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Objectives: Study objective was to map the current literature on the economic effects of priority setting at the system level in healthcare., Design: The study was conducted as a scoping review., Data Sources: Scopus electronic database was searched in June 2023., Eligibility Criteria: We included peer-reviewed articles published 1 January 2020-1 January 2023. All study designs that contained empirical evidence on the financial effects or opportunity costs of healthcare priority setting were included excluding disease, condition, treatment, or patient group-specific studies., Data Extraction and Synthesis: Two independent researchers screened the articles, and two additional researchers reviewed the full texts and extracted data. We used Joanna Briggs Institute checklists to assess the quality of qualitative, quasi-experimental and economic evaluations and the mixed methods appraisal tool for the mixed method studies. Synthesis was done qualitatively and through descriptive statistics., Results: 8869 articles were screened and 15 fulfilled the inclusion criteria. The most common study focus was health technology assessment (7/15). Other contexts were opportunity costs, effects of programme budgeting and marginal analysis, and disinvestment initiatives. Priority setting activities analysed in the studies did not achieve cost savings or cost containment (4/15) or have mixed findings at best (8/15). Only five studies found some indication of cost savings, cost containment or increased efficiency. Also, many of the studies consider costs only indirectly or qualitatively., Conclusions: All in all, there is very little research addressing the pressing question of whether explicit priority setting and priority-setting methods can support cost containment on a health service system level (regional or national). There is limited evidence of the economic effects of priority setting., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Cold weather operations are logistically difficult to orchestrate and extremely challenging for soldiers. Decades of research and empirical evidence indicate that humans are extremely vulnerable to cold and that individual responses are highly variable. In this context, it may be necessary to develop personalised strategies to sustain soldiers' performance and ensure overall mission success in the cold. Systematic cold weather training is essential for soldiers to best prepare to operate during, and recover from, cold weather operations. The purpose of this review is to highlight key aspects of cold weather training, including (1) human responses to cold, (2) nutrition, (3) sleep and (4) protective equipment requirements. Bringing science to practice to improve training principles can facilitate soldiers performing safely and effectively in the cold. Cold weather training prepares soldiers for operations in cold, harsh environments. However, decreases in physical, psychological and thermoregulatory performance have been reported following such training, which influences operational ability and increases the overall risk of injuries. When optimising the planning of field training exercises or operational missions, it is important to understand the soldiers' physical and cognitive performance capacity, as well as their capacity to cope and recover during and after the exercise or mission. Even though the body is fully recovered in terms of body composition or hormonal concentrations, physical or cognitive performance can still be unrecovered. When overlooked, symptoms of overtraining and risk of injury may increase, decreasing operational readiness., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Changes in physiological markers and physical performance in relation to paratroopers' initial body composition were investigated during a 20-day winter military field training (MFT) and the subsequent 10-day recovery period. Body composition, serum hormone concentrations and enzymatic biomarkers, and physical performance of 58 soldiers were measured before, during, and after MFT. Comparisons were done according to soldiers' body fat percentage before MFT between low-fat (<12% body fat) and high-fat (>12% body fat) groups. Correlations between body fat percentage preceding MFT and changes in muscle mass, physical performance, and serum hormone concentrations and enzymatic biomarkers were investigated. It was hypothesized that soldiers with a higher fat percentage would have smaller decrements in muscle mass, physical performance, and serum testosterone concentration. The change in muscle and fat mass was different between groups ( p < 0.001) as the low-fat group lost 0.8 kg of muscle mass and 2.0 kg of fat mass, while there was no change in muscle mass and a loss of 3.7 kg of fat mass in the high-fat group during MFT. Fat percentage before MFT correlated with the changes in muscle mass ( R 2  = 0.26, p < 0.001), serum testosterone concentration ( R 2  = 0.22, p < 0.001), and evacuation test time ( R 2  = 0.10, p < 0.05) during MFT. The change in muscle mass was correlated with the changes in evacuation test time ( R 2  = 0.11, p < 0.05) and countermovement jump test results ( R 2  = 0.13, p < 0.01) during MFT. Soldiers with a higher initial fat percentage lost less muscle mass, and had smaller decrements in some aspects of physical performance, as well as in serum testosterone concentration during MFT., Competing Interests: The authors declare there are no competing interests.

