Download Total Force Fitness: A Brief Overview

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This presenta,on is intended to provide a brief overview of the Chairman, Joint Chiefs of Staff Total Force Fitness (TFF) ini,a,ve. The purpose is to introduce the eight domains that make up the TFF framework to include both the mind and body; provide some brief background on how these were developed; explain on one slide per domain what the main components of that domain are and how leaders can promote that domain in day-­‐to-­‐day training or opera,ons; give a few examples of how the domains inter-­‐relate; and, provide the references that support the TFF ini,a,ve. So let’s get started. . . . 2
In the CJCS Guidance for 2009-­‐2010, then CJCS Admiral Mike Mullen, USN, in his second priority and strategic objec,ve under Health of the Force, stated: “Health of force goes beyond our people ─ our systems and capabili,es are under extraordinary stress as well, and reseVng and recons,tu,ng the force will take significant ,me and resources. Our core responsibility is to win wars while caring for our people and their families. They are the heart and soul of our forma,ons. . . .” Of concern to the CJCS was the lack of a holis,c approach to fitness that included approaches to strengthening and crea,ng fitness for both the mind (emo,onal) and body (physical). The Chairman also charged leaders to begin a new apprecia,on and understanding of fitness through an approach called “total fitness” that looks not only at individual fitness but unit fitness. And, in a further reference dedicated to the en,re TFF ini,a,ve, Admiral Mullen stated in the Military Medicine special supplemental issue of August 2010: “Total fitness is a state where mind and body are seen as one. It is a state where people, their families, and the organiza,ons in which they serve are connected and thriving. . . ” Since that ,me, a CJCS Instruc,on has been published that outlines the basics of TFF: CJCSI 3405.01. This instruc,on is also the primary resource and reference for this brief. Addi,onal ,more current drivers for TFF include the Joint Publica,on 1, “Doctrine for 3
TFF may be defined as: A state in which the individual, family and organiza,on can sustain op,mal well-­‐being and performance under all condi,ons.” It is a force preserva,on and readiness issue. As Admiral Mullen stated: “I see readiness as all about being capable of being able to accomplish something you are called to do.” A goal of TFF is to provide holis,cally based approaches, as we will soon see in this presenta,on, that promote resilience and allow individuals, units, and families to grow and recover in ever changing environments with mul,ple demands. The end state of this is op,mal health where all thrive and are not merely free from injury or disease. As shown here, the four pillars of physical, mental, social, and spiritual health should all be taken into considera,on when defining health or fitness. We will talk more about this in a few minutes. And, TFF is not designed to be a new program but rather, a new doctrine. In fact, as we will see later, it is being wriaen into the revision of the capstone Joint Doctrinal Publica,on 1: Doctrine for the Armed Forces of the United States and will be formulated into a stand alone test doctrinal publica,on in the near future. So what are it’s core components? 4
TFF takes into considera,on these five key components: 1) A holis,c, integrated approach is necessary for us to asses and sustain the op,mal well-­‐being of our warriors and their families 2) TFF for our warriors and families should be considered a life,me commitment 3) Commanders and leaders at all levels are responsible for promo,ng the fitness across all eight domains 4) A service member cannot be fully prepared to execute his or her mission un,l they are comfortable that the needs of their families are being met 5) And TFF u,lizes metrics, or is developing metrics now, to measure the effec,veness of strategies used to integrate the domain into training or opera,ons. And as previously stated, for the purposes of this brief, we will not go into metrics since they vary from domain to domain, are not all well-­‐established at this ,me, and, as men,oned, are in current development 5
From 6-­‐9 December 2009, 70 subject maaer experts from all military branches, academia, and civilian agencies represen,ng all eight domains assembled at the Uniformed Services University of the Health Sciences. Each of the SME’s were assigned to one of the eight domains shown in their respec,ve “mind” or “body” categories on this slide. The SME’s were tasked by then CJCS, Admiral Mike Mullen, USN, to expand the defini,on of fitness from that of just “physical fitness” to a more holis,c approach of fitness that worked also not only for the individual but for families, units, and even communi,es where service members reside. This slide shows the four components for the “mind” and “body” categories for TFF which was also shown when you saw the TFF Octagon Shield a few slides back. The next slide shows how these two areas categories of “mind” and “body” intersect for the individual and also fitness for and supported by their family, organiza,on or unit, and even the community in which they live. 6
