defining total fitness for the 21 st century: getting to total fitness wayne b. jonas, md ltc (ret)...
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Defining Total Fitness for the 21st Century: Getting to Total Fitness
Wayne B. Jonas, MDLTC (RET) USA
Samueli InstituteDecember 6-9, 2009
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
What’s a Warrior and Commander To Do?
Demand analysis
Lean 6Team training
Reset retreats
Getting toTotal Fitness
???
Adaptive leader courses COTS
SMART Clinics
Combines
Load assist
Psychological hardening
E-stim
Water
CaffeineTyrosine
Biomonitoring
PDAs and GPSThe -omics
Ambien
Amphetamines
EEGBiofeedback
Cultural conditioning
Hypnosis
Omega-3s
Antioxidants
Accelerated learning
EM Machines
Meditation Brain StimulationPPE
PTSD Tapes
EKG Biofeedback
Anabolic Steroids
Acupuncture
Carbs
Quercitine
FMS
Yoga
Finance$$$
Foundations of Total Fitness
Readiness and Prevention
HPO
Resilience
Health and Wellness
Functional Excellence
Stress Resistance
System Balance
Risk Reduction
T o
t a l
F
i t n
e s
s
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.
Why is Health Important?
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
What Contributesto Human Health?
PhysicalActivity
Rest
DietDrugs
Supplements
MindSpirit
LeadershipFriendsFamily
Environment
What Contributes Most toHuman Health and Performance?
Conditioning
Regression
Bias
Other
Optimal Health and
PerformanceEnvironment
Treatment
Total Fitness RequestFrom Joint Chiefs
Total Fitness: The New Paradigm
MIND BODY
SpiritualPsychologicalBehavioralSocial
PhysicalNutritionalMedicalEnvironmental
Slide 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 emergent properties 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.
•
Slide 15
Entire Correlation Network : Organized complexity
~3400 nodes
~17000 edges
abs R > 0.8
Correlation Network in a Whole Organism
- Courtesy of Jan van der Greef, TNO, Netherlands
Slide 16
Healthyand Fit
Example – Effect of Reductionist ApproachCorrelation Network in a Whole Organism
Network in Fat from Animal Model of T2DM
Slide 17
Disease Animal+DrugUnhealthy
andUnfit
Example – Effect of Reductionist ApproachCorrelation Network in a Whole Organism
Slide 18
Unhealthy+
Single Treatment
Example – Effect of Reductionist ApproachCorrelation Network in a Whole Organism
Slide 19
Unhealthy
+
Single Treatment
Example – Effect of Reductionist ApproachCorrelation Network in a Whole Organism
unmet biochemical need
Slide 20
Unhealthy+
Single Treatment
Example – Effect of Reductionist ApproachCorrelation Network in a Whole Organism
unmet biochemical needbiochemicalside effect
Slide 21
How to design an intervention for a whole system?
Current paradigm: Monotherapy1 function– 1 target – 1 treatment fits all
Reductionistic approach
New paradigm : Integrated InterventionMedicine, nutrition, exercise, environmentBehavior, Psychology, social, spiritual
Systems Theory :
“The scale and complexity ofthe problem and solution should match”
- Yaneer Bar-Yam
Disease
Healthy
Stress Injury Aging
Health Reversible Irreversible
“Total Fitness”Maintain Health
Reduce Risk
Improve resilience
Enhance performance
“Disease management”
Symptom and treatment focus
Changes in behavioursto maintain performance
Optimal
- Adapted from Jan van der Greef, TNO, Netherlands
Slide 23
What Cannot Be Learnt from a Genome
Creating a Total Fitness Environment
One Animal
One Genome
Two States
The Performance of a Person and Unit is
Optimized with a
Total Fitness Environment
Understandingfrom
a Systems Perspective?
Total Fitness
Medical & Behavioral
Fitness
Physical
Environmental Fitness
Nutritional Fitness
Psychological
Fitness
Spiritual Fitness
Social Fitness
DefinitionsDescriptions
OutcomesEvidenceMetrics
IntegrationApplication
Delivery
The Domains of Total Fitness
Slide 25
Physical Fitness
Physical Fitness
Strength
Endurance
Flexibility
Mobility
Injury Prevention
Rest & Recovery
Outcomes/Metrics
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
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.
