Ascent to altitude can cause a variety of physiologic disturbances due to the drops in temperature and humidity, and the lack of oxygen. Some major concerns are weight loss, disturbances in digestion, and vitamin, mineral and fluid needs.

Physical performance can suffer dramatically with changes in altitude. The lower oxygen concentrations at altitude can reduce aerobic capacity by 1-2% every 100 meters (328 feet) above 1,500 meters (4,918 feet). Many adaptations occur during extended exposure to high altitudes including:

♦ Increased number of oxygen-carrying proteins in the blood (hemoglobin) and muscle.

♦ Increased density of blood vessels to and within the muscle.

♦ Increased rate of respiration.

Adequate nutrition can play a crucial role in maintaining performance.

Energy Needs

Energy requirements are 15-50% greater than at sea level

Virtually all persons who go to altitude experience weight loss and loss of lean body mass. At altitudes below 5,000 m weight loss can be prevented by increased caloric intake; whereas above 5,000 m, a 5-10% weight loss is inevitable. Some reasons for weight loss at high-altitude are:

♦ Energy requirements are 15-50% greater than at sea level.

♦ Decreased appetite and sense of taste.

♦ Loss of body water from increased breathing rate and dry air.

♦ Impaired absorption of nutrients.

♦ Acute Mountain Sickness (AMS) - symptoms include headache, nausea, vomiting, fatigue and poor appetite.

Worksheet 12-3. Calculate Your Energy Requirements at Altitude

Your Estimated Energy Requirement (EER) =_kcal/day

(see Chapter 1)

A 50% increase in energy requirements equals:

Your total energy requirement equals:

A high-CHO diet (60% of total daily kcals) is preferred at altitude because it restores glycogen, requires less oxygen to metabolize than a high-fat diet, and can blunt or delay the severity of AMS symptoms.

Vitamin and Mineral Needs

Vitamin and mineral needs are likely to increase at altitude. In particular, the increased metabolic rate and the lack of oxygen can increase the production of harmful free radicals. These free radicals can slow blood circulation and impair physical performance. Preliminary findings in men indicate that taking 400 IU per day of vitamin E, an antioxidant, at high altitude reduces free radical production and maintains aerobic energy production. Increased amounts of many other nutrients should be considered, especially since food intake usually decreases (see Table 12-2).

Tips for Maintaining Performance at Altitudes

♦ Plan on decreased physical performance the first few weeks.

♦ Drink plenty of fluids. Fluid requirements may be as high as 4.25 quarts, or more, each day.

♦ Listen to your body, be aware of any warning signs of illness or symptoms of AMS and seek medical attention.

♦ Try to avoid substances that cause dehydration (Table 12-1).

As noted throughout this chapter, meeting energy and fluid requirements are vital for maintaining physical performance in adverse environmental conditions. Being physically fit and eating a healthy diet prior to deployment will greatly improve your acclimation and adaptation to the new environment.

Training and

Overuse Injuries

In this chapter you will learn about:

♦ Treatment and prevention of injuries.

♦ When to seek medical care.

♦ Overtraining syndrome.

One of the hazards of physical training is becoming injured. Sustaining either a sudden injury or an overuse injury can mean loss of work days, forced rest, and pain for a period of days to weeks. The goal of this chapter is not to have you treat your own injuries, but rather to be informed so that you will seek appropriate help when needed. Central to rapid recovery from training-related injuries is a step-wise reconditioning program which starts immediately after the injury. Such programs are designed to arrest the inflammatory process, promote healing and accelerate the return to full duty.

Injuries: Treatment and Prevention

A variety of injuries can occur during physical training. Table 13-1 has a brief description of acute and overuse injuries, as well as their treatment and prevention. Both sudden-onset and recurring injuries can result in inflammation (localized warmth, swelling, redness and pain). If left unchecked the inflammatory response rapidly leads to:

♦ Tissue swelling.

♦ Stiffness.

♦ Loss of normal function.

♦ Weakness.

♦ Decreased range of motion of the joint.

CD r




Delayed-Onset Muscle Soreness - Muscle pain occurring in deconditioned muscle 12-72+ hours after training.

Ice, stretch, warm-up. Do not use NSAIDs.

Resolves as muscle adapts to training. Slowly increase training intensity.

Contusions - Swelling and bleeding (bruising) in the muscle, tendon, or bone due to a direct blow.


Wear protective gear.

Muscle Cramp - Muscle pain caused by prolonged activity, high heat or humidity, dehydration, and poor conditioning.

Rehydrate (Chapter 2), stretch, massage with ice.

Allow time to adjust to training and climate; drink frequently.

True Fractures - Break or chip in the bone.

Seek medical help.

Use protective gear; recondition.

Stress Fractures - Pain and weakening of the bone caused by excessive stress and use.

Seek medical help.

Reduce high-impact activities, cross-train, use proper gear, slowly increase training.

Sprains - Acute or overuse injury to ligaments (connective tissue that joins bone to bone).

Seek medical help.

Follow medical advise; slowly increase training intensity, use proper gear.