Background: Exercise self-efficacy is a crucial aspect of adopting and maintaining a physically active lifestyle. Regular physical activity may enhance exercise self-efficacy. This study aimed to investigate the baseline associations of physical fitness, physical activity, and body composition with exercise self-efficacy and the effects of military service on exercise self-efficacy. Methods: The sample consisted of healthy young Finnish conscripts ( n  = 243) undergoing military service. The participants were divided into two groups: an intervention group undergoing a high-intensity functional training program ( n  = 113) and a control group undergoing traditional physical training within their military service ( n  = 130). Exercise self-efficacy (adoption and barrier) and aerobic and muscular fitness were measured thrice (baseline, month 3, and month 5). Self-reported leisure-time physical activity and measured fat percentage were collected at baseline., Results: Adoption and barrier exercise self-efficacy correlated positively with aerobic and muscular fitness and leisure time physical activity ( r  = 0.33-0.59, p  < 0.001), and barrier self-efficacy negatively with fat percentage ( r  = -0.15, p  < 0.05) at baseline. No changes in adoption (time p  = 0.912) and barrier self-efficacy (time p  = 0.441) occurred during the military service. There were no differences between groups in these changes (group × time interaction p  = 0.643 for adoption self-efficacy and p  = 0.872 for barrier self-efficacy). Change in muscular fitness correlated positively with change in barrier self-efficacy in the high-intensity functional training group ( r  = 0.35, p  < 0.05). Conclusions: Exercise self-efficacy is positively associated with physical fitness and physical activity among young males. However, military service, whether it involves high-intensity functional physical training or more diverse traditional physical training, does not improve exercise self-efficacy., Competing Interests: Author RH was employed by company Analyysitoimisto Statisti Oy. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Kekäläinen, Pulkka, Kyröläinen, Ojanen, Helén, Pihlainen, Heikkinen and Vaara.)

Bullying has been associated with status goals among peers, but this research has not distinguished among forms of bullying, nor included actual status or popularity among peers in an integrated analysis. To this aim, in concurrent correlational data, we examined adolescent status goals as predictors of peer-reported physical, verbal, exclusionary and electronic bullying, and these further as predictors of popularity and peer rejection ( N  = 256; 67.2% girls; M age = 12.2 years). We also explored potential indirect associations of status goals with popularity and peer rejection via forms of bullying. The findings indicated that verbal bullying was the most common form of bullying. Status goals were positively related to all but physical bullying, yet only verbal bullying partially mediated this association with popularity. Electronic bullying was unrelated to popularity and peer rejection, when controlling for other bullying forms (but was positively related to rejection at the bi-variate level). The findings underscore the importance of assessing bullying as a heterogeneous construct, as related goals and adjustment among peers may depend on its specific form.

Background: Military operations in urban environments requires faster movements and therefore may place greater demands on soldier strength and anaerobic ability., Objective: The aim was to study how physical fitness and body composition are associated with occupational test for urban combat soldiers before and after a 5-day military field exercise (MFE)., Methods: Twenty-six conscripts (age = 20±1 yrs.) volunteered, of which thirteen completed the study. Occupational performance was determined by using the newly developed Urban Combat Simulation test (UCS); which included 50-m sprinting, moving a truck tire (56 kg) 2 meters with a sledgehammer, a 12-m kettlebell carry (2×20 kg) up the stairs with a 3-m ascent, 4-time sandbag lifts (20 kg) with obstacle crossing, and a 20-m mannequin (85 kg) drag. Aerobic and muscle fitness, as well as anaerobic capacity were measured, and, body composition was assessed with multifrequency bioimpedance analysis., Results: The UCS performance correlated significantly with standing long jump performance, as well as lower and upper body maximal strength before (r = -0.56 to -0.66) and after (r = -0.59 to -0.68) MFE, and, with body mass and FFM before (r = -0.81 to -0.83) and after (r = -0.86 to -0.91) MFE. In the regression analyses, fat free mass (R2 = 0.50, p = 0.01) and counter movement jump in combat load (R2 = 0.46, p = 0.009) most strongly explained the UCS performance., Conclusion: This study demonstrated that muscle mass and lower body explosive force production together with maximal strength are key fitness components related to typical urban combat soldiers' military tasks. Physical training developing these components are recommended.

