Defining Total Fitness for the 21 st Century: Getting to Total Fitness

1. Defining Total Fitness for the 21st Century: Getting to Total Fitness Wayne B. Jonas, MD LTC (RET) USA Samueli Institute December 6-9, 2009

4. Capability Gaps (COL O’Connor/RDML Miller) • Alertness and sleep/rest management • Stress/mental management – schedule pressure • Endurance and Rapid recovery - short and long-term • Fatigue and sustainment – “add in the heat, cold, altitude” • Knee, leg, ankle and spine – premature OA, “broken” • Fitness – “quick ramp-up” • Not sustained during deployment • Not mission specific to prevent injury • Psychological trauma – 12% to 40% - even the “tough” are affected • Rapid learning requirements and mental hardiness • Drug and supplement side effects and interactions • Pain, pain and pain – conscious and physiological • NO PLACE TO GO AND NO PROCESS TO GET CREDIBLE, RELEVANT, TIMELY INFORMATION AND KNOWLEDGE ON TF

5. What’s a Warrior and Commander To Do? Accelerated learning Cultural conditioning Reset retreats Team training EEG Biofeedback FMS Lean 6 COTS Adaptive leader courses Hypnosis Load assist SMART Clinics Psychological hardening Getting to Total Fitness ??? Acupuncture Combines EM Machines Demand analysis E-stim PTSD Tapes Yoga Water PPE Carbs Brain Stimulation Meditation Omega-3s Anabolic Steroids Finance$$$ Tyrosine EKG Biofeedback Caffeine Ambien Biomonitoring Antioxidants Amphetamines The -omics PDAs and GPS Quercitine

6. Foundations of Total Fitness Readiness and Prevention Functional Excellence Stress Resistance System Balance Risk Reduction HPO Resilience T o t a l F i t n e s s Health and Wellness

7. Why is Health Important? Nothing works without it! • money • work and play • science, art, culture, thought, action • wars are won and lost on health Health arises from our inherent capacity to resist breakdown and rapidly heal/recover.

8. What is Health? • Definition: the general condition of a person in all aspects. It is also a level of functional and/or metabolic efficiency of an organism, often implicitly human. • WHO Definition: “A state of complete physical, mental and social well-being, and not merely the absence of disease” • Military: • Prevention– risk factor reduction • Health - Well-being vs dis-ease • Resilience – resistance and rebound from stress/injury • Optimal Functioning – human performance • Sustainability • Throughout the deployment and military lifecycle • Total – Mind, Body, Spirit and Social • Holistic, Biopsychosocial

9. What Contributes to Human Health? Environment Mind Spirit Physical Activity Rest Diet Drugs Supplements Leadership Friends Family

10. What Contributes Most to Human Health and Performance?

12. Total Fitness Request From Joint Chiefs

13. Total Fitness: The New Paradigm BODY MIND Spiritual Psychological Behavioral Social Physical Nutritional Medical Environmental

14. Integrated Whole: Dynamic Systems Theory • Systems (persons) cannot be understood by studying fundamental • constituents, the properties of the parts are not intrinsic but can • be understood within the context of the whole • Nature of life > interconnection, interdependent, multileveled • Living systems are dynamic and highly nonlinear • Patterns of self-organization are the key • Patterns of organized complexity have emergentproperties at • various levels of organization • The key to Total Fitness is to provide warriors, families and commanders with knowledge, skills and tools from which health, resistance and optimal performance can emerge.

15. Entire Correlation Network : Organized complexity Correlation Network in a Whole Organism ~3400 nodes ~17000 edges abs R > 0.8 - Courtesy of Jan van der Greef, TNO, Netherlands

16. Example – Effect of Reductionist Approach Correlation Network in a Whole Organism Healthy and Fit Network in Fat from Animal Model of T2DM

17. Disease Animal+Drug Example – Effect of Reductionist Approach Correlation Network in a Whole Organism Unhealthy and Unfit

18. Unhealthy + Single Treatment Example – Effect of Reductionist Approach Correlation Network in a Whole Organism

19. Unhealthy + Single Treatment Example – Effect of Reductionist Approach Correlation Network in a Whole Organism unmet biochemical need

20. Unhealthy + Single Treatment Example – Effect of Reductionist Approach Correlation Network in a Whole Organism biochemical side effect unmet biochemical need

21. Current paradigm: Monotherapy 1 function– 1 target – 1 treatment fits all Reductionistic approach New paradigm : Integrated Intervention Medicine, nutrition, exercise, environment Behavior, Psychology, social, spiritual How to design an intervention for a whole system? Systems Theory : “The scale and complexity of the problem and solution should match” - Yaneer Bar-Yam