Strains, Tendonitis - Acute or overuse injury to muscle or tendons (connective tissue that joins muscle to bone).


Seek medical help.

See "Sprains."

Heat Injuries (cramp, exhaustion, heat stroke) - Painful muscle contractions, nausea, fatigue, fever, or dizziness from dehydration and electrolyte depletion; fevers >104oF can damage vital organs and result in death.

Place person in a cool location and rehydrate. Seek medical help.

Acclimate to climate, avoid exercise in extreme heat, avoid substances that cause dehydration (Chapter 12), stay well hydrated (Chapter 2).

Cold Injuries (hypothermia, frost bite, trench foot) - Body temperature <95°F causing shivers, slurred speech, clumsiness, and freezing of exposed body parts.

Gently place the person in dry blankets with another warm person.

Wear proper gear, stay dry, avoid exercise in extreme cold, stay well hydrated (Chapter 2).

RICE = rest, ice, compression, and elevation. See page 102.

RICE = rest, ice, compression, and elevation. See page 102.

The treatment of any injury should focus on controlling the inflammation and allowing full joint range of motion for a rapid return to daily activities. To accelerate healing, you must first decrease the inflammatory process. Treatment steps to achieve this include:

RICE = Rest + Ice + Compression + Elevation

♦ Rest - partial or no weight-bearing of the extremity, using crutches for locomotion. "Relative Rest" means decreasing activities that cause pain and replacing them with activities that are pain-free.

♦ Ice - as soon as possible apply ice, wrapped in a bag or towel, to the injured area. Ice for 20 minutes every two hours on the first day, then 3 times a day until the swelling has decreased. To prevent nerve damage, do not ice for longer than 20 minutes at a time. Never apply ice directly to the skin or to an open wound!

♦ Compression - wrap the injury for periods of 2-4 hours. Never sleep with a compression wrap unless medically advised.

♦ Elevation - place the injury above the level of the heart, allowing gravity to reduce the swelling.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

In addition to RICE, non-steroidal anti-inflammatory drugs (NSAIDs) are often used to decrease the symptoms due to inflammation and fever associated with injury. Although NSAIDs are usually available over-the-counter, these medications should not be taken lightly. In the case of an acute injury which involves bleeding, bruising, or swelling, NSAIDs should not be started until after the bleeding has stopped (may take days) and the swelling has stabilized. Some side-effects of NSAIDs include:

♦ Nausea, heartburn, vomiting, ulcers, and bleeding.

♦ Increased blood pressure.

♦ Decreases the ability of blood to clot.

♦ Worsening of asthma.

♦ Potential kidney damage with long-term use.

Some of the most common NSAIDs are aspirin (Bayer, Aspirin, Ecotrin),

ibuprofen (Advil, Motrin), and ketoprofen (Orudis). Remember: NSAIDs should not be used with alcohol. If you have stomach or gastrointestinal problems, check with your doctor for the appropriate pain reliever.

When to Seek Medical Care

Table 13-1 provides the description, prevention, and treatment for some training injuries. Knowing the differences between these injuries will help you safely administer first aid treatment, should they occur, and help you determine when you need to seek medical treatment. Some conditions demand immediate medical attention, including:

♦ Joint dislocation.

♦ Suspected fracture.

♦ Any hip pain which causes a limp.

♦ Back pain that radiates into the thigh, leg or foot.

♦ Severe pain or pain limiting activity for 3 to 5 days.

♦ Any lower extremity injury in which the individual is unable to bear weight.

Return to Duty

After the pain and swelling are reduced and full range of motion is possible, ask your physician or physical therapist to design a reconditioning exercise program with the overall goal of returning to full activity. The exercises prescribed will be specific to the site and type of injury, and will work towards maximizing:

♦ Specific Duty Tasks.

Overtraining Syndrome

Overtraining can negatively affect physical and mental performance. Moreover, it can increase the likelihood of sustaining an injury. Overtraining is exactly what the word implies: too much physical activity.

The overtraining syndrome can present with a wide range of physiologic or psychological symptoms which vary widely among individuals (See Table 13-2). Overtraining is generally associated with endurance sports, such as swimming or running. The best indicators of overtraining include a 10-15 beat elevation in (morning) resting heart rate and an altered mood state, such as feelings of frustration, anger, depression or apathy. Cross-training, rest, monitoring of morning heart rate, assessing mood and taking time off from certain physical activities will all reduce overtraining symptoms and injuries. The person who continues training despite the symptoms listed in Table 13-2 will only become more overtrained, continue to have decreases in performance, and will be at an increased risk for injury.

Table 13-2. Symptoms of Overtraining Syndrome

Decreases in performance and strength.

Feeling "burned-out" or stale.

Difficulty making decisions.

Difficulty concentrating.

Chronically fatigued.

Angry and irritable.

Lacking motivation.

Muscle soreness.

Disturbances in mood.

Increased distractibility.

Feelings of depression.

Difficulty sleeping.

Supplements and Performance

In this chapter you will learn about:

♦ Vitamin and mineral supplements.

♦ Nutritional ergogenic agents; hype versus reality.

♦ Risks associated with using performance enhancers.

