Proposal for Revised AFT requirements in the IGR A Final Revised Position Paper for Consideration For SGAUS MEDICAL ACADEMY AUG 23 RD 2017 1
PREAMBLE The INDIANA GUARD RESERVE (IGR) fitness test currently matches the US ARMY fitness standards for sit-ups, push-ups and a 2-mile run. (Soldiers are scored based on their performance in three events consisting of the push-up, situp, and a two-mile run, ranging from 0 to 100 points in each event. A minimum score of 60 in each event is required to pass the test. The soldier's overall score is the sum of the points from the three events. If a soldier passes all three events, the total may from 180 to 300.) The IGR has two methods of assessing physical fitness. One uses the U.S. Army fitness standards. The other is the completion of a two-and-a-half mile walk in NUMBER OF MINUTES or less. The latter method takes into account, that the many of the IGR soldiers may not be able to or may not desire to maintain the more rigorous fitness life styles required of the active and reserve military forces. However, many of the IGR soldiers wish to maintain a lifestyle that supports a balance upper body, core, lower body and cardiovascular fitness. These soldiers elect to be tested according to the Army standards, with sit ups, push-ups and a timed two-mile run. Election of this fitness standard is exemplary and should be encouraged. However, the evaluation standards must be both safe and fair. Because nearly all regular and reserve army soldiers separate from the service after age 62, the Army fitness standards are calculated by professional exercise physiology and medical staff for age levels up to and including 62-years-old. The standards take into account the effects of advancing age on physiological performance, and base exercise repetition numbers and completion times on the soldiers' ages. The IGR allows soldiers to continue to serve until the age of 75. Unfortunately, because official Army fitness standards are not currently available beyond age 62, all soldiers above the age of 62 are required to perform at the fitness level required of 62-year-olds. The assumption that this is a safe or fair procedure is contrary to the established Army policy of accounting for incrementally decreasing performance levels for soldiers advancing in age from 18 to 62. This paper proffers that, to continue to encourage whole-body fitness of IGR members over the age of 62, without endangering their health with unreasonable performance demands, IGR should develop performance standards adjusted to include levels appropriate for this group. The standards should be developed by qualified professionals. 2
The Army's over-40 cardiovascular screening program (CVSP) does the following: Identifies soldiers with a risk of coronary heart disease. Provides guidelines for safe, regular CR exercise. Gives advice and help in controlling heart-disease risk factors. Uses treadmill testing only for high-risk soldiers who need it. Soldiers who reached age 40 before 1 January 1989 must be cleared through the cardiovascular screening program before taking a record APFT. Prior to their CVSP evaluation, however, they may still take part in physical training to include diagnostic APFTs unless profiled or contraindications to exercise exist. All soldiers must undergo periodic physical examinations in accordance with AR 40-501 and NGR 40-501. These include screening for cardiovascular risk factors. The IGR has no mechanism for such risk aversion procedures. The upper age limit for the sliding scale in the US Army is 62 years of age. Since the IGR allows service beyond that age soldiers are nevertheless expected to meet the 62-year-old standard for the