After more than 50 years of studying soldiers in the cold, we are well past the phase of defining the unique problems; the research requirements are known but the solutions have been slow in coming. This requires iterative testing of proposed lab-based solutions with soldiers in the real environment. Representing a renewed effort to produce and implement solutions to human biomedical challenges in Arctic operations, this journal supplement highlights presentations from a three-day NATO Human Factors and Medicine panel-sponsored symposium in Washington DC in October 2022. While technology can certainly aid soldiers in extreme environments, it is ultimately training that is the most important factor for ensuring optimal performance and survival. By investing in the development of specialized Arctic forces training and implementing new solutions to protect their health and performance, we can ensure success in the coldest and harshest of environments.

The present study investigated physiological, mental and physical performance changes during a 20-day winter military training course and the following 10-day recovery period. Fifty-eight (age 19 ± 1 years, height 182 ± 6 cm, body mass 78.5 ± 7.2 kg) male soldiers volunteered. Body composition, serum biomarker levels and performance tests were measured four times during the study. In addition, questionnaires were collected daily for subjective stress and rate of perceived exertion. The course induced significant declines in body (-3.9%, p  < 0.05) and fat mass (-31.6%, p  < 0.05) as well as in all assessed physical performance variables (-9.2 - -20.2%, p  < 0.05), testosterone (-73.7%, p  < 0.001) and IGF-1 concentrations (-43.6%, p  < 0.001). At the same time, the sex hormone-binding globulin, creatine kinase, and C-reactive protein values increased significantly (46.3-1952.7%, p  < 0.05). After the 10-day recovery period, the body composition and hormonal values returned to the baseline ( p  < 0.05), as did some physical performance variables, such as 2 min sit-ups and the evacuation test ( p  < 0.05). However, explosive force production in the upper and lower bodies remained unrecovered. The 20-day winter military training caused significant physiological and mental stress, as well as a drastic decline in physical performance even for highly physically fit soldiers, and the 10-day recovery period did not establish full recovery.

Heart rate variability (HRV) is a useful method to study the autonomic nervous system (ANS) status. As measuring devices have developed and become smaller, many researchers have become interested in the possibilities to implement the method for diving medicine research. The aim of this study was to review human ANS responses in cold water diving (water temperature <5°C), and to comprise the current knowledge of HRV studies in diving and hyperbaric exposure into one review article. A literature search was conducted on 5 December th 2022, with the search terms "HRV" or "heart rate variability" and "diving" or "diver" or "divers", with search functions of the data bases PubMed and Ovid Medline. Peer reviewed original articles, review articles and case reports were accepted to this review. Twenty-six articles met the pre-defined criteria and were included in this review. Studies from very cold water conditions were rare, but suggested that cold strengthens the ANS responses of diving - especially parasympathetic nervous system (PNS) activity due to the trigeminocardiac reflex and baroreceptor and cardiac stretch receptor activity, caused cold and pressure-induced centralisation of the blood. Overall, studies showed predominant PNS activity when putting the face in water, during immersion and when ambient pressure increased.

The present study investigated performance changes during three runs (1 min recovery) of repeated military simulation task test (RMST) and its associations with physical performance. Voluntary male soldiers ( N  = 114) participated in a series of measurements of physical performance. Lower body explosive force production, anaerobic endurance and upper body strength endurance together explained 58% of the variance in the first RSMT ( p  < 0.001). The same variables explained the variance in the second and third runs of RSMT by 60% and 51%, but explosive force production was replaced with aerobic endurance, assessed by the 3.2 km loaded run ( p  < 0.001). This study demonstrated that the role of explosive power of the lower body decreased and military specific aerobic endurance increased when occupational performance was assessed under acute fatigue even during a short high-intensity test. These results may benefit tactical strength and conditioning coaches in training optimisation for improved occupational performance in military. Practioners summary: Soldiers are required to perform occupational tasks in a repeated manner with short recovery time. In the present study, the role of explosive power of the lower body decreased and military specific aerobic endurance increased when occupational performance was assessed with a repeated high-intensity task specific performance test.