♦ Ergolytic agents.

Gaining and maintaining physical fitness takes time and dedication. Often, to achieve these goals, people turn to various supplements based on their claims as performance enhancers. However, no supplement can replace the benefits of a well-planned exercise routine and a nutritionally-sound diet!

The definition of a nutritional supplement is "a nutrient taken in addition to your diet". An ergogenic agent is a substance taken with the intent of improving physical performance. This chapter will address vitamin and mineral supplements, nutritional ergogenic agents (performance enhancers), and substances that can be harmful to your health and decrease physical performance.

Vitamin and Mineral Supplements

Taking a vitamin or mineral supplement may be something you are considering, especially if you find it difficult to eat a variety of foods. Due to the various physiologic functions of vitamins and minerals, the supplement industry has tried to encourage supplement use by physically active people. However, multivitamin and mineral supplements do not appear to enhance performance in healthy, well-nourished individuals. A multivitamin and mineral supplement is useful if:

♦ You have an existing vitamin or mineral deficiency.

♦ You have poor dietary habits. In this case, increase the amount of nutrient dense foods and food variety in your diet!

♦ You are exposed to extreme environmental conditions, such as cold climates or high altitudes (Chapter 12).

Buying Vitamin and Mineral Supplements

The more informed you are about the marketing and manufacturing of supplements the more likely you can save money and still buy a good supplement. Facts you should know before buying a supplement are:

♦ Amount of Nutrients - Follow RDA/DRI guidelines in Chapter 2, taking too much of certain nutrients can be toxic. If you choose to supplement, take a multi-vitamin and mineral supplement that supplies nutrients in amounts close to the RDA/DRIs. Excessive amounts of a single nutrient can upset your nutrient balance and cause a deficiency of other nutrients. Avoid "high potency" supplements.

♦ Natural Versus Synthetic Vitamins - Both forms are used by your body. If manufacturers add plant extracts or a bit of the natural vitamin, they label the supplement as "natural" and sell it at a higher price.

♦ Additives - Many supplements contain additives that may cause headaches or other side effects in some people.

♦ Store Brands Versus Name Brand - A store brand supplement from a national retailer is of similar quality to a name brand supplement.

♦ Disintegration Rate - Supplement disintegration in the gut should meet the U.S. Pharmacopoeia (USP) standards (found on the label) of 30 to 45 minutes. This does not apply to time-release or chewables.

♦ Check the expiration date of the supplements you buy.

♦ Stress tablets are a marketing ploy.

♦ Men should not take iron supplements, unless directed by their doctor.



Nutritional Ergogenic Agents

Taking performance-enhancing supplements is a personal choice. Table 14-1, which lists some popular ergogenic agents grouped by type (identified in bold), their claimed benefits, and research findings, is designed to educate you as a consumer. Many of the ergogenic agents listed in this table are classified as nutritional supplements. When marketed as a nutritional supplement, these substances are not regulated by the Federal Drug Administration (FDA). Often this means that the performance claims and the risks associated with using these substances have not been thoroughly tested.

Table 14-1. Claims and Risks of Ergogenic Agents



Benefit / Risk / Side Effect

<A 0


Increases endurance and strength, facilitates postexercise recovery, increases oxygen release to tissues.

No benefits demonstrated; may cause an increase in free radical production.

.c c

Coenzyme Q10 (COQIO)

Raises heart enzyme levels to increase aerobic energy production.

No benefits in normal, healthy people.

m >.

Desiccated Liver

Increase energy and performance by supplying extra vitamins and minerals.

No benefits demonstrated.

0 c m

Bee Pollen

Improves performance and post-exercise recovery because it is a natural food with numerous nutrients.

No benefits demonstrated; may cause allergic reactions.

<A <A (A CD


Delays fatigue by increasing the use of fats for energy.

No benefits demonstrated; diet meets needs; not depleted with exercise; may cause nausea, vomiting and cramps.

Fat Burner ean Body M

Gamma Oryzanol, Ferulic Acid

Increases testosterone and lean body mass.

No benefits demonstrated; the plant sterols are not readily absorbed by the body.

Hydroxy-Methyl-Butyrate (HMB)

Slows muscle breakdown during intense training, increases strength.

Research is inconclusive.

Chromium Picolinate

Increases muscle mass, burns fat by enhancing the function of insulin.

Benefits are questionable; may cause stomach upset, anemia, or DNA damage.

o ü



Benefit / Risk / Side Effect

Arginine, Lysine, Ornithine

Stimulate GH release.

Some benefits for Arginine and Lysine, but not Orthinine; may cause gastrointestinal (GI) upset, potential amino acid imbalances, and decreases in GH.

Branched chain Amino Acids (Leucine, Isoleucine, Valine)

Stimulate GH, enhance muscle strength, endurance, and aerobic capacity by providing fuel to muscle and sparing muscle protein.

Some benefits demonstrated; may cause diarrhea and cramping.

Free Amino Acids

More readily absorbed in gut.

Little benefit demonstrated.

Dibencozide, Cobamamide

Promotes growth.

No benefits demonstrated on performance.

