Physical performance responses during 72 h

of military operational stress

BRADLEY C. NINDL, CARA D. LEONE, WILLIAM J. THARION, RICHARD F. JOHNSON, JOHN W. CASTELLANI,
JOHN F. PATTON, and SCOTT J. MONTAIN
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Military Performance Division; Military Nutrition Division; and Thermal and Mountain Medicine Division, U.S. Army
Research Institute of Environmental Medicine, Natick, MA
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ABSTRACT
NINDL, B. C., C. D. LEONE, W. THARION, R. F. JOHNSON, J. CASTELLANI, J. F. PATTON, and S. J. MONTAIN. Physical
performance responses during 72 h of military operational stress. Med. Sci. Sports Exerc., Vol. 34, No. 11, pp. 1814 –1822, 2002.
Purpose: To characterize the impact of prolonged work, underfeeding, and sleep deprivation (i.e., sustained operations; SUSOPS) on
physical and occupational related performance during military operational stress. Methods: Ten male soldiers were tested on days 1
(D1), 3 (D3), and 4 (D4) of a control and an experimental week that included prolonged physical work (total daily energy expenditure
~4500 kcal·d⫺1), underfeeding (~1600 kcal·d⫺1), and sleep deprivation (~2 h·d⫺1). Body composition was measured with dual-energy
x-ray absorptiometry (DEXA). Ballistic power was assessed by 30 repetitive squat jumps and bench-press throws. Military-relevant
occupational performance was evaluated with a 10-min box lift, obstacle course, grenade throw, rifle marksmanship, and a 25-min
wall-build task. Results: Fat-free mass (⫺2.3%) and fat mass (⫺7.3%) declined (P ⱕ 0.05) during SUSOPS. Squat-jump mean power
(⫺9%) and total work (⫺15%) declined (P ⱕ 0.05) during SUSOPS. Bench-press power output, grenade throw, and marksmanship
for pop-up targets were not affected. Obstacle course and box-lift performances were lower (P ⱕ 0.05) on D3 but showed some recovery
on D4. Wall building was ~25% lower (P ⱕ 0.05) during SUSOPS. Conclusion: Decrements in performance during SUSOPS are
primarily restricted to tasks that recruit muscles that are over-utilized without adequate recovery. General military skill tasks and
occupational physical performance tasks are fairly well maintained. Key Words: WEIGHT LOSS, OVERTRAINING, SLEEP
DEPRIVATION, ENERGY RESTRICTION, MILITARY PERSONNEL, OCCUPATIONAL PERFORMANCE

resulting in an average weight loss of 1.75 ⫾ 0.21% did not

P
rolonged physical work without adequate rest and
energy intake can compromise physical performance.
Studies on human starvation conducted by Keys and
colleagues in the Laboratory of Physiological Hygiene at the
University of Minnesota were the first concerted efforts to
characterize human performance decrements during an ex-
tended energy deficit (13,17,32). Reminiscent of Keys et
al.’s early work, a series of studies conducted by the United
States Army Research Institute of Environmental Medicine
(USARIEM) during the early 1990s on U.S. Army Ranger
training clearly demonstrated that muscular strength and
power output were degraded after severe weight loss (13–
16% losses in body mass over a 61-d period) (6,7,15,25,26).
Studies involving lesser and shorter-term energy deficits
have shown minimal changes in physical performance (4 –
6,10,19,34). For example, Fogelholm et al. (4) reported that
vertical jump was not impaired by a 5% weight reduction
over 3 wk, and Zachwieja et al. (34) recently demonstrated
that 2 wk of moderate energy restriction (~750 kcal·d⫺1)
0195-9131/02/3411-1814/$3.00/0
MEDICINE & SCIENCE IN SPORTS & EXERCISE®
Copyright © 2002 by the American College of Sports Medicine
Submitted for publication February 2002.
Accepted for publication July 2002.
Address for correspondence: Bradley C. Nindl, Ph.D., FACSM, Military
Performance Division, U.S. Army Research Institute of Environmental
Medicine, Natick, MA 01760; E-mail: bradley.nindl@na.amedd.army.mil.