Introduction: The purpose of the present study was to investigate the effects of a winter military field training course consisting of strenuous physical stressors (e.g. physical activity, sleep deprivation and cold weather) on cognitive performance among Finnish soldiers. Methods: Fifty-eight (age 19 ± 1 years, height 182 ± 6 cm, body mass 78.5 ± 7.2 kg) male soldiers took part in a 20-day military field training course in northern Finland. Cognitive performance was assessed before, during, and after the course four times on a tablet computer. Sustained Attention to Response Task (SART) was used to assess soldier's executive and inhibitory function. Baddeley's 3-min reasoning task (BRT) was used to assess grammatical reasoning, and Change Blindness (CB) task was used to assess visual perception. Results: Strenuous winter field training had detrimental effects in all performance tests compared to baseline. SART response rate decreased 27.3% ( p  < 0.001), and BRT and CB task scores decreased 20.6% ( p  < 0.01) and 14.1% ( p  < .05), respectively. Conclusion: The present study showed a decline in soldier's cognitive performance after 20-days of physically demanding winter military field training. To be able to optimise field training, it is important to be aware of how cognitive performance changes during military exercises and missions.

Abstract: Helén, J, Kyröläinen, H, Ojanen, T, Pihlainen, K, Santtila, M, Heikkinen, R, and Vaara, JP. High-intensity functional training induces superior training adaptations compared with traditional military physical training. J Strength Cond Res 37(12): 2477-2483, 2023-This study examined the effectiveness of concurrent strength and endurance training with an emphasis on high-intensity functional training (HIFT) during military service. Voluntary male conscripts (aged 18-28 years) were placed in either an experimental (EXP: n = 50-66) or a control (CON: n = 50-67) group. The training for the EXP group included HIFT using body mass, sandbags, and kettlebells. The CON group trained according to the current practice. Physical performance and body composition were assessed at baseline (PRE), at week 10 (MID), and after (POST) the 19-week training period. Significance was set at p < 0.05. The total distance covered in a 12-minute running test increased in both groups, but the change in EXP was superior to the change in CON (11.6%, ES: 0.79 vs. 5.7%, ES: 0.33; p = 0.027). Maximal strength and power characteristics increased in EXP (3.1-5.0%), whereas no improvements were observed in CON. Conscripts with the highest initial fitness showed no improvements in physical performance in either group. Body mass and waist circumference decreased in EXP, whereas CON showed an increase in muscle mass. These findings suggest that HIFT is an effective and time-efficient approach to improve soldiers' aerobic fitness during military service. For the optimal development of strength, the training equipment used may not have provided sufficient and progressive loading to yield considerable strength adaptations. More focus should be placed on sufficient intensity and volume in both strength and endurance training, especially for the most fit soldiers., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the National Strength and Conditioning Association.)

Background: Most Western adults do not meet the recommendations for sufficient activity, and obesity is a global problem. Similar trends are also seen among Western military personnel. Many successful physical training interventions have been carried out in military environments, but the interventions have been quite short term, and the training has been supervised. Therefore, the aim of this study was to investigate the effects of a 12-month voluntary motivational training intervention among the Finnish Defence Forces' (FDF) Navy soldiers., Methods: In total, 77 FDF Navy soldiers, serving in missile patrol boats, took part in the study. The intervention group (IG) contained 45 participants and the control group (CG) contained 32 participants. The IG was divided into four teams that carried out the intervention, while the CG took part in only the measurements., Results: Most of the participants (65%) in the IG reported that they had increased their exercise volume during the intervention, but no major beneficial impacts on the physical fitness, body composition, or health markers were observed. Nevertheless, there was a clear diversity visible between the subgroups in the IG. The team that reported the most exercise had the best motivation and the most motivated team coach and also had the most improved physical fitness and body composition results., Conclusions: The present study points out that in military environments, long-term voluntary training interventions may not be as successful as short-term supervised interventions. The results also suggest that in voluntary training interventions among military personnel, the participants' motivation to exercise is a key factor when improving physical fitness.