fitness requirements. This applies to sit ups push-ups and a 2-mile run. CURRENT RISK It is the opinion of MEDCOM that holding soldiers for 13 years to the 62-year-old fitness test might be contra-indicated from a safety standpoint 1 including cardiac risk and maximal heart rate demands. Below we will provide data from the cardiac literature including the longitudinal study from the classic Framingham Study (Brigham and Women s Hospital, Harvard Medical School). These will show the aging heart parallels the maximal heart rate and cardiac output suggesting support for our fear of cardiac stress in those subjected to fitness tests applicable to soldiers ten years younger. The recommendation will therefore 1 In fact, I pulled out 4 IGR soldiers this AT due to BP and irregular heart rhythms, EKG and HR issues prior to the run, even though they had been considered green at the MEDCOM intake medical a day before. 3
include a progressive lengthening of the run times along an exact regression along the army trajectory from 62 to 75 years of age. Over a third of IGR soldiers have cardiac issues including hypertension, and over half are overweight according to current BMI standards. 2 These issues make the revision of the standards more imperative so that IGR soldiers will not be put at risk. It is the primary mission of MEDCOM to provide a safe environment for all IGR soldiers by ensuring health and wellness while on training exercises and especially during the fitness test which is the most challenging drill they will endure on a non-emergency basis. The recommendations below therefore take into account the current state of health of the IGR as well as act in preventing possible cardiac related events. 2 Col. Agley provided the BMI statistics for each brigade as well which can be provided on request. 4
3 The latest recommendations from a US Government body for the older corps members includes the following: 1. Reduce run to 1.5 miles 3 I am grateful to LtCol Richard Friedman for providing me this study 5
2. Scores for 1.5 mile run: Men 3. Scores for Push Ups: Men 4. Scores for Sit ups: Men 5. 1.5 mile run: Scores for Women 6
6. Push Ups: Scores for Women 7. Sit ups: Scores for Women Based on these 2016 recommendations we are proposing a reduction in running distance to 1.5 miles for all IGR soldiers over 55 years of age. 7
Recommendation Based on the above government changes and medical evidence we are recommending a sliding scale to continue beyond the age of 62 until age 75 which reflects the capability of the aging heart WITHOUT RISK TO IGR SOLDIERS, and nevertheless in keeping with the tradition for physical fitness. Current US Army 2-mile run sliding scale: 4 5 4 5 https://www.marist.edu/studentlife/rotc/pdfs/apft.pdf 8
Current Cardiac Recommended Rates From American Heart Association guidelines to running appropriately 6 6 http://www.heart.org/heartorg/healthyliving/physicalactivity/fitnessbasics/target-heart- Rates_UCM_434341_Article.jsp#.WDBBY6IrIcg 9
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Cardiological Studies: 7 All conclude the aging heart maximum rate declines in a steady state linear trajectory. We can therefore be safe in providing a progressive reduced target times by extending a regression curve for the 13 years after 62 for the IGR. Maximal Heart Rate Regression Curve 7 http://content.onlinejacc.org/article.aspx?articleid=1126908 11
Since the regression is so linear we felt it appropriate and safe to apply the same decrease with age to the fitness test. *From a recent study 8 by Tanaka, Monahan and Seals. Age-predicted maximal heart rate revisited Cardiac competence and age In the classical NIH study age, related heart incompetence rises dramatically as is seen in the Brubaker and Kitzman paper. 9 8 American College of Sports Medicine. ACSM s Guidelines for Exercise Testing and Prescription. 6th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2000. 9 https://www.ncbi.nlm.nih.gov/pmc/articles/pmc3065291/ 12