As shown on this figure from the cover of Military Medicine, August 2010, Volume 175, No 8, the two categories of the “mind” and the “body” intersect. This represents a new paradigm. Total holis,c fitness does not just involve, as previously understood, physical fitness. It also involves the seven other domains, which you will see for the second ,me in the next slide. And, it is at more than on an individual level. Of importance is fitness for the individual shown in the center of this figure, but also fitness for the Service member’s family, their organiza,on or unit to which they belong, and also the larger community where they reside to include their base or duty sta,on or even the outside local community. The next slide is the TFF Octagon Shield you saw several slides ago and it will put together the four domains for the mind and the four domains for the body showing all eight domains for TFF. 7
The TFF octagon shield is the signature figure of TFF. This shield is a figure that shows all of the eight domains. The psychological, behavioral, social, and spiritual domains represent those of the “mind” or emo,on . The physical, environmental, medical and dental, and nutri,onal domains represent those of a physical nature or those of the “body.” We will soon go through each domain and talk briefly about each of the The next slide that you will see is a figure that gives a composite of these two inter-­‐related broad areas that we address in TFF: the “body” and the “mind.” components. Let’s start with the body domains with physical being our first area to look at. 8
Note: All photos in the domain slides to follow are retrieved from the Department of Defense Imagery Website which may be accessed at: hap://dodimagery.afis.osd.mil All of the defini,ons and components for these domains come from the CJSI 3405.01, September 1, 2011: “Chairman’s Total Force Fitness Framework.” They are all fairly straighkorward and easy to understand. The main components of each domain are found in the TFF shield, and that’s what we’ll be learning about and a couple of strategies leaders can do to enhance or promote several sample components for each domain. Let’s start with the four domains that address “the body.” The defini,on of physical fitness is: “The ability to physically accomplish all aspects of the mission while remaining healthy and uninjured.” To fully accomplish the military mission, regardless of in a garrison or deployed status, it is impera,ve that all members aaain the highest possible levels of “physical fitness.” Components of physical fitness: In order to achieve this it is recommended that members concentrate on a well-­‐rounded physical fitness program that includes cardio training such as running, biking and swimming as well as balanced strength training which may be achieved through working with cer,fied fitness instructors (all of the Services have these) to develop a personalized weight training program. Developing and maintaining flexibility, speed and agility are also essen,al. 9
The defini,on of medical and dental fitness is: “The ability to meet established standards for medical readiness.” To fully accomplish the military mission, it is impera,ve that all members be medically fit and in the highest standards of dental readiness to avoid injury to themselves and those with whom they serve. Components of medical and dental fitness: Immuniza,ons, screening and preven,on apply to all aspects of medical care to include medical, dental, auditory and vision health. Preven,on and pretreatment are the keys to well-­‐rounded medical health. This is especially important in a deployed environment where care may be limited requiring medevac from a hos,le or remote environment. This requires much logis,cal support and addi,onal troops and places greater risk on more personnel. Strategies leaders might take enhance medical and dental fitness could include: 1) Ensuring that all members of the unit are in the highest prescribed state of medical and dental readiness as required by direc,ves and instruc,ons that address this area of fitness 2) Providing a s,gma-­‐free environment for those seeking care for health problems, and encourage and support aaendance at appointed medical appointments for any health concern 10
The defini,on of environmental fitness is: “The ability to perform mission-­‐specific du,es in any environment.” The physical environment in which service members operate is omen seen as “the first enemy.” It is impera,ve that the opera,ng environmental condi,ons within the area of opera,ons or responsibility is understood, and that challenging factors encountered (heat, cold, mountains, heights) are mi,gated to the best degree possible. Components of environmental fitness include: condi,ons of extreme heat or cold, al,tude, noise and poor air quality. These will all affect the performance of both the individual and the unit. The environment also includes possible contaminants in water or local food as well as chemical, biological, nuclear and radiological (CBNR) concerns. A proper understanding of the risks and challenges of the environment in which troops will be or are exposed to is essen,al to the overall fitness of units and their members. Strategies leaders might take to enhance environmental fitness could include: 1) Ensuring that all members of the unit understand the environment that they will be deployed in, and are as familiar as possible with known and exis,ng risks to include: heat/cold, al,tude, noise, air quality and par,cular CBNR threats 2) Ensure that all members have every possible protec,ve gear and all supplies necessary to survive and thrive in any environment, especially those with extreme condi,ons (such as the heat in the Middle East, and the al,tude challenges of 11