Objectives: Survival training can provide a unique setting for scientific examination of human stress responses and physical performance in a realistic operational military context. The aim of the present study was to observe effects of a 36-h recovery period on serum hormone concentrations, salivary cortisol, and marksmanship during 10-day winter military survival training in north of the Arctic Circle., Design and Methods: Sixty-eight male soldiers were randomly divided into two groups; EXP (n = 26) and CON (n = 42). While CON performed the whole exercise phase in the field, EXP had 36-h recovery period between days 6 and 8. Several hormones were measured during the study to investigate recovery., Results: Subjective physical and mental demand as well as catabolic hormone levels increased and anabolic hormones decreased in CON (p < 0.05), whereas in EXP, recovery period attenuated negative effects of survival training. Prone shooting performance decreased (87.5 ± 6.5 vs. 76.3 ± 8.8, points out of 100, p < 0.05) between days 6 and 8 in CON while EXP was able to maintain shooting performance throughout the study., Conclusion: A short recovery during a strenuous training can prevent the degradation in psychophysiological state and shooting performance in soldiers, which can be crucial for survival in demanding operational winter environment. In the present study, 36-h rest period during the field training seems to enhance recovery but the duration of the period was inadequate for full recovery from the accumulated operative stress. In conclusion, appropriate recovery periods should be implemented in order to optimize occupational performance during high operative stress., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Recently discovered measurement-induced entanglement phase transitions in monitored quantum circuits provide a novel example of far-from-equilibrium quantum criticality. Here, we propose a highly efficient strategy for experimentally accessing these transitions through fluctuations. Instead of directly measuring entanglement entropy, which requires an exponential number of measurements in the subsystem size, our method provides a scalable approach to entanglement transitions in the presence of conserved quantities. In analogy to entanglement entropy and mutual information, we illustrate how bipartite and multipartite fluctuations can both be employed to analyze the measurement-induced criticality. Remarkably, the phase transition can be revealed by measuring fluctuations of only a handful of qubits.

Introduction: Physical fitness is a fundamental capability required of military personnel, but studies focusing on longitudinal changes in physical fitness and anthropometrics in soldiers are lacking. The aim was to evaluate physical fitness and anthropometrics in soldiers during their early career., Methods: A 3-year prospective study included 180 male soldiers (baseline age 26±2 years) with measures of a 12 min running test, standing long jump, sit-up and push-up tests, and body mass, height and waist circumference (WC). Baseline data were stratified into tertiles, and the changes within each tertile were analysed using dependent t-tests and analysis of variance., Results: 12 min running test distance decreased on average by 2% (-54 m), sit-up performance 3% (-1.5 repetitions (reps)/min), push-up performance 4% (-1.9 reps/min) and standing long jump performance 1% (-2.1 cm) over the 3-year period (p<0.05). Both aerobic and muscular fitness decreased consistently among the highest baseline tertile (12 min running test: -70 m, sit-ups: -3.2 reps/min, push-ups: -7.5 reps/min, standing long jump: -5.5 cm; p<0.001), whereas both aerobic and muscular fitness levels were maintained and push-up performance was improved (p<0.05) in the lowest baseline tertiles. Body mass increased on average by 4% (+3.4 kg) and WC by 4% (+3.9 cm) (p<0.001), and these increases were observed for all baseline tertiles (p<0.05)., Conclusions: Small decrements in physical fitness and anthropometrics exist during the early career of soldiers. The changes in physical fitness differed according to baseline fitness levels. The results indicate that support for exercise training may be needed even in a soldier's early career., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Severe energy deficit may impair hormonal regulation and physical performance in military trainings. The aim of this study was to examine the associations between energy intake, expenditure, and balance, hormones and military performance during a winter survival training. Two groups were studied: the FEX group ( n = 46) had 8-day garrison and field training, whereas the RECO group ( n = 26) had a 36-h recovery period after the 6-day garrison and field training phase. Energy intake was assessed by food diaries, expenditure via heart rate variability, body composition by bioimpedance, and hormones by blood samples. Strength, endurance and shooting tests were done for evaluating military performance. PRE 0 d, MID 6 d, POST 8 d measurements were carried out. Energy balance was negative in PRE and MID (FEX -1070 ± 866, -4323 ± 1515; RECO -1427 ± 1200, -4635 ± 1742 kcal·d -1 ). In POST, energy balance differed between the groups (FEX -4222 ± 1815; RECO -608 ± 1107 kcal·d -1 ( p < 0.001)), as well as leptin, testosterone/cortisol ratio, and endurance performance ( p = 0.003, p < 0.001, p = 0.003, respectively). Changes in energy intake and expenditure were partially associated with changes in leptin and the testosterone/cortisol ratio, but not with physical performance variables. The 36-h recovery restored energy balance and hormonal status after strenuous military training, but these outcomes were not associated with strength or shooting performance.