DOI: 10.1249/01.MSS.0000037093.39080.3E
1814
impair a battery of physical performance tests. In a review
of studies examining the effects of an energy deficit on
soldier physical performance, Friedl (6) suggested that body
mass losses of at least 5% and possibly 10% are necessary
before any significant decrements in performance occur.
More research is required to verify this hypothesis, as pre-
vious studies examining the impact of short-term energy
deficits on physical performance have primarily utilized
conventional tests of strength, anaerobic power, and mea-
surement of aerobic capacity. When occupational type tasks
have been used, they have been limited primarily to pro-
longed sustained running tests (6). Despite the early obser-
vation of Taylor et al. (32) that maximal movement velocity
was slowed during underfeeding, no studies have evaluated
the effect of underfeeding on repetitive explosive power or
the impact this may have on occupationally relevant tasks.
Military and emergency response personnel perform mis-
sions that include sleep deprivation as well as prolonged
work and underfeeding. Sleep deprivation impairs perfor-
mance on complex cognitive tasks or those with a substan-
tial vigilance component (12,14,21). Studies that have in-
vestigated the impact of the combined stress of several days
of prolonged work, underfeeding, and sleep deprivation
have reported little or no decrement in short-duration, well-
learned task performance (e.g., weapon assembly) (12) and
mixed results on anaerobic performance (9,11,18,30,34).
The effects of sleep deprivation, prolonged work, and
underfeeding on physical performance tasks that have per-
 TABLE 1. Timeline and activities for experimental protocol.
Time Day 1 Day 2 Day 3 Day 4 Day 5
0100 Road march Road march Road march 12-h
hormonal
profile
analysis
0200
0300 Travel sleep
0400 Sleep Sleep
0500 Break Unload truck/break Break
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0600 Blood draw Confidence course Blood draw Blood draw Body
composition
0700 Cognitive and Cognitive and Cognitive
marksmanship marksmanship and
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testing testing marksmanship

testing
0800
0900 Physical Break Physical Physical
performance performance testing performance
testing testing
1000 Battle drills Debrief
1100 Travel to field site Break Cold test
1200 Set Up command Hot walk
1300 Post
1400 Break
1500 Land Navigation Travel Physical training
1600 Course Litter carry
1700 Break
1800 Break 12-h
hormonal
profile
analysis
1900 Break Battle drills Light training
2000 Battle Drills Pack command post
2100 Sleep
2200 Sleep Road march Sleep
2300 Road march Road march
2400
Bold text is for the testing blocks that were performed during both the Control and SUSOPS weeks, whereas the light text is for activities that were only performed during the SUSOPS
week.

sistence (the ability to intrinsically sustain one’s motivation)
or vigilance components have not been examined.
Currently, the U.S. Army is planning to revolutionize
soldier performance by the initiation of a strategy entitled
Objective Force Warrior (OFW). The goal of OFW is to
modernize the warfighter (i.e., soldier, sailor, airmen, and
marine) by aggressively employing science and technol-
ogy efforts that enhance the warfighter’s survivability,
lethality, sustainment, and mobility on the modern bat-
tlefield. A fundamental goal of OFW is to ensure peak
physical performance during military operational stress.
The purpose of the present investigation was to further
characterize the impact of prolonged work, underfeeding,
and sleep deprivation on physical performance. Perfor-
mances on five unique tests were measured before and
after several days of prolonged work (total daily energy
expenditure ~ 6100 kcal) under conditions of limited food
intake (~1600 kcal·d⫺1) and sleep (~2 h·d⫺1). The phys-
ical performance tests were chosen to elucidate whether
this type of multi-stressor environment would impair the
ability to generate and sustain power during repetitive
ballistic activity, reduce maximal capability to perform
occupationally relevant work and military skill tasks, and
its effects on a self-paced physical work task not limited
by muscle fatigue (i.e., persistence to perform). It was
hypothesized that several days of prolonged work, sleep
deprivation, and limited food intake would reduce mean
PHYSICAL PERFORMANCE AND MILITARY OPERATIONS
power during repetitive ballistic performance, lower
maximal work productivity during physically exhausting
work, and compromise military skill tasks and perfor-
mance during self-paced work.