The defini,on of nutri,onal fitness is: “The ability to recognize and select the requisite nutri,on to sustain and op,mize physical and cogni,ve performance and health.” Nutri,onal fitness includes the provision and consump,on of food in quan,,es, quality and propor,ons sufficient to preserve mission performance and to protect against disease or injury. The nutri,onal requirements of members of an infantry baaalion or special opera,ons unit are far different and surpass the nutri,onal needs of a service member who has a garrison desk job. Components of nutri,onal fitness are: food quality, nutri,onal requirements and food choices. Much of this is dependent upon who we are, how we were raised and what our par,cular culture or religion may dictate. Given the diverse make-­‐up of our military Services, special dietary concerns must omen be taken into considera,on. Examples include prohibi,ons of ea,ng certain foods, and special requirements during holy days observed by service and family members. All Services have lately taken up healthy ea,ng campaigns for the dining facili,es. All the Services are currently using the Military Nutri,onal Environmental Assessment (m-­‐NEAT). Another important area to consider is the use of supplements. Members may educate themselves and receive informa,on on supplements and what they are using from the HPRC Website. Strategies leaders might take to enhance nutri,onal fitness could include: 1) Provide opportuni,es to educate members on healthy ea,ng choices to include 12
The defini,on of psychological fitness is: “The ability to effec,vely cope with the unique mental stressors and challenges needed to ensure mission readiness.” Psychological fitness includes one’s ability to be resilient. It involves being able to adapt, be flexible (see figure) and recover from adversity and apply mental strength especially in difficult ,mes. Psychological fitness is the ability to manage and use external resources (leadership, training) and internal resources (managing feelings and framing challenging situa,ons posi,vely). Components of psychological fitness include: the ability to cope with adversity and challenges; awareness of how you are doing mentally and emo,onally; being able to formulate and ar,culate values and beliefs and make accurate and omen fast appraisals of situa,ons; the ability to make sound decisions that not only affect yourself but those you lead; and, being able to be engaged and aaen,ve to the mission and task at hand. Strategies leaders might take to enhance psychological fitness could include: 1) Modeling op,mism and self-­‐confidence to help service members cope and frame up beliefs and appraisals posi,vely; it’s catchy!! 2) Learn about and u,lize each unit member’s strengths and weaknesses, and encourage members to use their strengths to benefit the mission at hand and the unit (engagement) 13
The defini,on of behavioral fitness is: “The ability to adopt behaviors that support individual readiness and health.” Behavioral health refers to the ability to integrate op,mal and posi,ve behaviors that enhance one’s health. It involves individual responsibility to care for oneself in one’s daily ac,ons. Components of behavioral health include: the ability to not abuse drugs or alcohol so that it impairs with daily physical and psychological func,oning; proper hygiene and cleanliness, which is especially important in a deployed environment; and mi,ga,ng risky behaviors, such as drinking or drugging and opera,ng machinery or vehicles, or smoking tobacco products which are known to cause cancer or at least shortness of breath in physical ac,vi,es. Finally, behavioral health involves peer support − both receiving help from friends and peers in the units and watching out for your buddy on the baale field or in the barracks or bar amer work. Strategies leaders might take to encourage behavioral fitness could include: 1) Enforcing a command climate where unit members care for each other, watch out for each other, feel free to reach out for help, and understand the value of unit cohesiveness and esprit de corps 2) Encouraging unit members to get the sleep they need to func,on properly and safely, and discourage the use of tobacco products under any circumstance 14
The defini,on of social fitness is: “The ability to engage in healthy social networks that promote overall well-­‐being and op,mal performance.” “Semper fidelis” (always faithful), the Marine Corps moao, demonstrates this best: members are faithful to their country, their Corps and mostly to each other. Service members reach out to their peers, have their back in and out of combat, and know that their unit buddies have their backs as well. Components of social fitness include the ability to receive support from one’s family ─ this may be your immediate or extended family, and for some single service members may be their unit members and even families of other unit members. Social support from peers has already been discussed above. Task cohesion, or the ability to work together to fulfill the mission is a key component of social fitness. All of these lead to a greater sense of what is called social cohesion: the bond of trust and confidence
that occurs by overcoming shared challenges.
