Across all service components, predictive factors for APFT failure included high body mass index (BMI), fair/poor health, and unhealthy diet. Predictive factors for physical injury included high BMI, fair/poor health, and binge drinking. CONCLUSION: Our analyses suggest that AD women Soldiers are more physically fit than NG/R women Soldiers, which is accompanied by a greater prevalence of physical activity-related injuries. As women's roles expand into combat military occupation specialties, a thorough understanding of service component differences will be critical to inform training programs, mitigate physical injury, and enhance force health protection and readiness.

Single-dose oral quercetin improves redox status but does not affect heat shock response in mice.

Inflammation and oxidative stress are considered as likely contributors to heat injury. However, their roles in regulating the heat shock response in vivo remain unclear. We tested the hypothesis that acute quercetin treatment would improve redox status and reduce heat shock responses in mice. Mice underwent two heat tests before and after single oral administration of either quercetin (15 mg/kg) or vehicle. We measured physiologic and biochemical responses in mice during and 18 to 22 hours after heat tests, respectively. There were no significant differences in core temperature, heart rate, or blood pressure between quercetin and vehicle groups during heat exposure. Mice with relatively severe hyperthermia during the pretreatment heat test showed a significant trend toward a lower peak core temperature during the heat test after quercetin treatment. Compared with mice not exposed to heat, quercetin-treated mice had significantly lower interleukin 6 (P < .01) and higher superoxide dismutase levels (P < .01), whereas vehicle-treated mice had significantly lower total glutathione and higher 8-isoprostane levels in the circulation after heat exposure. Heat exposure significantly elevated heat shock proteins (HSPs) 72 and 90 and heat shock factor 1 levels in mouse liver, heart, and skeletal muscles, but no significant differences in tissue HSPs and heat shock factor 1 were found between quercetin- and vehicle-treated mice. These results suggest that a single moderate dose of quercetin is sufficient to alter redox status but not heat stress response in mice. Acute adaptations of peripheral tissues to heat stress may not be mediated by systemic inflammatory and redox state in vivo.