40-30-30, high fat/ protein diets

Increase endurance by promoting fat metabolism.

Some benefits; potential long-term risks are increased blood cholesterol and heart disease. Diet change 24-48 hr. before event leads to decrease in performance.

Medium Chain Triglycerides

Increase energy and decrease body fat because they are easier to absorb and use as fuel than triglycerides.

No benefits demonstrated; may cause GI problems.


Reduces fatigue, increases energy and work capacity.

No benefit demonstrated; may cause allergic reaction or excitability; may contain alcohol.


Delays fatigue by maintaining blood glucose levels.

Some benefits demonstrated.


Delays fatigue, burns fat, increases performance by elevating fatty acid levels in blood.

Some benefits; may cause irritability, GI pain, tremors, loss of concentration, and interfere with iron absorption. No increase in anaerobic or maximal aerobic capacity. Fewer benefits seen in habitual users.


Delays fatigue, reduces fat, improves physical and mental performance.

Benefits questionable; may cause nausea, diarrhea, and "fishy" body odor.

CD r



Benefit / Risk / Side Effect


Phosphate Salts

Delay fatigue and increase oxygen transport to muscle.

Results questionable; may cause GI upset.


Aspartate Salts (Magnesium/ Potassium)

Increase aerobic capacity, delay fatigue by neutralizing ammonia produced during exercise.

Results are inconclusive.

75 o


Increases endurance and delays onset of fatigue by buffering hydrogen ions produced during metabolism.

Some benefits demonstrated; may cause GI upset, diarrhea, nausea. Avoid large doses.


Sodium Bicarbonate

Delays fatigue during short, high intensity exercise by buffering lactic acid.

Some benefits demonstrated; may cause cramps or diarrhea.

Glandulars (grounded organs)

Ingesting animal organs high in testosterone leads to greater lean muscle mass.

No benefits demonstrated; may cause your own production of testosterone to decline.

(Smilax, Diascorea, Trillium, Yucca, Sarsaparilla)

Ingesting testosterone precursors leads to greater testosterone concentrations and muscle mass.

No benefits demonstrated; may cause light-headedness or aggression.

c ro .n c m a> c


Aphrodisiac and purported to cure male impotence. Increases muscle mass and decreases body fat.

No demonstrated increase in testosterone levels; conflicting results with regard to impotence; may cause dizziness, nausea, headaches, or depression.

0 <A


Increases production of testosterone.

No benefits demonstrated; may cause rashes nausea, vomiting, diarrhea, lethargy.

(A 0 1-

Androstenedione, Androstenediol, Norandrostenediol Andro

Increases energy, strength, muscle mass, and possibly greater sexual arousal and sense of well-being. Termed "prohormones.".

Considered a steroid; banned by many organizations; long-term risks are not well known. Risk of failing drug tests. "Natural" does not mean "safe"!


Slows aging, builds muscle, burns fat, boosts libido by increasing testosterone in body.

Little or no benefits demonstrated with respect to performance; side effects include acne, nausea, virilization. May increase risk of some cancers.




Benefit / Risk / Side Effect

Octacosanol (Wheat Germ Oil)

Improves aerobic capacity by enhancing central nervous system function.

Some benefits demonstrated in reaction times but not aerobic capacity; may cause allergic reactions.


Improves endurance by increasing blood volumes and decreasing core temperatures.

No benefits demonstrated; may cause cellular dehydration, nausea, vomiting, diarrhea.

Omega-3 Fatty Acids

Improve aerobic capacity.

No ergogenic effects have been demonstrated.


Increases stores of Creatine phosphate in muscle used for ATP-PC anaerobic energy system.

Some benefits demonstrated during short-term, high intensity exercise, but negated if ingested with caffeine.



Maintains cognitive performance during cold, stressful, or distracting conditions.

Benefits demonstrated.


Promotes muscle growth, prevents fatigue, overtraining, and immune deficiency.

No performance benefits demonstrated.


Glucosamine Sulfate with Chondroitin Sulphate

Component of connective tissue; has anti-inflammatory properties which increase recovery from musculoskeletal or overuse injuries.

Has potential for preventing and treating injuries, however, is not yet endorsed by doctors because of the lack of research.


Increases mental and physical performance by enhancing quality of sleep.

Benefits demonstrated; may cause sleepiness and fatigue at time of administration, but not upon awakening.

Steroid Alternatives

Increase muscle mass.

Risks include aggressiveness, acne, changes in behavior/ emotions, injury to connective tissue, impaired immune function, tumors, shrinking of testicles, decrease sperm and testosterone production, and masculinization in women. Use banned by the military.

Other sources of information include the Ergogenics Pamphlet (http://; the Alcohol Tobacco and Firearms web site at; the Federal Drug Agency at http:// (select the "Food" icon); and the Federal Trade Commission at (search "consumer publications"). Be aware of substances that are banned by the military and various athletic associations.

Ergolytic Agents

Ergolytic agents are those substances which impair physical and/or mental performance. When using these substances, you are undoing the benefits gained through training. Hopefully, by avoiding these substances, you can maximally improve your physical fitness and performance.