Background: Naval service can have a significant impact on the wellbeing of seafarers, and the operation of warships is highly dependent on the personnel on board. Nevertheless, there is a lack of knowledge concerning the impact of seafarers' individual characteristics on their wellbeing in a naval environment. Therefore, the aim of this study was to investigate individual characteristics of the naval personnel that may be associated with the amount of sleepiness, fatigue and stress responses experienced during shift work and irregular working hours in a naval environment., Methods: The study took place on a Finnish Defence Forces' Navy missile patrol boat on which 18 crewmembers served as study participants. The measurement periods lasted two separate weeks (seven days and six nights) during shift work with two different watchkeeping systems (4:4, 4:4/6:6). The onboard measurements consisted of the Karolinska Sleepiness Scale, salivary stress hormones, cognitive tests (Sustained Attention to Response Task and N-back Task) and heart rate variability., Results: Participants of older ages or with a longer history in naval service were associated with a greater amount of sleepiness, fatigue and stress responses on board. On the contrary, increased physical activity and a higher level of physical fitness, especially standing long jump, were associated with a lower amount of sleepiness, fatigue and fewer stress responses. In addition, an athletic body composition together with a healthy lifestyle may be beneficial, considering the stress responses on board., Conclusion: The present results are well in line with the previous literature regarding shift work and irregular working hours. The results highlight the importance of regular physical activity and good physical fitness during service in the naval environment.

The operation of naval vessels involves watchkeeping 24 h per day, which is globally carried out by a variety of different watch systems. In this study, the rotating 4:4 and fixed 4:4/6:6 two-section watch systems were compared in terms of sleepiness, fatigue, and stress responses. The data collection took place on a Finnish Defence Forces' (FDF) Navy missile patrol boat with 15 crew members serving as study participants. The data collection periods lasted two separate weeks (7 days, 6 nights) with the different watch systems. The subjective sleepiness of the participants was assessed before and after every watch using the Karolinska Sleepiness Scale (KSS). Stress responses were assessed daily by the recorded levels of salivary alpha-amylase (sAA), cortisol (sCor), immunoglobulin A (sIgA), and dehydroepiandrosterone (sDHEA). The participants' sustained attention, inhibitory control, and working memory were assessed daily by cognitive tests (SART, N-Back). The heart rate variability (HRV) during an orthostatic test was used as an additional daily marker to assess the amount of psychological stress of the participants. In this study, the difference regarding sleepiness and fatigue between the study weeks was most visible in the subjective KSS, which clearly favored the 4:4/6:6 system. The results of sAA and sIgA also suggested that the subjects were psychologically less stressed during the study week with the 4:4/6:6 watch system. Cognitive test results (SART, N-Back) indicated that there were overall no significant differences in the subjects' sustained attention, inhibitory control, or working memory during the study weeks or between the study weeks. The results of the HRV data during the daily orthostatic tests were inconclusive but there was some indication that the subjects were less stressed during the study week with the 4:4/6:6 watch system. In conclusion, the present study indicates that in navy surface operations: working with the fixed 4:4/6:6 watch system causes less sleepiness, fatigue, and psychological stress than working with the rotating 4:4 watch system. The study result is well in line with previous research regarding watch systems.