METHODS
Experimental Design
This study utilized a within subjects repeated measures
design consisting of two 96-h testing blocks (see Table 1).
Physical performance tests were performed on the morning
of days 1, 3, and 4 (D1, D3, and D4) of each test block. The
initial block (control week) included the experimental tests
but no other scheduled exercise. Sleep and food intake were
ad libitum. The following week (sustained operations;
SUSOPS), the second 96-h block was performed. Physical
performance tests were performed on the morning of D1,
D3, and D4. After completing D1 physical performance
tests, the subjects performed nearly continuous physical
work through the D4 physical performance tests. Sleep was
restricted to two 1-h sleep periods per day. Food was limited
to one meal, ready-to-eat (1200 –1300 kcal/meal) and an
additional small meal per day or ~1600 kcal·d⫺1.
Before the control week, preliminary testing and practice
sessions were performed. The investigators provided verbal
feedback, and suggestions for improvement, after each
Medicine & Science in Sports & Exercise姞 1815
 practice test. These practice sessions were included to min-
imize any performance changes due to learning effects dur-
ing experimental testing. On each test day, body mass was
measured and a small standardized meal was consumed.
Approximately 1 h later, the subjects completed the Profile
of Mood States questionnaire followed by the wall-build test
and the grenade throw. At 0900 h, approximately 15 min of
stretching and aerobic exercise were performed. All subjects
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were then tested on the obstacle course. Each subject was
tested twice and was given 15 min of rest between tests. The
subjects were then divided into two groups. One group
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performed the repetitive box lift test while the other com-
pleted the ballistic tests (i.e., squat jumps followed by bench
throws). A 20-min rest period was provided between these
two stations.
Field training consisted of the performance of military
relevant tasks and military basic skill training. It included
basic patrolling, combat drills, road marches, land naviga-
tion, a litter obstacle course, and a confidence course (refer
to Table 1). Physical activity and movement were recorded
every minute by a wrist-worn Actigraph (Mini Mitter, Bend,
OR, and Precision Control Designs, Ft. Walton Beach, FL).
Energy expenditure, estimated from body composition
changes and distance traversed during the course, was ap-
proximately 4500 kcal·d⫺1. Sleep time was calculated by
adding the time periods in which no activity signal was
measured. Water was consumed ad libitum.
Subjects
Fourteen healthy male soldiers volunteered to participate
in the study. Three injuries and one illness prevented four of
these test subjects from completing all of the physical per-
formance tests. The data from the remaining 10 volunteers
(22 ⫾ 3 yr, 183 ⫾ 7 cm, 87 ⫾ 8 kg) are presented in this
paper. The experiment was approved by the appropriate
Institutional Scientific Review and Human Use Review
Committees. The subjects were briefed on the study proce-
dures, and written consent was obtained before study par-
ticipation. Seven of the 10 soldiers had graduated from
combat basic training and advanced individualized training
within the previous 6 months. During this time, their phys-
ical training history consisted of general calisthenics and
running targeted at improving muscular endurance and aer-
obic fitness. The military occupational specialties of the
soldiers participating in this included combat support (i.e.,
medics, unit supply specialties, and personnel administra-
tion clerks) and combat arms (i.e., infantry soldier).
Experimental Methods
Body composition. Body composition was assessed
by whole body dual-energy x-ray absorptiometry (DEXA)
scans and skin-fold measurements. Total body estimates of
percent fat, bone mineral density (BMD), and bodily content
of bone, fat, and nonbone lean tissue were determined using
manufacturer described procedures and supplied algorithms
(Total Body Analysis, version 3.6, Lunar Corp., Madison,
WI). Precision of this measurement is better than ⫾ 0.5%
1816 Official Journal of the American College of Sports Medicine
body fat (7,26,27). Scanning was in 1-cm slices from head
to toe by using the 20-min scanning speed. Skin-fold mea-
surements of the chin, triceps, chest, subscapular, mid-
axillary, suprailiac, abdomen, thigh, and calf were obtained
on the right side of the body by a trained and experienced
technician both before and after the SUSOPS week.