Table 14-2. Ergolytic Agents and Performance


Common Beliefs

Side Effects / Risks


Relaxes, increases self-confidence, alters perception of fatigue.

Heavy drinking can cause severe dehydration and decrease performance.


amphetamines, ephedrine

Improve performance by increasing central nervous system arousal.

Banned by the military; increases heart rate, increases blood pressure; may cause dizziness, stomach upset, irritability, insomnia, and death.

Cigarettes or Smokeless Tobacco (Nicotine)

Buzz leads to improved performance and reaction time.

Increases heart rate and blood pressure, leading to decreased performance.

Training Issues for Women

In this chapter you will learn about:

♦ Guidelines for exercise during pregnancy and lactation.

♦ Eating Disorders

♦ Osteoporosis.

Guidelines for nutrition and exercise for optimal health and performance are the same for women and men. However, special issues, such as pregnancy, will alter these practices. Seek the advice of your physician, Registered Dietitian, Health Promotion personnel, or contact the American College of Obstetricians and Gynecologists (ACOG) at (202)863-2518 for more information on women's health.

Pregnancy and Lactation

Pregnancy is one of the most physiologically stressful events undergone by healthy women. Because exercise is also a physiologic stress, there have been concerns about the effects of exercise on the health of the mother and child during pregnancy. To address these concerns, ACOG has established guidelines for exercise during pregnancy. The general consensus is that women in good health may continue (or start) exercising during pregnancy. However, each woman should consult her physician for personal recommendations.

Proper nutrition and routine exercise during pregnancy is important for your health and the health of your baby. Table 15-1 outlines general nutrition and exercise guidelines that you should follow during pregnancy.

Table 15-1. Nutrition and Exercise Guidelines for Pregnant Women

Nutrition Guidelines

Exercise Guidelines

Choose nutrient dense foods (Chapter 3, page 23).

Exercise at least three times per week. Ideally, start this before your pregnancy or during the first trimester. Consult your doctor.

Eat according to the Food Guide Pyramid to meet your increased energy needs (Chapter 3).

Monitor exercise intensity according to perceived exertion or effort (Chapter 5). Target heart rate zone is not accurate since heart rate is higher during pregnancy.

Get adequate folate intakes prior to and during pregnancy to prevent birth defects (Chapter 2, Table 2-2).

Try swimming as it is an excellent, low-impact aerobic exercise and the water helps regulate body temperature.

Talk to your doctor about the proper amount of weight to gain for your pregnancy.

Stop exercise if you feel short of breath, feel any pain, feel dizzy or faint, or have contractions.

Meet nutritional demands for both pregnancy and exercise. You should not attempt to lose weight.

Avoid supine (lying on your back) exercises after the first three months of pregnancy.

Drink adequate amounts of water for both hydration and dissipation of heat.

Avoid activities that may result in trauma to the abdominal area, such as contact sports.


Avoid exercises requiring balance, especially during the last three months of pregnancy.

Avoid exhaustive and maximal exercise.

Avoid exercising in environmental extremes.

Avoid saunas, stream rooms, and whirlpools.

Exercise guidelines adapted from the AGOC exercise guidelines.

Exercise guidelines adapted from the AGOC exercise guidelines.

There are some contraindications to exercise during pregnancy. If you have any of the contraindications listed below, discuss them with your doctor.

High blood pressure.

Irregular heart beats.


Premature labor.

History of premature labor.


Third trimester breech.

Extreme obesity or underweight.

Extremely sedentary lifestyle.

Incompetent cervix.

Multiple spontaneous abortions.

Unexplained complications.

♦ Thyroid, cardiac, vascular, or ♦ Bleeding or abnormal symptoms lung disease. during this pregnancy.

♦ Carrying more than one baby.

After the baby's birth, gradually resume exercise, ultimately building up to your pre-pregnancy levels of duration and intensity. To lose weight after your pregnancy, do so according to the guidelines in Chapter 1 and the Navy Nutrition and Weight Control Self-Study Guide (NAVPERS 15602A).

Nutrition and Exercise Guidelines for Lactating Women

Consult your baby's pediatrician or your family physician with questions and concerns you have about your and your baby's diet.

♦ Energy needs are higher when breast feeding than during pregnancy. Consume adequate kcals (roughly an extra 500 kcal per day).

♦ Choose nutrient dense foods (Chapter 3, page 23).

♦ Drink adequate fluids to prevent dehydration.

♦ Consume adequate calcium (see Chapter 2).

♦ Lactic acid production during exercise can affect the taste of breast milk, so breast feed prior to exercise.

♦ If you drink coffee, drink less than 2 cups a day; the caffeine may cause your baby to be sleepless and irritable.

♦ Avoid alcohol; alcohol enters the breast milk and can decrease the baby's appetite.

♦ Avoid cigarette smoking; smoking decreases milk production.

Female Athlete Triad

The Female Athlete Triad is a trio of associated disorders found among female athletes trying to balance the pressures of body image and physical performance. The triad (Figure 15-1), marked by inadequate food intake, menstrual abnormalities, and bone loss, can be fatal if left untreated. Therefore, a healthy relationship between food, body image, and performance must be established.