Abstract: Pihlainen, K, Kyröläinen, H, Santtila, M, Ojanen, T, Raitanen, J, and Häkkinen, K. Effects of combined strength and endurance training on body composition, physical fitness, and serum hormones during a 6-month crisis management operation. J Strength Cond Res 36(9): 2361-2370, 2022-Very few studies have examined the impact of training interventions on soldier readiness during an international military operation. Therefore, the present study investigated the effects of combined strength and endurance training on body composition, physical performance, and hormonal status during a 6-month international military deployment consisting of typical peacekeeping tasks, e.g., patrolling, observation, and on-base duties. Soldiers ( n = 78) were randomly allocated to a control group (C) or one of 3 combined whole-body strength and endurance training groups with varying strength-to-endurance training emphasis (Es = 25/75%, SE = 50/50% or Se = 75/25% of strength/endurance training). Body composition, physical performance (3000-m run, standing long jump [SLJ], isometric maximal voluntary contraction of the lower [MVC lower] and upper extremities [MVC upper ], muscle endurance tests), and selected serum hormone concentrations were determined prior to training (PRE), and after 9 (MID) and 19 (POST) weeks of training. Within- and between-group changes were analyzed using linear regression models. The average combined strength and endurance training frequency of the total subject group was 3 ± 2 training sessions per week. No changes were observed in physical performance variables in the intervention groups, whereas SLJ decreased by 1.9% in C ( p < 0.05). Maximal voluntary contraction lower increased by 12.8% in the combined intervention group ( p < 0.05), and this was significantly different to C ( p < 0.05). Testosterone-to-cortisol ratio increased in SE and Se ( p < 0.05), whereas no change was observed in C. The intervention groups maintained or improved their physical performance during deployment, which is beneficial for operational readiness. However, the high interindividual variation observed in training adaptations highlights the importance of training individualization during prolonged military operations., (Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the National Strength and Conditioning Association.)

Understanding the effect of stress, fatigue, and sleep deprivation on the ability to maintain an alert and attentive state in an ecologically valid setting is of importance as lapsing attention can, in many safety-critical professions, have devastating consequences. Here we studied the effect of close-quarters battle (CQ battle) exercise combined with overnight military training with sleep deprivation on cognitive performance, namely sustained attention and response inhibition. In addition, the effect of the CQ battle and overnight training on cardiac activity [heart rate and root mean square of the successive differences (RMSSD)] during the cognitive testing and the relationship between cardiac activity and cognitive performance were examined. Cognitive performance was measured with the psychomotor vigilance task (PVT) and the sustained attention to response task (SART). Altogether 45 conscripts participated in the study. The conscripts were divided into control (CON) and experimental (EXP) groups. The CON completed the training day after a night of sleep and the EXP after the overnight military training with no sleep. Results showed that the effect of the overnight training on cognitive performance and the between-group difference in heart rate (HR) and heart rate variability (HRV) depended on the cognitive test. Surprisingly, the cognitive performance was not largely affected by the CQ battle. However, as expected, the CQ battle resulted in a significant decrease in RMSSD and an increase in HR measured during the cognitive testing. Similarly, the HR parameters were related to cognitive performance, but the relationship was found only with the PVT. In conclusion, fatigue due to the overnight training impaired the ability to maintain sufficient alertness level. However, this impairment in arousal upregulation was counteracted by the arousing nature of the SART. Hence, the conscripts' cognitive performance was mainly preserved when performing a stimulating task, despite the fatigue from the sleep loss of the preceding night and physical activity., Competing Interests: Authors JL and JN are employed by VTT Technical Research Centre of Finland Ltd. Author JR is employed by Savox Communications Oy Ab. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationship that could be construed as a potential conflict of interest., (Copyright © 2022 Passi, Lukander, Laarni, Närväinen, Rissanen, Vaara, Pihlainen, Kallinen, Ojanen, Mauno and Pakarinen.)

