As of February 2019, approximately 56 thousand soldiers were non-deployable. This is equivalent to 13 Brigade Combat Teams (BCT). Approximately 21 thousand soldiers were on temporary profile and nearly 15.5K on Permanent Profile. In 2018, 56% of soldiers were injured per year. 71% of these soldiers suffered lower extremity micro-traumatic musculoskeletal “overuse” injuries. Injury is a significant contributor to the Army’s healthcare burden. It impacts medical readiness and soldier health. Musculoskeletal injuries accounted for approximately $557 million in inpatient care costs among active duty soldiers. In addition, the current force suffers from obesity and sleep deprivation. The Army continues to modernize its approach to fitness and health to shape a more ready and resilient force. One initiative nearing the end of its pilot phase is the Holistic Health and Fitness (H2F) program.
What is H2F, and Why are We Using It
H2F is similar to other programs developed within the special operations communities. It employs interdisciplinary teams to coach and develop personnel within the Brigade Combat Team (BCT). The H2F initiative aims to replicate the effects of special operations programs, at scale, across the Army.
The initial six-month pilot, conducted in 2017, was titled the Soldier Readiness Test (SRT). It temporarily embedded a strength and conditioning coach (CSCS), a physical therapist (PT), a registered dietician (RD), and an occupational therapist (OT) into selected BNs. Due to the success of the pilot, the Army launched the SRT and Training Program (SRT2P). The SRT2P began in the fall of 2018 with increased funding, equipment orders, and personnel embedded for two years. It quickly rebranded to the H2F-lite pilot, and continues to solidify into the current and growing version of H2F. From here forward, I will use H2F to refer to any and all stages of this program’s evolution.
Currently, the Army plans to implement the interdisciplinary H2F model across the majority of units, regardless of warfighting function. The goal is to create a climate and culture focused on growth and performance. This will yield soldiers who are mentally, physically, and spiritually ready for the demands of training and combat.
Key Personnel in the H2F Program
The initial wave of H2F-lite embedded several different combinations of personnel, with allocations mostly contingent upon the size, AOC manning available, and warfighting function. Of the 60 H2F pilot BNs across the Army, only eight BNs received the full team consisting of two contracted CSCS, a contracted certified athletic trainer (ATC), a military PT, a military OT, and a contracted or military RD. With a focus on human performance optimization, these disciplines aim to integrate their mission sets in order to create an interdisciplinary approach that augments the overall health promotion and readiness of the total force.
The Certified Strength & Conditioning Coach
The role of the CSCS focuses on high-level soldier athlete performance fitness and physical readiness of the formation. The CSCS creates training programs in coordination with the operations training calendar to prepare soldiers for upcoming CTC rotations, deployments, badge competitions, and other training events.
The Athletic Trainer, Certified
The ATC is a bridge between the CSCS and musculoskeletal medical readiness provided by the PT and OT. The ATC facilitates fitness training for soldiers on profile within the same vicinity as the rest of the soldiers. This allows the soldiers to participate in the CSCS’s prescribed fitness training with on-site adaptations provided by a trained medical professional. For injuries that occur during fitness training, the ATC offers immediate care at the point of injury, thus starting the healing process early and expediting return to duty (RTD) rates.
For injuries requiring additional oversight, the PT provides expert evaluation and treatment for the majority of musculoskeletal injuries. In conjunction with the traditional BDE PT, this new H2F PT is embedded in the unit; thus access to care is significantly expedited compared to traditional medical models and facilitates rapid RTD. The PT, in addition to the OT, RD, and ATC, has direct access to care, meaning soldiers can schedule an appointment directly and without a referral from a primary care provider.
The Occupational Therapist
The OT is primarily involved in the mental fitness of soldiers, utilizing skills such as coaching on sleep optimization behaviors, goal setting, habit change, attention and focus control, energy management, communication, team dynamics, and other tactical mental operations involved in leadership, planning, and Warrior tasks. As an expert in both cognitive and musculoskeletal domains, the OT also supports physical aspects of physical performance such as ergonomics of load carriage, visuospatial skills in marksmanship, and evaluation and treatment of the upper extremities.
The Registered Dietician
The RD’s role is in fueling and nutritional needs for various aspects of performance. The RD coaches soldiers on diets that support fitness training, brain performance, healing from injury, and special dietary needs in the field environment. Consequently, the RD helps soldiers consider meal planning, grocery shopping, cooking skills, and how to navigate the complex market of supplements. Additionally, the RD supports command with the implementation and adherence of the Army Body Composition Program.