Figure 15-1. The Female Athlete Triad

Eating Disorder

Amenorrhea -

(cessation of menstrual cycles)


Some signs of the Triad are:

♦ Dieting excessively to lose weight.

♦ Occurrence of stress fractures.

♦ Compulsively overexercising.

♦ Irregular or absent menstrual cycles.

♦ Self-esteem governed by body weight.

Eating Disorders

Eating disorders are more prevalent than one might think, especially among young female athletes. An eating disorder results in inadequate intakes of kcals and nutrients to replenish the energy used during daily activities. Two common types of eating disorders are Anorexia Nervosa and Bulimia Nervosa. Some behaviors people with eating disorders engage in are starvation, self-induced vomiting, excessive exercise, and the misuse of laxatives or diuretics. Both disorders are extremely damaging to the mind and body, and, if untreated, can lead to death. These disorders can have long-term health consequences by affecting the heart, liver, kidneys, and bone. In addition, these behaviors severely limit physical and mental performance.


Amenorrhea is the cessation of menstrual cycles. A women is considered amenorrheic when she misses three or more consecutive menstrual cycles. In well-nourished women, heavy physical training should not result in amenorrhea. When non-pregnant, premenopausal women become amenorrheic it may reflect malnutrition.

From FS Kaplan. Prevention and Management of Osteoporosis. CIBA Clinical Symposia. 47(1); 1995.

From FS Kaplan. Prevention and Management of Osteoporosis. CIBA Clinical Symposia. 47(1); 1995.


The decreased levels of female hormones during amenorrhea can lead to calcium loss from the bones and ¿||gjFl increase the likelihood of developing osteoporosis later in f |||||

life. Osteoporosis is a major cause of bone fractures in the jr^rjf elderly. Bone density throughout the adult lifespan is m bjgl greatly impacted by the amount of bone formed prior to the M W^

early thirties. Therefore, amenorrhea and eating disorders ™ \\

in young adults can negatively affect bone health for life. u (

Prior to menopause, a healthy diet (including adequate iff '

calcium intakes) and the performance of weight bearing | I

activities are the two factors that have the greatest positive y I influence on bone health (see Chapters 3, 4, 5, and 7). For more information on bone health, ask your doctor or health care provider.

In this chapter you will learn about:

♦ Age-associated changes in metabolism and body composition.

♦ Countering age-associated changes in physical performance.

Aging is a natural process that most, if not all, people would like to avoid. Most people associate aging with gaining weight, getting weaker, and not being able to perform many of the activities they did in their youth. Many of these conditions are actually the result of inactivity, not aging. Although there are several inevitable physiologic changes that will occur as you age, the degree of these changes can be manipulated through sound dietary and exercise practices.

Changes in Metabolism and Body Composition

Maintaining a healthy body weight and body fat percentage throughout your adult life is key to maintaining health and fitness as you age. This often seems easier said than done, considering basal metabolic rate (BMR, see Chapter 1) declines as you age.

With aging, expect to see a gradual decline in BMR, possibly resulting in needing 100 fewer kcal a day with each passing decade.

Taken from Tufts University Health and Nutrition Letter. November 1998; 16(9): 6.

The loss of muscle mass as you age is directly responsible for the decline in BMR. Muscle is metabolically active, which means that it requires a set number of kcals each day to maintain its mass. On average, people lose some muscle mass each year after the age of 35 years. This results in fewer metabolic demands and less total daily kcal requirements. However, the amount of muscle mass that you lose is dependent upon how much physical activity you perform as you age, particularly activities that require muscle strength such as strength training. By engaging in strength training exercises you will preserve and possibly gain muscle mass, leading to a 10% to 15% boost in your BMR!

Along with a decrease in muscle mass, inactivity can also lead to an increase in body fat. This occurs if the number of kcals consumed is greater than the number of kcals expended through physical activity, as explained in the energy balance equations in Chapter 1. This simultaneous increase in body fat and decrease in muscle mass leads to a greater body mass index (BMI) and is associated with an increased risk for heart and blood vessel diseases, obesity, diabetes, and other diseases (see Chapter 1).

Any alterations in energy expenditure, either through changes in BMR or changes in physical activity level, need to be countered by changes in kcal intake to keep your net energy balance at zero and to maintain your current body weight. Therefore, a combination of sound nutritional practices and regular physical activity will enable you to maintain a healthy body weight and body composition and remain physically fit as you age.

Nutritional Needs

The Dietary Guidelines for Americans and the Food Guide Pyramid (outlined in Chapter 3) were designed to provide basic nutritional information and serve as educational tools for Americans over 2 years of age. Therefore, these guidelines should be followed to ensure good nutrition throughout your life. An important point to note is that although the age-related decline in BMR results in the need for fewer daily kcals, the requirements for nutrients such as vitamins, minerals, and proteins do not decrease with age (see Chapter 2). Therefore, proper food selection is essential to meet this challenge. Some ideas to help you meet your nutrient requirements without eating extra kcals include following the 5-A-Day campaign (eat at least five fruits and vegetables a day) and eating nutrient dense foods (see Chapter 3 and Appendix A).