Strategies leaders might take to enhance social fitness could include: 1) Encouraging unit cohesion through posi,ve leadership, communica,on, encouraging flexibility and adaptability, and providing opportuni,es for unit members to interact posi,vely both in the mission and social seVngs 2) Extend leadership to families; be a posi,ve role model; and connect unit personnel to 15
The defini,on of spiritual fitness is: “The ability to adhere to beliefs, principles, or values needed to persevere and prevail in accomplishing missions.” It involves developing personal quali,es that go beyond the self (transcendence) and are grounded in something bigger than the self and the military, and benefit the unit as a whole. Such things as making sense of difficult situa,ons, engaging in journaling or prayer, offering care and support to others in need, and having a posi,ve sense of iden,ty and self are all spiritual acts. Spirituality does not have to be religion or religious, but it can be for those who choose this as a form of spiritual expression. Components of spiritual fitness are: perspec,ve; core values; iden,ty, meaning, and purpose; ethical founda,on; and, embracing diversity. One’s perspec,ve or worldview is precisely that ─ how one sees the world as a whole (good, bad, indifferent). Core values are as basic as knowing and adhering to your branch of Service core values and moaos. Having a sense of iden,ty and who you are in the world and even in the unit and developing a sense of purpose around that is a spiritual virtue. And, embracing and apprecia,ng the diversity within your unit and society and world as a whole is a component of living a spiritual life that is sound and fit.
Strategies leaders might take to encourage spiritual fitness could include: 1) Encouraging unit members to appreciate the diversity within their unit to include: 16
This figure can be arranged in any way with any of the domain circles in any order. All of the circles relate to each other. This figure merely provides one overview showing how all domains are inter-­‐related. We’ll start with the mind domains first. Psychological: Perhaps one of the most direct links to the psychological fitness domain is the spiritual fitness domain. Two examples of this overlap become very apparent in the area of spiritual prac,ces, as they enhance awareness and how meaningfulness is directly ,ed to the psychological area of beliefs and aVtudes. Many spiritual and psychological prac,ces overlap, such as mindfulness and mind-­‐body training, which can alter and enhance specific aspects of the psychological domain of self and environmental awareness. Marine and Army ground combat units have both used mindfulness and mind-­‐body training to improve aaen,on and self-­‐regula,on. Spiritual: The spiritual fitness domain also naturally intersects with the social domain where social support, task cohesion, and social cohesion form the core components. All of these components of the social domain ,e in to the spiritual domain via posi,ve connec,ons with others. Also, one’s culture and social systems create social reali,es that influence people’s percep,ons of what is right and wrong, what are the values to lead and live by, how should we treat each other, what provides work and life meaning, and what are noble purposes to pursue (core values). The spiritual domain also intersects with the medical domain: there are many studies showing the rela,onship between prac,cing spirituality and posi,ve health outcomes. Behavioral: The Behavioral domain influences mul,ple domains, such as psychological and physical. The rigorous physical fitness demands of our military service requires we avoid becoming overweight, and demands people adopt nutri,on and physical fitness behaviors which will equip them to carry out their mission. Another example of how domain elements overlap relate to the importance of geVng proper sleep, which is necessary to deal with stringent opera,onal demands. Social influences such as peer behaviors can have a posi,ve or nega,ve influence on health behaviors. For example, when leaders such as drill instructors smoke, they set an example to those around them that smoking is condoned and okay. No maaer where someone fits in the organiza,onal hierarchy, they are an example to others. Hence, the behaviors we put into prac,ce have a profound effect on those around us whether we recognize it or not. Social: Social fitness is highly intertwined with the other domains of TFF. Social support in a unit, family, and community is a key part of psychological fitness, as the