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.*
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.
Mushroom Supplements to Improve Physical Performance
http://www.personalbestnutrition.com/cgi-bin/pbn/415.html
Slide 29
Psychological
Fitness
Psychological Fitness
Attitudes, Beliefs, Expectations
Mindfulness, Awareness,
Intention, Insights
Emotional Flexibility, Emotional Choice
Self:
Other Focus: 1:1
Outcomes/Metrics
Positivity 3:1
Meta-analysis of omega-3’s on depressive symptoms, randomized placebo controlled trials, effect size = 0.54, p<0.008
Study name Statistics for each study Hedges's g and 95% CI
Hedges's Standard Lower Upper g error Variance limit limit Z-Value p-Value
Marangell 0.096 0.346 0.120 -0.582 0.774 0.277 0.782Peet 0.496 0.362 0.131 -0.214 1.205 1.370 0.171stoll 0.974 0.386 0.149 0.217 1.730 2.523 0.012Keck 0.030 0.187 0.035 -0.337 0.396 0.159 0.873Su 1.887 0.542 0.293 0.826 2.949 3.485 0.000Nemets 0.892 0.512 0.263 -0.113 1.896 1.740 0.082Silvers -0.342 0.234 0.055 -0.799 0.116 -1.462 0.144Frangou 0.645 0.245 0.060 0.165 1.126 2.630 0.009Hallahan 1.020 0.327 0.107 0.379 1.660 3.120 0.002
0.538 0.203 0.041 0.140 0.936 2.648 0.008
-1.00 -0.50 0.00 0.50 1.00
Favours Placebo Favours Omega-3
Omega-3 EFA in Affective Disorders
Eff ect Size g, SE, Variance 95% CI Z and P (Best Case)
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 .
0
Time to First Suicide Attempt (days)
0
200 400 600 800
Sur
viva
l Pro
babi
lity
0.2
0.4
0.6
0.8
1.0
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 AttemptsCox proportional hazard ratio=0.29, p<0.002
Sublette, Hibbeln et al Am J Psychiatry 2006;163: 1100-1102
InpatientDischarge
Slide 33
Medical & Behavioral
Fitness
Medical & Behavioral
Fitness
Immunizations
Disease Screening
Drug ProphylaxisRisk Factors
Environmental(see environmental figure)
Behavioral/ Occupational
(see behavioral figure)
Outcomes/Metrics
Example of Extra-ordinary Pain and Healing Control
Integrative Neural Immune Programhttp://neuralimmune.nih.gov/index.html
Brain~Mind Body Connections
Train the BrainMind-body approaches can reduce pain, improve immune function and wound healing
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)
1
1
77
0.00
0.25
0.50
0.75
1.00
Sur
viva
l fun
ctio
n
0 5 10 15Days after wounding
Social support, visit 1 Conflict, visit 2
Time to Healing Across Visits
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.
Slide 39
Social Fitness
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.
Social Fitness
Peer Support/ Relationships
Family Support/ Relationships
Economic Relationships
Quality of Unit Leadership
Outcomes/Metrics
Unit Cohesion
High Performance Teams vs. Low Performance Teams
Losada M. Mathematical and Computer Modeling 30 (1999): 179-192.
The personal connectivity of a team is highly correlated with its performance.
Slide 43
Total Fitness
Medical & Behavioral
Fitness
Physical Fitness
Nutritional Fitness
Psychological
Fitness
Spiritual Fitness
Social Fitness
The Challenge forThe Total Fitness Group
Science and Evidence
Utility and ApplicationIsolated Domains Whole Systems
Translation to Military Mission
A Total Fitness UPSfor the Warrior and Commander
Nutritional
Physical
Social
SpiritualPsychological
Behavioral
Medical
0.00%
50.00%
100.00%
15.00%45.00%
87.00%
47.00%
67.00%
55.00%
56.00%
Total Fitness Domains
Percentage Value
Fitness Facilitators
An Integrated Total Fitness System
Fitness Metricsand
Monitoring
Evidence BasedTraining
Nutritional
Physical
Social
SpiritualPsychological
Behavioral
Medical
0.00%
50.00%
100.00%
15.00%45.00%
87.00%
47.00%
67.00%
55.00%
56.00%
Creating Total Fitnessin Military Operations