Countering Age-Associated Changes in Fitness

Ever heard the saying "use it or lose it?" This is true for physical fitness. Whether it is muscle strength or aerobic endurance, if you do not remain physically active as you age you cannot maintain the muscle mass or heart adaptations you need for peak performance (review the effects of detraining listed in Chapter 4). Though aging can lead to decreases in fitness levels, the amount of decline is strictly dependent on your exercise routine. Therefore, age itself does not predispose you to have large decrements in physical performance.

Some gradual changes you can expect in your physical performance as you age are listed below.

♦ Aerobic Capacity - Declines in aerobic capacity, about 5% to 15% per decade, can start occurring after the age of 30. This is due to a combination of less physical activity, a lowering of the maximal heart rate, and decreases in the elasticity of the blood vessels. Declines in aerobic capacity can be minimized by maintaining a regular aerobic exercise routine. In particular, maintaining your exercise intensity, even if you exercise less frequently each week, will enable you to preserve much of your cardiorespiratory fitness as you age (see Chapters 4, 5, and 6).

♦ Anaerobic Performance - Declines more than aerobic capacity mainly because people tend to perform less near-maximal exercise as they age. This decline can be minimized by performing speed work in addition to your aerobic conditioning (see Chapter 5 for performance-related workouts). Training for speed is only necessary if you want to maintain your performance-related fitness or are still participating in competitive sports (see Chapters 4 and 5).

♦ Muscle Mass and Strength - Both muscle mass, particularly the fast twitch fibers, and muscle strength decline after the age of 40. Losses can be minimized and even reversed if strength training exercises are performed regularly. As with aerobic fitness, the intensity of the strength exercises will determine the degree of your training benefits and slow the loss of muscle as you age (see Chapters 4, 7, 8, 10, and Appendix C).

♦ Flexibility - Connective tissue around your joints can become less elastic with age. However, no measurable declines in flexibility will occur if you regularly perform stretching exercises. Maintaining your flexibility is important as this determines the range of motion of your joints and decreases the feeling of stiffness in your joints. Flexibility also serves an important role in injury prevention and may reduce symptoms of arthritis. (See Chapters 4 and 9.)

Other fitness issues to be aware of as you age include the following:

♦ Warm-Up and Cool-Down - Longer warm-up and cool-down times are needed to optimize performance as you age, particularly if you are participating in strenuous exercise. These longer warm-up and cool-down times will help prepare your body for the upcoming exercise and reduce your risk of injury (see Chapter 4).

♦ Recovery from Workouts - You will need to allow for longer recovery times from strenuous workouts and competition as you age. You may actually notice this before you notice a decline in your performance. Listen to your body and allow for adequate recovery time by following a hard workout with a couple rest days or light workout days. In addition, allow your body adequate time to adapt to increases in your workout. Again, maintaining your intensity is more important than exercising more frequently to maintain your fitness. Also, pay attention to the warning signs of overtraining (see Chapter 13).

♦ Recovery from Injuries - As with recovery from a strenuous workout, you will need more time to recover from training injuries. Be patient and allow yourself to fully recover. This will help you avoid future injuries (see Chapter 13).

♦ Cross-Training - No specific exercise is better than another to offset all the health and fitness changes mentioned. However, many of these concerns can be addressed by cross-training, or altering the types of exercises you perform, throughout the week (see Chapter 5). By cross-training you can improve and maintain your aerobic fitness while recovering from intense workouts or while taking a break from weight-bearing exercises. This will help prevent overtraining and overuse injuries (see Chapter 13) while you remain physically active. Consider making cross-training a regular practice in your exercise routine, if it is not already.

As you grow older your responsibilities, interests, leisure time activities, as well as your level of motivation may affect how physically active you are. However, it is important to remember that a sedentary or inactive lifestyle, combined with poor eating habits, can increase the risk for developing obesity, heart disease, strokes, diabetes, some types of cancers, high blood pressure and osteoporosis. Adopting sound eating and exercise habits (the earlier the better) can help reduce the risk for developing the above mentioned diseases. Chapter 17 provides information on how to develop and maintain healthy habits.

Adopting Healthy Habits

In this chapter you will learn about:

♦ Setting SMART goals.

♦ Evaluating progress.

♦ Staying motivated and overcoming setbacks.

Forming habits to enhance physical performance and for achieving a healthier lifestyle is both personally and professionally rewarding. Using the information provided in the preceding chapters, you can set goals, develop healthy habits and achieve your objectives. For example, if your objective is to improve cardiovascular fitness, use the information provided in Chapters 4, 5, 6, and 11 to design your a plan of action. Remember, effective programs for enhancing physical performance and overall health include both sound nutrition practices and appropriate physical training.

The process of developing and maintaining healthy habits can be challenging. It is a gradual process which requires commitment, effort and perseverance. Ultimately, the payoff will be in the form of enhanced job-related physical performance, being in great physical shape, and lowering your risk for developing chronic health problems as you get older. Everyone ages: steps you take now will last a lifetime!