(see references at end of the proposal) RECOMMENDATIONS for REVISED AFT TIMES FOR IGR 13
1.5-Mile Run: Recommendations: MEN We are proposing a sliding scale linear increase in running times for the 13 years until IGR retirement age, using a simple linear regression/extrapolation curve from 62 years of age until mandatory retirement age of 75 (based on statistical analysis and regression analysis). For men: minimum target rates for 1.5-mile run to score the basic passing standard of 100: Age Range Middle of the Target (s) Target mm:ss 62-64 63 1200 20:00 64-66 65 1239.1915 20:39 66-68 67 1250.9537 20:51 68-70 69 1262.7159 21:03 70-72 71 1274.4781 21:14 72-74 73 1286.2403 21:26 74-76 75 1298.0025 21:38 Below is the regression analysis we based these figures on: Min Middle of the Bottom of Top of min sec sec total 17-21 19 17 21 15 54 954 #VALUE! 22-26 24 22 26 16 36 996 42 27-31 29 27 31 17 0 1020 24 32-36 34 32 36 17 42 1062 42 37-41 39 37 41 18 18 1098 36 42-46 44 42 46 18 42 1122 24 47-51 49 47 51 19 30 1170 48 52-56 54 52 56 19 48 1188 18 57-61 59 57 61 19 54 1194 6 62-64 63 62 64 20 0 1200 6 64-66 65 64 66 1239.1915 66-68 67 66 68 1250.9537 68-70 69 68 70 1262.7159 70-72 71 70 72 1274.4781 72-74 73 72 74 1286.2403 74-76 75 74 76 14
Max seconds allowed to pass test y = 5.8811x + 856.92 R² = 0.9704 1400 Men - Maximum time, in seconds, allowed for runners in different age s. 1350 1300 1250 y = 5.8811x + 856.92 R² = 0.9704 1200 1150 1100 sec total Linear (sec total) 1050 1000 950 900 0 10 20 30 40 50 60 70 80 90 Middle of age 15
1.5-Mile Run: Recommendations : WOMEN For women: minimum target rates for 1.5-mile run to score the basic passing standard of 100: Age Range Middle of the Target (s) Ttarget mm:ss 62-64 63 1200 20:00 64-66 65 1579.73 26:20 66-68 67 1598.53 26:39 68-70 69 1617.33 26:57 70-72 71 1636.13 27:16 72-74 73 1654.93 27:35 74-76 75 1673.73 27:54 16
Max seconds allowed to pass test 1600 1500 Women - Maximum time, in seconds, allowed for runners in different age s. y = 9.4x + 968.73 R² = 0.9747 1400 1300 1200 1100 sec total Linear (sec total) 1000 900-10 10 30 50 70 90 Middle of age And the regression analysis below we based the women s scores on: Middle of the Bottom of Top of min sec sec total 17-21 19 17 21 18 54 1134 22-26 24 22 26 19 36 1176 27-31 29 27 31 20 30 1230 32-36 34 32 36 21 42 1302 37-41 39 37 41 22 42 1362 42-46 44 42 46 23 42 1422 47-51 49 47 51 24 0 1440 52-56 54 52 56 24 24 1464 57-61 59 57 61 24 48 1488 62-64 63 62 64 1560.93 64-66 65 64 66 1579.73 66-68 67 66 68 1598.53 68-70 69 68 70 1617.33 70-72 71 70 72 1636.13 72-74 73 72 74 1654.93 17
74-76 75 74 76 1673.73 y = 9.4x + 968.73 R² = 0.9663 18
Revised Push Ups recommendation:men Middle of the Bottom of Top of min 17-21 19 17 21 35 22-26 24 22 26 31 27-31 29 27 31 30 32-36 34 32 36 26 37-41 39 37 41 24 42-46 44 42 46 47-51 49 47 51 52-56 54 52 56 57-61 59 57 61 62-64 63 62 64 64-66 65 64 66 66-68 67 66 68 68-70 69 68 70 70-72 71 70 72 72-74 73 72 74 74-76 75 74 76 y = -0.54x + 44.86 R² = 0.9746 Age Range Middle of the Target - Line fit Target - Log fit 64-66 65 6 9 66-68 67 5 8 68-70 69 3 7 70-72 71 2 7 72-74 73 1 6 74-76 75-1 5 19
40 Minimum Push Ups Men 35 30 25 20 15 10 5 0 y = -15ln(x) + 79.25 R² = 0.9714 y = -0.54x + 44.86 R² = 0.9746 0 20 40 60 80 100 min Log. (min) Linear (min) Revised Push Ups recommendation:women Middle of the Bottom of Top of min 17-21 19 17 21 13 22-26 24 22 26 11 27-31 29 27 31 10 32-36 34 32 36 9 37-41 39 37 41 6 42-46 44 42 46 6 47-51 49 47 51 52-56 54 52 56 57-61 59 57 61 62-64 63 62 64 64-66 65 64 66 66-68 67 66 68 68-70 69 68 70 70-72 71 70 72 72-74 73 72 74 74-76 75 74 76 20