Maximal strength. Maximal lifts in the squat and
bench press exercises were determined during preliminary
testing. With the barbell placed on the shoulders, a success-
ful parallel squat required descending by flexing the knees
and hips until the proximal head of the femur reached the
same horizontal plane as the superior border of the patella.
The subject then returned to a standing position. For the
1-repetition maximum (1-RM) bench press, the subject
gripped the barbell slightly wider than shoulder width and
lowered the barbell under control until it lightly touched
(i.e., without bouncing) the chest. The subject then lifted the
barbell back to a straight-arm position while keeping the feet
and hips in contact with the floor and bench. All strength
testing was conducted on a MaxRack (Max Rack, Inc.,
Columbus, OH). Warm-up consisted of performing 5–10
repetitions at 40 – 60% of perceived maximum, a 3- to 5-min
rest and stretching period, and the completion of 3–5 repe-
titions at 60 – 80% of maximum. Three to five subsequent
lifts were then made to determine the 1-RM with 5 min of
rest between lifts. An attempt was considered successful
when completed through a full range of motion without
deviating from proper technique and form.
Ballistic power tests. A repetitive bench-press throw
and squat-jump test were used to elucidate the impact of
SUSOPS on upper-body and lower-body ballistic power.
Subjects were required to perform 30 consecutive repeti-
tions at a load of 30% of their 1-RM. This load was chosen
as muscle power is near maximal at 30% of maximal vol-
untary contraction (20,33). All testing was performed in a
ballistic, explosive manner on a MaxRack interfaced with a
Ballistic Measurement System (Innervations, Muncie, IN).
For the bench-press throw, subjects started with the arms
extended straight over the shoulders and were instructed to
throw the bar as high as possible at the end of the concentric
movement to produce the maximum power output. The
subject caught the bar on its descent and immediately,
without pause, initiated another maximal bench-press throw
and continued until 30 repetitions were completed. For the
squat jump, subjects squatted to a self-selected depth nec-
essary for optimal vertical jump height then explosively
jumped with the load as high as possible. After descent, the
subjects, without pause, initiated another jumping move-
ment and continued until 30 repetitions were completed.
Mean power (W), peak power (W), mean velocity (m䡠s⫺1),
peak velocity (m䡠s⫺1), maximum displacement (m), mini-
mum displacement (m), and work (J) were calculated (33).
Repetitive box lift (RBL). To assess manual material-
handling capability, the subjects lifted as many 20.5-kg
metal boxes (0.47 m ⫻ 0.23 m ⫻ 0.31 m; with side handles)
onto a 1.3-m-high platform as possible in 10 min. This test
simulates loading a truck as fast as possible and requires
muscular strength and endurance. Encouragement was
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 provided throughout the test to motivate the subjects to
perform maximally. During the test, the subject was posi-
tioned in between two platforms spaced 2.4 m apart. After
the subject lifted a box onto the platform in front of him, he
turned 180°, stepped up to the other box, and lifted again.
Technicians lowered the box to the ground after each lift, so
that the volunteer lifted but never lowered the boxes. Total
work (J) performed during the test was calculated and used
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for statistical analysis. The intraclass correlation coefficient
for this test is 0.94 (29).
Obstacle course (OC). Soldier mobility was assessed
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via a six-station indoor obstacle course that simulated im-
pediments to movement that a soldier might encounter dur-
ing a conflict (29). Rapid navigation of the course required
high levels of speed, strength, coordination, agility, and
anaerobic endurance of both the lower and upper body. The
first course obstacle was a set of five 46-cm-high plastic
hurdles, spaced over 16.8 m. The subjects then ran a zigzag
pattern around nine staggered plastic cones covering a dis-
tance of 26.8 m. They then rounded a corner and low-
crawled through a 3.7-m-long wood-frame tunnel (61 cm
high and 91 cm wide). Upon exiting the low-crawl, the
volunteers shimmied along a 3.7-m-long pipe suspended
2 m above the ground, a movement requiring them to hang
from the pipe upside-down, with the legs crossed around the
pipe, and advance by pulling with their hands. The next
obstacle was a 137-cm-high wooden wall, over which the
subjects climbed or bounded. Subjects finished the OC by
running around a 180° corner and sprinting 28.7 m. The
subjects performed two trials on each test day. Times were
obtained for each course segment using a light-beam system
with telemetry (Brower Timing Systems, Salt Lake City,
UT). The best time for each day was used for statistical
analysis. The intraclass correlation coefficient for this test is
0.92 (29).