communica,on, engagement, and cohesion that help people stay connected also mi,gates stress and enhances coping. People with close, trusted social bonds may feel supported and encouraged to seek mental health assistance, as needed. A fellow unit member who has endured shared challenges and successes and who has developed trust with his or peers, can be in the best posi,on to iden,fy emerging and exis,ng problems in all eight domains and encourage the peer to find resources and get help. Now let’s look at how body domains inter-­‐relate with other domains. Physical: The Physical domain is inextricably linked to the other seven domains. First, no Warfighter can be considered physically fit without proper nutri,on and medical fitness. Perhaps not surprisingly, it has been consistently shown that ea,ng the right foods at the right ,me will both enhance performance and increase the health related benefits of physical fitness. Addi,onally, being medically fit is essen,al to maintaining physical fitness and ul,mately, readiness. For those diagnosed with chronic diseases such as high blood pressure and diabetes, physical fitness helps control and treat their disease. Maintaining a physical fitness program posi,vely influences the behavioral, psychological, spiritual and social domains. Adverse outcomes such as substance abuse, PTSD, burnout and depression can occur when exposed to high opera,onal demands and physical ac,vity can help to lessen associated symptoms such as depressed mood and increased anxiety. Regular physical ac,vity improves mood and reduces anxiety. Nutri6on: Nutri,on is an essen,al domain in physical fitness as men,oned above. There are, however, addi,onal overlaps with both the psychological and medical domains. One of these overlaps relates to the inverse correla,on between the amounts of omega-­‐3s a member takes in, with low levels experiencing increased depression and psychiatric symptoms and increased omega-­‐3 faay acid intake associated with reduced suicidal idea,on. A balanced diet enhances the medical domain by decreasing risk of heart disease, high blood pressure and diabetes. Medical and Dental: The medical and dental domain provides service leadership with a medically healthy force, free of contagious disease or injury that would prevent the successful execu,on of the mission. Advancements in medical science and technology con,nue to verify the direct rela,onship that exists between a physically healthy body and the mind. Research confirms that the body’s immune system responds posi,vely to medita,on (spiritual) or biofeedback (psychological) thus becoming more resistant to environmental irritants and disease. And, being socially connected to fellow service members and family members can, in fact, provide a wounded or ill service member with sufficient purpose and will to survive the injury or illness. Environmental: It is clear that the environmental domain overlaps with all the others. Environmental factors affect the Warfighters’ bodies (physical) in how they are clothed, the physical stressors on their bodies (for example if it is a rugged terrain, they may exert more effort) and how they exist in the terrain around them. There is also a connec,on with nutri,on. For example, in cold weather there are different caloric requirements to help off-­‐set the effects of freezing temperatures. The environment can also affect psychological fitness. Extreme climates produce physical and emo,onal stressors not present in normal climates. Now for final slide which provides the over-­‐riding references and drivers for TFF. 17
As previously stated, the primary source of informa,on for this presenta,on, and a good star,ng place for further informa,on on TFF is from the CJCSI 3405.01 of September 1, 2012. This document may be accessed by going to this website: hap://www.d,c.mil/cjcs_direc,ves/cdata/unlimit/3405_01.pdf The Joint Publica,on 1 is s,ll under revision, but in it’s newest revision will include a short sec,on on TFF. This may be accessed through visi,ng this website: hap://
www.d,c.mil/doctrine And, the August supplement of Military Medicine is dedicated to the TFF model. The supplement contains ar,cles about each of the mind and body domains, program evalua,ons and other strategic considera,ons. It goes into far more depth than either the instruc,on or doctrinal publica,on, and is intended more for line leaders and care providers who are interested in one or more of the eight domains. The full supplement can be downloaded on the web at: hap://www.amsus.org/images/stories/journal/Vol175No8S/TotalForceFitness.PDF 18