Age Range Middle of the Target - Line fit Target - Log fit 47-51 49 4 5 52-56 54 3 4 57-61 59 1 3 62-64 63 0 3 64-66 65-1 3 66-68 67-1 2 68-70 69-2 2 70-72 71-2 2 72-74 73-3 2 74-76 75-4 1 15 Minimum Push Ups Women 10 5 0-5 -10 y = -0.2914x + 18.347 R² = 0.9568 y = -8.675ln(x) + 38.755 R² = 0.95 0 20 40 60 80 100 min Log. (min) Linear (min) 21
REVISED Sit Ups: Men and Women Middle of the Bottom of Top of min 17-21 19 17 21 47 22-26 24 22 26 43 27-31 29 27 31 36 32-36 34 32 36 34 37-41 39 37 41 29 42-46 44 42 46 22 47-51 49 47 51 21 52-56 54 52 56 57-61 59 57 61 62-64 63 62 64 64-66 65 64 66 66-68 67 66 68 68-70 69 68 70 70-72 71 70 72 72-74 73 72 74 74-76 75 74 76 Age Range Middle of the Target - Line fit Target - Log fit 52-56 54 15 18 57-61 59 10 16 62-64 63 7 14 64-66 65 5 13 66-68 67 3 12 68-70 69 1 11 70-72 71 0 11 72-74 73-2 10 74-76 75-4 9 22
60 50 40 30 20 10 0-10 -20-30 Minimum Sit Ups Men and Women y = -0.9071x + 63.986 R² = 0.9816 y = -28.8ln(x) + 133.33 R² = 0.973 0 20 40 60 80 100 min Log. (min) Linear (min) This paper assumes that a linear extrapolation of the decrease in cardiac performance with age accurately reflects the decrease to age 75 and may, at least partially, underlie an expected depression of physical performance at the older age. It is understood that factors such as the age-related decline in mitochondrial function, that affect all ATP-dependent systems, may well underlie this decreased cardiac affect with age. The present paper suggests that, while the linear extrapolation of the age-related decrease in cardiovascular performance may not be accurate, especially at the higher ages closer to 75, it strongly suggests that safer and more fair fitness goals should be established for soldiers older than the age of 62. The present premise seems wiser than assuming a stable, constant level of cardiovascular function beyond the age of 62 and fixing the required fitness level at that point. 10 10 I acknowledge the work of LCol Richard Friedman for these caveats. 23
ALTERNATE AEROBIC EVENTS Alternate aerobic events assess the cardio respiratory and muscular endurance of Soldiers with permanent medical profiles, or long-term temporary profiles that cannot perform the 2-mile run. The alternate aerobic APFT events are the following: 800-Yard-Swim Test. 6.2-Mile Bicycle Test. 2.5-Mile Walk Test. Revised Men s Alternate 800 Yard Swim 24
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Revised Women s Alternate 800 Yard Swim Min Middle of the Bottom of Top of Min 17-21 19 17 21 21 22-26 24 22 26 21 27-31 29 27 31 22 32-36 34 32 36 22 37-41 39 37 41 23 42-46 44 42 46 23 47-51 49 47 51 24 52-56 54 52 56 26
57-61 59 57 61 62-64 63 62 64 64-66 65 64 66 66-68 67 66 68 68-70 69 68 70 70-72 71 70 72 72-74 73 72 74 74-76 75 74 76 6x + 1146 R² = 1 Age Range Time target (s) Time target mm Target time ss 52-56 1470 24 30 57-61 1500 25 0 62-64 1524 25 24 64-66 1536 25 36 66-68 1548 25 48 68-70 1560 26 0 70-72 1572 26 12 72-74 1584 26 24 74-76 1596 26 36 52-56 24:30 57-61 25:00 62-64 25:24 64-66 25:36 66-68 25:48 68-70 26:00 70-72 26:12 72-74 26:24 74-76 26:36 27
Women s 800 yard swim graph 28
