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COVID-19 presents challenges to heart health, physical fitness

Four military personnel, wearing masks, running on a track U.S. Coast Guard recruits from company Romeo-199 participate in a Jan. 8 run program on the track at U.S. Coast Guard Training Center in Cape May, New Jersey, as part of their modified training schedule due to COVID-19 restrictions. (Photo by Navy Seaman Josalyn Brown.)

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A healthy heart is a prerequisite for a fully trained combatant or a fit beneficiary. Without a healthy heart, a soldier cannot expect to complete tasks such as loading 155 mm rounds onto a bustle rack, or a beneficiary may huff and puff going up stairs.

"A heart at rest stays at rest, while a heart in motion stays in motion, to paraphrase the old axiom," said Navy Lt. Cmdr. (Dr.) Olamide Oladipo, chief of cardiology at the Navy Medical Center-San Diego (NMC-SD).

Due to on-again, off-againshutdowns resulting from the COVID-19 pandemic, the overall health of both military personnel and beneficiaries has taken a hit over the last year, he noted. A more sedentary lifestyle increases the risk of cardiovascular disease and, therefore, death.

One way the military is addressing this issue is through the Aging Warrior study, which intends to look at cardiovascular risks in men 40 and older and women 52–55 with one risk factor for cardiac disease, such as hypertension, Oladipo explained. Following a CT scan, study participants will receive preventative medication or other interventions if they show early signs of cardiac atherosclerosis (a narrowing or blockage of the heart vessels).

As to fitness, NMC-SD has “adopted more of a holistic approach; we treat the whole person” among active-duty personnel and beneficiaries, said Melissa Palacios, a nurse and head of the Health and Wellness Department at NMC-SD’s Naval Medical Readiness Training Command. “We’re looking at concomitant diagnoses that affect a person’s heart health,” such as diabetes, sleep apnea, obesity, stress, PTSD.

“We do this though more virtual classes, group-based exercise programming, fitness trackers and apps that help with heart rate monitoring, food intake, medication, and sleep hygiene, for example,” she said, also noting the negative impact COVID-19 has had on the base’s effectiveness in physical training and meeting beneficiaries’ fitness needs.

“Getting moving can have a profound impact on lowering blood pressure, strengthening muscles, controlling weight, lowering stress, and reducing inflammation, therefore decreasing risk for heart disease,” Palacios said. “We encourage our active-duty members and beneficiaries to not only participate in aerobic activities such a swimming, dancing, cycling, brisk walking or cycling but also in identifying opportunities in their everyday lives to intentionally become more physically active such as taking the stairs.”

The ideas behind fitness training also have changed in the Army. At Ft. Leonard Wood in Missouri, unit physical training “used to be very focused on the Army Physical Fitness Test events (pushups, sit-ups, and running),” said Army Maj. Brett Dougherty, director, Physical Performance Service Line, General Leonard Wood Army Community Hospital. “However, over the last few years, that focus has slowly changed to incorporate more resistance training, specifically functional lifting, and that change accelerated with the introduction of the Army Combat Fitness Test that looks at the body more functionally.”

Functional lifting are exercises that help troops perform everyday activities more easily, such as changing heavy tires.

The Army follows the October 2020 FM 7-22 guidance on fitness and physical performance, which includes five domains of combat physical fitness: muscular strength, muscular endurance, aerobic endurance, explosive power, and anaerobic endurance. The guidance lays out exercises, stretches, progressions, and sample schedules of how to train for Army fitness tests and overall fitness. It includes aerobic exercise, strength and resistance training, agility, flexibility, and balance.

FM 7-22 also gives guidance on nutrition, sleep hygiene, mental wellness, and the overall well-being of soldiers, all factors integral to overall heart health.

Physical fitness is therefore much more than laps run, push-ups done, crunches crunched. It’s a holistic framework of both physical and mental fitness that means being able to exercise while avoiding injury and enjoying a longer life span. And, when it comes to physical fitness, a healthy heart is paramount.

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This Practice Management Guide does not supersede DoD Policy. It is based upon the best information available at the time of publication. It is designed to provide information and assist decision making. It is not intended to define a standard of care and should not be construed as one. Neither should it be interpreted as prescribing an exclusive course of management. It was developed by experts in this field. Variations in practice will inevitably and appropriately occur when clinicians take into account the needs of individual patients, available resources, and limitations unique to an institution or type of practice. Every healthcare professional making use of this guideline is responsible for evaluating the appropriateness of applying it in the setting of any particular clinical situation. The Practice Management Guide is not intended to represent TRICARE policy. Further, inclusion of recommendations for specific testing and/or therapeutic interventions within this guide does not guarantee coverage of civilian sector care. Additional information on current TRICARE benefits may be found at www.tricare.mil or by contacting your regional TRICARE Managed Care Support Contractor.

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DoD COVID-19 Practice Management Guide Version 5

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This Practice Management Guide does not supersede DoD Policy. It is based upon the best information available at the time of publication. It is designed to provide information and assist decision making. It is not intended to define a standard of care and should not be construed as one. Neither should it be interpreted as prescribing an exclusive course of management. It was developed by experts in this field. Variations in practice will inevitably and appropriately occur when clinicians take into account the needs of individual patients, available resources, and limitations unique to an institution or type of practice. Every healthcare professional making use of this guideline is responsible for evaluating the appropriateness of applying it in the setting of any particular clinical situation. The Practice Management Guide is not intended to represent TRICARE policy. Further, inclusion of recommendations for specific testing and/or therapeutic interventions within this guide does not guarantee coverage of civilian sector care. Additional information on current TRICARE benefits may be found at www.tricare.mil or by contacting your regional TRICARE Managed Care Support Contractor.

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