Grenade throw. To directly assess a combat-related
military skill, grenade-throwing accuracy was measured. In
a standing position, subjects threw a dummy grenade at a
target 35 m away. Five separate throws were attempted at a
circular target. A throw was considered a “hit” if it was
thrown within 5 m of the target. The grenades were the same
shape (spherical) and mass (0.5 kg) as live grenades. For
scoring, the number of hits and the distance from the center
of the target were recorded.
Marksmanship. Evaluation of M16 rifle marksman-
ship was conducted using the Model 70 Weaponeer Rifle
Marksmanship Simulator (Spartanics, Rolling Meadows,
IL) that utilizes a demilitarized M16A2 rifle and incorpo-
rates a realistic simulation of recoil according to methods
described previously (16). Briefly, the subject was required
to assume a standing foxhole position and shoot at a rapidly
appearing mix of 50 stationary and moving targets (inter-
target interval of ⱕ 1 s) presented singly and in pairs.
Wall building. Physical persistence, defined as the abil-
ity to maintain a prolonged repetitive physical task, was
assessed by means of a wall-building task. This test was
selected because it is a monotonous, repetitive task, much
like assembly line work and performance is limited by
PHYSICAL PERFORMANCE AND MILITARY OPERATIONS
factors (e.g., drive to perform) other than muscle strength
and endurance (23). Subjects were instructed to build as
many 10 ⫻ 10 block walls in 25 min using 100 wooden
blocks (2 ⫻ 4 ⫻ 8 inches). Each block weighed less than 0.2
kg. Subjects were required to move the blocks a total of 5 m
from a starting supply pile to assemble a wall. After a wall
was built, the blocks were rapidly dispersed into a pile by a
technician for the volunteer to move back to the initial
location 5 m away to build a second wall. This process was
continued for the 25 min. The task was self-paced with no
verbal encouragement given. A “1-minute-to-go” warning
signal was given 24 min into the test. The intraclass corre-
lation coefficient for the wall-build task was 0.84.
Profile of Mood States (POMS). To assess subjective
mood states, all subjects completed a POMS questionnaire
(24). For this test, subjects rated a series of 65 adjectives to
assess six mood states (tension, depression, anger, vigor,
fatigue, and confusion). Each adjective was scored from 0
(not at all) to 4 (extremely). The response set of “How are
you feeling right now?” was used. The POMS was admin-
istered at the same time on D1, D3, and D4 immediately
before the wall-building task.
Statistics
All data are presented as mean ⫾ SEM. An analysis of
variance with repeated measures was employed to assess
changes over time during the study. Where appropriate, a
Tukey post hoc follow-up test was used. An alpha value of
0.05 was used for all statistical tests. All statistical analyses
were used with Statistica software packages (StatSoft,
Tulsa, OK).
RESULTS
Subjects consumed an average of 1653 ⫾ 25 kcal·d⫺1
(225 ⫾ 6 g carbohydrate, 54 ⫾ 2 g fat, 69 ⫾ 3 g protein) and
slept a total of 3.6 ⫾ 0.3 h. SUSOPS resulted in decreased
(P ⱕ 0.05) vigor and increased (P ⱕ 0.05) tension, depres-
sion, anger, fatigue, and confusion (Table 2). Body mass
was stable during the control week and SUSOPS D1, aver-
aging 87.5 ⫾ 4.5 kg. Body mass declined during SUSOPS,
being 2.1 and 2.5 kg lower on D3 and D4, respectively.
Total soft-tissue lean and fat mass declined (P ⱕ 0.05) by
1.5 kg and 1.2 kg, respectively (Table 3). Percent body fat
decreased (P ⱕ 0.05) from 18.5 ⫾ 5% to 17.7 ⫾ 6%.
Soft-tissue lean mass declined (P ⱕ 0.05) by 4 –5% in both
the arms and trunk but not the legs. Fat mass declined (P ⱕ
0.05) 13% and 9% in the arms and trunk, respectively, but
not in the legs. Subcutaneous fat reflected by the total
skinfolds declined 5% (P ⱕ 0.05).
