Operational Physical Performance and Fitness in Military Women: Physiological, Musculoskeletal Injury, and Optimized Physical Training Considerations for Successfully Integrating Women Into Combat-Centric Military Occupations

Abstract

This article summarizes presentations from a 2014 United States Department of Defense (DoD) Health Affairs Women in Combat symposium addressing physiological, musculoskeletal injury, and optimized physical training considerations from the operational physical performance section. The symposium was held to provide a state-of-the-science meeting on the U.S. DoD's rescinding of the ground combat exclusion policy opening up combat-centric occupations to women. Physiological, metabolic, body composition, bone density, cardiorespiratory fitness, and thermoregulation differences between men and women were briefly reviewed. Injury epidemiological data are presented within military training and operational environments demonstrating women to be at a higher risk for musculoskeletal injuries than men. Physical training considerations for improved muscle strength and power, occupational task performance, load carriage were also reviewed. Particular focus of this article was given to translating physiological and epidemiological findings from the literature on these topics toward actionable guidance and policy recommendations for military leaders responsible for military physical training doctrine: (1) inclusion of resistance training with special emphasis on strength and power development (i.e., activation of high-threshold motor units and recruitment of type II high-force muscle fibers), upper-body strength development, and heavy load carriage, (2) moving away from "field expediency" as the major criteria for determining military physical training policy and training implementation, (3) improvement of load carriage ability with emphasis placed on specific load carriage task performance, combined with both resistance and endurance training, and (4) providing greater equipment resources, coaching assets, and increased training time dedicated to physical readiness training.

1.5 mile run time and body mass predict 8 mile loaded march performance, irrespective of sex

“…Strength is considered a vital physical fitness component for military performance. 21 In the present study, SL appeared to be the RMT that women found most challenging, with only 15% of the cohort achieving the Infantry pass standard of 40 kg. This difference may be attributed to men having a greater stature (179.0 ± 6.5 vs. 166.5 ± 6.0 cm) and FFM (63.1 ± 6.7 vs. 47.0 ± 5.3 kg) compared to women.…”

Systematic review of gender differences in the epidemiology and risk factors of exertional heat illness and heat tolerance in the armed forces

“…The reported lower incidence of heat stroke/higher incidence of other heat illness in women compared with men could be because women in the military in the USA were excluded from combat positions until 2013 when the ban was lifted. 20 Evidence in the literature suggests that service members who were…”

“…It has been suggested that more research is required to determine whether or not a new protocol should be developed for women. 12 As restrictions on gender based-exclusions from military specialisations are lifted, 20 it is imperative to understand and evaluate exertional heat illness in women compared with men and identify the gender-specific risk factors. Furthermore, it is important to understand how women respond to the heat tolerance test compared with men.…”

Positive, limited and negative responders: The variability in physical fitness adaptation to basic military training

“…[4][5][6] However, our existing understanding of the heterogeneity of cardiorespiratory endurance adaptations during military training is limited. 7 Furthermore with respect to muscular strength, an essential physical attribute for military service, 8 inter-individual variability in response to basic military training has not previously been described.…”