Research on interpersonal rejection is voluminous, but less is known about perceived rejection in relation to social goals among peers during adolescence, especially while also considering factors that may moderate these associations. In a correlational design, we surveyed a diverse sample of middle school students to examine concurrent (Study 1; N = 269) and short-term longitudinal (Study 2; N = 321) links between rejection and adolescent communal (affiliation, closeness) and agentic (status, influence) goals, and narcissism and gender as moderators in the associations between rejection and social goals. Rejection was negatively related to (Study 1) and predicted decreases in (Study 2) communal goals. Narcissism was positively related to and predicted increases in agentic goals, and moderated the association between rejection and agentic goals (in both studies). One moderated effect of gender was found: perceived rejection predicted decreases in agentic goals for girls, but increases in agentic goals for boys. Our findings mostly align with existing research on interpersonal rejection in youth, and extend this literature by demonstrating that perceived rejection is meaningfully related to changes in trait-like social goals among peers, suggesting it may alter not only situation-specific cognitions, but also globalized goals, or motivations for peer interaction. The findings also call for further research on individual differences in associations between rejection and social goals, along with other outcomes.

The aim of this study was to examine changes in body composition, energy metabolites and electrolytes during a 10-day winter survival training period. Two groups of male soldiers were examined: the REC group ( n = 26; age 19.7 ± 1.2 years; BMI 23.9 ± 2.7) had recovery period between days 6 and 8 in the survival training, whereas the EXC group ( n = 42; age 19.6 ± 0.8 years; BMI 23.1 ± 2.8) did not. The following data were collected: body composition (bioimpedance), energy balance (food diaries, heart rate variability measurements), and biomarkers (blood samples). In survival training, estimated energy balance was highly negative: -4,323 ± 1,515 kcal/d (EXC) and -4,635 ± 1,742 kcal/d (REC). Between days 1 and 10, body mass decreased by 3.9% (EXC) and 3.0% (REC). On day 6, free fatty acid and urea levels increased, whereas leptin, glucose and potassium decreased in all. Recovery period temporarily reversed some of the changes (body mass, leptin, free fatty acids, and urea) toward baseline levels. Survival training caused a severe energy deficit and reductions in body mass. The early stage of military survival training seems to alter energy, hormonal and fluid metabolism, but these effects disappear after an active recovery period., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Nykänen, Ojanen, Heikkinen, Fogelholm and Kyröläinen.)

Physically demanding essential military tasks include load carriage, manual material handling and casualty evacuation. This narrative review characterizes the main physical attributes related to performance of these occupational tasks and reviews physical training intervention studies in military settings to improve performance in these military tasks. Load carriage performance requires both aerobic and neuromuscular fitness with greater emphasis on maximal strength and absolute maximal oxygen uptake, especially when carrying heavier loads. In manual material handling, maximal strength and power are strongly associated with discrete lifting, while muscular strength, muscular endurance and aerobic fitness are also associated with repetitive lifting performance. Maximal strength including grip strength, muscular endurance, absolute maximal oxygen uptake and anaerobic capacity are associated with casualty evacuation performance. The results of the present review particularly emphasize the role of muscular fitness in successful performance of the reviewed military occupational tasks. Training intervention studies indicate that load carriage performance can be effectively improved by combining strength, aerobic and specific load carriage training. Improvement in maximal lifting capacity can be achieved by strength training or combined strength and aerobic training, while strength and aerobic training alone, or their combination are effective in improving repetitive lifting, and carry tasks. Only a few studies are available for casualty evacuation and the results are inconclusive but may indicate benefits of strength or combined training. Moreover, emphasis on lower volume but higher intensity in combined training may be a feasible and effective mode to improve military occupational performance in recruits and active-duty soldiers.