Setting "SMART" Goals

As you go through the process of changing and adopting healthy habits, you are actively taking charge of your health. Begin by setting Specific, Measurable, Action-oriented, Realistic and Timed (SMART) goals to meet your fitness and health-related objectives. A SMART goal should be:

♦ Specific - The more specific the goal, the easier it is to plan your routines to reach the goal. If you have a general goal, pick a specific area to focus on. For example, define "I want to increase my running distance" to "I will increase my running distance by one mile." Another example, restate "I want to increase my dietary fiber intake" as "I will add one additional serving each of fruits and vegetables to my daily diet".

♦ Measurable - Your specific goal should be easy for you to measure so you can chart your progress. Taking the running example above, you can easily measure the distance you run to determine if you are meeting your goal. As for the fiber example, you can record your fruit and vegetable intake (see Appendix A).

♦ Action-oriented - When defining a specific goal state exactly what actions you must do to achieve the goal. This becomes your plan to reach your goals. For example, "I will increase my run by a quarter mile every two weeks until I am able to run an additional mile."

♦ Realistic - Be realistic in your expectations of yourself and what you expect to gain. Taking large or long-term goals and breaking them into smaller, more manageable goals to keep you motivated and focused on your actions. For example, train for and run a 5k race, then build up to a 10k race.

♦ Timed - Time lines provide direction in planning short-term goals and actions to reach long-term goals and objectives. Using the running example above: two weeks is the deadline for increasing run distance by a quarter mile, and two months is the long-term deadline for increasing distance by one mile.

Table 17-1 lists a number of general nutrition and fitness-related goals to assist you in identifying your own goals and in designing and setting "SMART" goals as described above.

Table 17-1. Some General Nutrition and Fitness-

Related Goals

Table 17-1. Some General Nutrition and Fitness-

Related Goals

General Nutrition-Related Goals

General Fitness-Related Goals

Read food labels when buying foods.

Health benefits (lower cholesterol, lower blood pressure, and lower stress).

Eat foods according to their serving sizes.

Improve/maintain heart and lung (cardiovascular) fitness.

Eat at least 5 servings of fruits and vegetables each day.

Improve/maintain muscular strength.

Include foods that are good sources of calcium.

Improve performance of job-related physically-demanding tasks.

Follow the U.S. Dietary Guidelines.

Maintain healthy body weight and body fat.

Drink plenty of fluids to maintain fluid balance.

Improve/maintain flexibility.

Eat more dietary fiber.

Have strong bones.

Reduce saturated fat and cholesterol intakes.

Improve physical appearance.



The more specific and realistic your goals, the easier it will be to develop and follow action plans to meet these goals. More than likely, unforeseen events will lead to altered plans; expect this and keep your ultimate goals in mind when replanning. Next incorporate your plan into your daily routines. At first you will have to consciously make efforts to follow your plans, but, after continuous practice, these plans will become your new habit. The following points and the steps and actions listed in Table 17-2 will help you reach your goals:

♦ Start simple: pick a goal that you feel will be easy to achieve.

♦ If you notice that you are having difficulty achieving a goal, revise your plan and alter your strategy.

Table 17-2. Steps and Actions To Take To Reach

Your SMART Goals




Develop an support system of friends, family and/or coworkers who will encourage you.


Make change a priority; Make time; Remember you control your off-duty schedule.


Create a plan of action -- one that works for you, motivates you and fits in your schedule.


Monitor your progress -- use the tracking charts provided in Appendixes A and B.


Reward yourself when you meet a goal.

Use long-term vision. Remember healthy habit will greatly enhance the quality of your life in later years.

Adapted from National Cancer Institute and Centers for Disease Control and Prevention (

Maintaining Healthy Habits

Once your "new" habit becomes a part of your routine and is performed without forethought or effort, you are maintaining, rather than adopting, this habit. Maintaining healthy habits during interruptions in your regular routine (such as vacations or illness) can create challenges of its own. So how can you maintain

your routine when faced with setbacks?

♦ Anticipate and try to avoid setbacks or upsets to your routine.

♦ Plan in advance how you will handle interruptions (e.g.vacation) to your schedule.

♦ Motivate yourself to restart your routine when things "return to normal". For example, give your workout buddy $20 before you go on vacation to keep on your behalf until you restart your exercise routine.

♦ Reward yourself once you have achieved maintenance for your goal. The reward should be appropriate for the goal attained (preferably non-food). For example: put $1 in a piggy bank for every workout you complete for a month and use it to buy yourself new exercise gear or a ticket to your favorite sporting event.

♦ Enhanced fitness builds self-confidence which is a powerful motivator!

Ultimately, your perceptions of the health and fitness benefits associated with healthy eating practices and regular exercise are important for maintaining healthy lifestyle behaviors. We hope that the information provided in this guide motivates you to personally follow healthy nutrition and physical fitness practices and to educate fellow navy personnel to do the same.

Health and Fitness 101

Health and Fitness 101

Self-improvement is a thing which you must practice throughout your life because once you started to believe that you are perfect then, things will start to become complex. You need to know that no one is perfect and no one can be perfect.

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