22. Are there opportunities to bring the system back in homeostasis? Health Reversible Irreversible “Total Fitness” Maintain Health Reduce Risk Improve resilience Enhance performance “Disease management” Symptom and treatment focus Disease Optimal Healthy Changes in behaviours to maintain performance Stress Injury Aging - Adapted from Jan van der Greef, TNO, Netherlands

23. Creating a Total Fitness Environment What Cannot Be Learnt from a Genome One Animal One Genome Two States Understanding from a Systems Perspective? The Performance of a Person and Unit is Optimized with a Total Fitness Environment

24. The Domains of Total Fitness Definitions Descriptions Outcomes Evidence Metrics Integration Application Delivery

25. Physical Fitness

26. Strength • Outcomes/Metrics Rest & Recovery Endurance Physical Fitness Injury Prevention Flexibility Mobility

27. Average Lap Time for Each 200 m of the 5 km Runs for Each Trial Ace Sponsored Study. Mind Over Body. May/June 2006. ACE FitnessMatters. 12-13

28. Mushroom Supplements to Improve Physical Performance 2nd Wind™, a unique, all-natural formulation of standardized herbal extracts, has been clinically proven to accelerate clearance of lactic acid from the bloodstream following exercise by over 100%. Faster utilization of lactate by the muscle after exercise indicates enhanced energy production, enabling speedier recovery of muscle strength and reaction time. Improved lactate clearance can also lead to a reduction in post-workout muscle soreness and fatigue.* People frequently use mushrooms as tonics, such as the Chinese caterpillar fungus (Cordyceps sinensis) for improving athletic performance and increasing energy, and species like reishi (Ganoderma lucidum), shitake (Lentinella edodes), and maitake (Grifola frondosa) to boost immunity. Research on medicinal mushrooms suggests that taking more than one at the same time gives better results. There is a combination mushroom extract called ESP, which is essentially the “second generation” of Second Wind product. All ingredients have a long history of safe use. Research involving ESP is currently ongoing and so far is showing a significant increase in physical stamina as indicated by a more than 800% increase in the maximum swim time of mice. http://www.personalbestnutrition.com/cgi-bin/pbn/415.html

29. Psychological Fitness

30. Outcomes/Metrics Positivity 3:1

31. Meta-analysis of omega-3’s on depressive symptoms, randomized placebo controlled trials, effect size = 0.54, p<0.008 Freeman M, Hibbeln JR, Davis JM et al. American Psychiatric Associations treatment recommendations for omega-3 fatty acids in psychiatric disorders. J Clin Psychiatry 2006; 67 12: 1954-1967 .

32. High DHA (n=16) Low DHA (n=17) (median split of plasma phospholipid % fatty acids) Low Plasma DHA at Baseline Predicts Greater Risk of Future Suicide Attempts Cox proportional hazard ratio=0.29, p<0.002 1.0 Inpatient Discharge 0.8 0.6 Survival Probability 0.4 0.2 0 0 400 200 600 800 Time to First Suicide Attempt (days) Sublette, Hibbeln et al Am J Psychiatry 2006;163: 1100-1102

33. Medical & Behavioral Fitness

34. Outcomes/Metrics

35. Example of Extra-ordinary Pain and Healing Control

36. Brain~Mind Body Connections Integrative Neural Immune Program http://neuralimmune.nih.gov/index.html

37. Train the Brain Mind-body approaches can reduce pain, improve immune function and wound healing

38. Family Conflict and Wound Healing: Time to healing was 1 day later following the conflict visit than after the social support visit (day 6 vs. day 5) Kiecolt-Glaser JK, Loving TJ, Stowell JR, Malarkey WB, Lemeshow S, Dickinson SL & Glaser R (2005). Hostile marital interactions, proinflammatory cytokine production, and wound healing. Archives of General Psychiatry.

39. Social Fitness

40. Stressful events and depression slow local cytokine production at the wound site which is important for wound healing while promoting maladaptive systemic proinflammatory cytokine production Kiecolt-Glaser JK, Loving TJ, Stowell JR, Malarkey WB, Lemeshow S, Dickinson SL & Glaser R (2005). Hostile marital interactions, proinflammatory cytokine production, and wound healing. Archives of General Psychiatry.

41. Outcomes/Metrics Unit Cohesion

42. The personal connectivity of a team is highly correlated with its performance. High Performance Teams vs. Low Performance Teams Losada M. Mathematical and Computer Modeling 30 (1999): 179-192.

43. Medical & Behavioral Fitness Social Fitness Physical Fitness Total Fitness Spiritual Fitness Nutritional Fitness Psychological Fitness

44. The Challenge forThe Total Fitness Group Utility and Application Isolated Domains Whole Systems Science and Evidence Translation to Military Mission

45. A Total Fitness UPS for the Warrior and Commander

46. An Integrated Total Fitness System Fitness Metrics and Monitoring Evidence Based Training Fitness Facilitators

47. Creating Total Fitness in Military Operations