Alternate MEN s 6.2 mile Bicycle Test Middle of the Bottom of Min Top of min Sec sec total #VALUE! 17-21 19 17 21 24 0 1440 22-26 24 22 26 24 30 1470 30 27-31 29 27 31 25 0 1500 30 32-36 34 32 36 25 30 1530 30 37-41 39 37 41 26 0 1560 30 42-46 44 42 46 27 0 1620 60 47-51 49 47 51 28 0 1680 60 52-56 54 52 56 57-61 59 57 61 62-64 63 62 64 64-66 65 64 66 66-68 67 66 68 68-70 69 68 70 70-72 71 70 72 72-74 73 72 74 74-76 75 74 76 = 0.1429x 2-2x + 1431.4 Age Range Time target (s) Time target mm Target time ss 52-56 1740.0964 29 0.0964 57-61 1810.8349 30 10.8349 62-64 1872.5701 31 12.5701 64-66 1905.1525 31 45.1525 66-68 1938.8781 32 18.8781 68-70 1973.7469 32 53.7469 70-72 2009.7589 33 29.7589 72-74 2046.9141 34 6.9141 74-76 2085.2125 34 45.2125 1740.096 4 60.0964 1810.834 9 70.7385 1872.570 1 61.7352 1905.152 5 32.5824 1938.878 1 33.7256 1973.746 9 34.8688 2009.758 9 36.012 2046.914 1 37.1552 2085.212 5 38.2984 29
52-56 29:10 57-61 30:11 62-64 31:13 64-66 31:45 66-68 32:19 68-70 32:54 70-72 33:30 72-74 34:07 74-76 34:45 30
Alternate Women s 6.2 mile Bicycle Test Min Middle of the Bottom of Top of Min sec sec total 17-21 19 17 21 25 0 1500 22-26 24 22 26 25 30 1530 27-31 29 27 31 26 0 1560 32-36 34 32 36 26 30 1590 37-41 39 37 41 27 0 1620 42-46 44 42 46 28 0 1680 47-51 49 47 51 30 0 1800 52-56 54 52 56 1877.0352 57-61 59 57 61 1986.3107 62-64 63 62 64 2084.0163 64-66 65 64 66 2136.2975 66-68 67 66 68 2190.8643 68-70 69 68 70 2247.7167 70-72 71 70 72 2306.8547 72-74 73 72 74 2368.2783 74-76 75 74 76 2431.9875 0.2857x 2-10.429x + 1607.1 Age Range Time target (s) Time target mm Target time ss 52-56 1877.0352 31 17.0352 57-61 1986.3107 33 6.3107 62-64 2084.0163 34 44.0163 64-66 2136.2975 35 36.2975 66-68 2190.8643 36 30.8643 68-70 2247.7167 37 27.7167 70-72 2306.8547 38 26.8547 72-74 2368.2783 39 28.2783 74-76 2431.9875 40 31.9875 52-56 31:17 57-61 33:06 62-64 34:44 64-66 35:36 66-68 36:31 68-70 37:28 70-72 38:27 72-74 39:28 31
74-76 40:32 32
Alternate Men s 2.5 mile Walk Test Min Middle of the Bottom of Top of min Sec sec total 17-21 19 17 21 34 0 2040 #VALUE! 22-26 24 22 26 34 30 2070 30 27-31 29 27 31 35 0 2100 30 32-36 34 32 36 35 30 2130 30 37-41 39 37 41 36 0 2160 30 42-46 44 42 46 36 30 2190 30 47-51 49 47 51 37 0 2220 30 52-56 54 52 56 2250 30 57-61 59 57 61 2280 30 62-64 63 62 64 2304 24 64-66 65 64 66 2316 12 66-68 67 66 68 2328 12 68-70 69 68 70 2340 12 70-72 71 70 72 2352 12 72-74 73 72 74 2364 12 74-76 75 74 76 2376 12 y = 6x + 1926 Age Range Time target (s) Time target mm Target time ss 52-56 2250 37 30 57-61 2280 38 0 62-64 2304 38 24 64-66 2316 38 36 66-68 2328 38 48 68-70 2340 39 0 70-72 2352 39 12 72-74 2364 39 24 74-76 2376 39 36 52-56 37:30 57-61 38:00 62-64 38:24 64-66 38:36 66-68 38:48 68-70 39:00 70-72 39:12 72-74 39:24 74-76 39:36 33
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Alternate Women s 2.5 Mile Walk Test Min Middle of the Bottom of Top of min sec sec total 17-21 19 17 21 37 0 2220 22-26 24 22 26 37 30 2250 27-31 29 27 31 38 0 2280 32-36 34 32 36 38 30 2310 37-41 39 37 41 39 0 2340 42-46 44 42 46 39 30 2370 47-51 49 47 51 40 0 2400 52-56 54 52 56 2430 57-61 59 57 61 2460 62-64 63 62 64 2484 64-66 65 64 66 2496 66-68 67 66 68 2508 68-70 69 68 70 2520 70-72 71 70 72 2532 72-74 73 72 74 2544 74-76 75 74 76 2556 y = 6x + 2106 Age Range Time target (s) Time target mm Target time ss 52-56 2430 40 30 57-61 2460 41 0 62-64 2484 41 24 64-66 2496 41 36 66-68 2508 41 48 68-70 2520 42 0 70-72 2532 42 12 72-74 2544 42 24 74-76 2556 42 36 52-56 31:17 57-61 33:06 62-64 34:44 64-66 35:36 66-68 36:31 68-70 37:28 70-72 38:27 72-74 39:28 74-76 40:32 35
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For further questions, comments or suggestions please contact: MAJ Julian Ungar-Sargon MD PhD Medical Director MEDCOM Julian.ungar@igr.in.gov On behalf of BG Philip Eskew and Col. Mark Griffith I acknowledge the contribution of: LtC Richard Friedman PhD And LtC Daniel Agley PhD References 37
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