The future of H2F at the unit level is very bright. Beginning in FY21, the full H2F program will begin rolling out to units, adding more H2F teams with upcoming years. With the full program, the military H2F providers (PT, OT, and RD) will become brigade-echelon assets, though the teams will grow larger with contracted and civilian H2F elements. Units can also anticipate Soldier Performance Readiness Centers (SPRC) that will house these H2F assets. Leaders can also anticipate the release of an updated FM 7-22 that will provide guidance on use and integration of the brigade H2F team. The new doctrine captures many best practices discovered by the H2F pilot phase; though all teams, both traditional BDE sections and H2F, will need to continue exploring the novel uses of this embedded performance team.
H2F in a Deployed or CTC Setting
The role of H2F in a deployed or CTC setting can assist in improving performance and preventing soldier injury, whether physical or mental. Incorporating H2F training topics, such as field nutrition, sleep in tactical environments, and other tactical mental operations, into the road to war plan can yield improved unit performance during CTC rotations or deployments. As indicated, teams should explore the ways H2F can optimize BDE performance of the deployment, mission execution, and redeployment of CTC rotations.
Reducing Injuries
While in the box, H2F presence can aid in a rapid RTD for some injuries where H2F providers see injured personnel earlier in the progression of care. The figure below demonstrates the preventative nature of H2F and how it encourages prevention. Capt. Erin Stone, OT, and her H2F teammates created this aid before an NTC rotation. They identified that mounted operations over long periods creates both acute and overuse musculoskeletal injuries, poor nutrition, and can erode coping skills to yield stress reactions and team conflicts.
When followed correctly, similar aids can reduce injury rates, improve cohesiveness, and keep soldiers in the fight longer. Thus, increasing overall unit readiness and effectiveness. Find effective ways to encourage soldiers to maintain a holistic approach to health, even in a deployed setting. For example, create similar aides that conform to the operating environment.
Location, Location, Location
More practically, for unit planners, the location of the H2F team presence is critical. During initial entry operations, holding H2F personnel at Brigade is the most feasible course of action. This is usually at the BDE surgeon cell or BDE Support Medical Company (BSMC). METT-TC considerations and operational tempo (OPTEMPO) will help BDE medical planners decide when ]to embed H2F personnel at lower echelons. With a large focus of H2F being on prevention, medical planners should continuously evaluate which echelon to employ H2F personnel . Employment of H2F personnel is likely to be a push-and-pull method as OPTEMPO changes. During lower OPTEMPO, H2F is pushed down to the lowest level feasible. Leaders then pull it back to the surgeon cell or BSMC as OPTEMPO increases again.
Maximizing H2F Efficacy
Creating ease of access to H2F team members for leaders at echelon is imperative to maintaining a successful program. Soldiers and leaders need the freedom to approach and receive coaching from H2F personnel when required. Similar to an open door policy, this allows soldiers to discuss maintaining a healthy state of mind and body. This will also enable soldiers to maintain privacy while discussing the sensitive topic of working to improve their overall health.
Integrating H2F personnel with other traditional specialty personnel within the BDE and creating a “health of the force” panel. Meeting as needed, they can discuss the health of the force at the individual or echelon level. The panel can also consist of chaplains, behavioral health officers, military resiliency trainers, master fitness trainers, etc. Additionally, integration of the installation Army Wellness Center (AWC) and unit BSMC could prove useful.
Maintaining a presence on social media is another way to stay connected with soldiers and their families. Most units use social media to keep the force informed. The H2F personnel can take advantage of current unit social media. For example, they can create a separate account to maintain an open dialogue and access to the force.
Examples of what some units have been successful in doing over social media follows:
- Creating video instruction on fitness techniques and movement patterns
- Instructional content on proper fitness recovery and cool down strategies
- Instructions for controlling attention to focus on high-pressure tasks such as marksmanship or promotion boards
- Coaching methods to manage daily stressors in garrison at work and at home
- Nutritional guides on fueling before, during, and after specific training events
- Cooking classes for soldiers and their families showing healthy eating options
- Instructional content on dealing with chronic musculoskeletal issues such as muscle soreness, and overuse injuries
- Instruction for tactical caffeine use and napping for performance
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The H2F program focuses on all aspects of human performance optimization (HPO). This includes physical training, mental performance skills, sleep optimization, and nutrition. As a result, the H2F program concentrates on building a healthy and resilient soldier. It prepares soldiers to withstand the rigors and demands of combat, and the demands of realistic training. Leaders providing H2F to their formations should consider making the program a priority effort to increase Unit health and readiness.
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