The ballistic power test results are presented in Table 4.
Bench-press throw performance was not affected by SU-
SOPS, with mean power averaging 351.6 ⫾ 22.7 W. In
contrast, squat-jump mean power and total work declined (P
ⱕ 0.05) during SUSOPS. The performance decrement was
associated with a shallower descent (P ⱕ 0.05) before
initiating the jump.
Medicine & Science in Sports & Exercise姞 1817
 TABLE 2. Profile of mood states (POMS) scores.
Control Week SUSOPS Week
Parameter Day 1 Day 3 Day 4 Day 1 Day 3 Day 4
Tension 5.21 ⫾ 1.17 a
4.43 ⫾ 0.69 a
5.07 ⫾ 1.11 a
5.14 ⫾ 1.06 a
7.93 ⫾ 0.88b
7.79 ⫾ 1.4b
Depression 3.00 ⫾ 1.1a 2.29 ⫾ 1.11a 1.57 ⫾ 0.59a 1.21 ⫾ 0.48a 7.79 ⫾ 2.75b 7.29 ⫾ 1.53b
Anger 2.64 ⫾ 1.0a 1.93 ⫾ 0.87a 2.86 ⫾ 1.12a 4.14 ⫾ 2.46a 11.0 ⫾ 2.49b 12.79 ⫾ 2.28b
Vigor 12.79 ⫾ 1.88a 9.29 ⫾ 1.95a,b 6.50 ⫾ 1.88b 8.38 ⫾ 2.07b 2.93 ⫾ 1.05c 2.57 ⫾ 1.0c
Fatigue 3.64 ⫾ 1.04a 6.00 ⫾ 1.82a 5.79 ⫾ 1.28a 3.64 ⫾ 1.61a 16.21 ⫾ 1.27b* 18.43 ⫾ 1.3b
Confusion 4.29 ⫾ 0.87a 4.07 ⫾ 0.75a 4.00 ⫾ 0.42a 3.71 ⫾ 0.45a 9.86 ⫾ 1.46b 11.64 ⫾ 1.41c
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Similar letters across days for a variable demonstrate statistical similarity, whereas different letters denote statistical differences.
* P ⱕ 0.05; data are presented as mean ⫾ SEM.
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Significant changes in the RBL and OC performance can walls). Grenade throwing ability and rifle marksmanship
be observed in Figures 1 and 2. When performing these (Table 5) were not significantly altered by SUSOPS.
tests, the subjects exhibited similar response patterns in that
performance was decreased (P ⱕ 0.05) on SUSOPS D3, but
demonstrated some recovery by D4 and performance scores
were no longer statistically different from SUSOPS D1. The
DISCUSSION
number of boxes lifted decreased from 199.5 ⫾ 12.5 on This study sought to experimentally construct a multi-
SUSOPS D1 to 182.8 ⫾ 12.3 and 189.6 ⫾ 12.7 on SUSOPS stressor environment (i.e., caloric and sleep restriction su-
D3 and D4, respectively, and resulted in 8.5% less work perimposed upon sustained physical exertion) to determine
completed on SUSOPS D3 (D1: 5289.3 ⫾ 332 J vs D3: the impact on soldier physical performance. Our data indi-
4848 ⫾ 325 J). cate that the sustained operations (SUSOPS) scenario was
Wall-building performance stabilized between D4 of the physically and mentally challenging as evidenced by the
control week and D1 of SUSOPS week (Fig. 3). SUSOPS estimated caloric deficit (~3,000 kcal·d⫺1), the loss in body
D3 (6.0 ⫾ 0.4 walls) and D4 (6.2 ⫾ 0.4 walls) performances mass (~3.1%), the limited amount of sleep achieved (total of
were ~25% lower (P ⱕ 0.05) than SUSOPS D1 (8.0 ⫾ 0.4 3.6 h), the continuous scheduling of physical activity (~22
h·d⫺1), and by the self-reported increases in tension, depres-
TABLE 3. Body composition measures pre- and post-SUSOPS.
sion, anger, fatigue, and confusion mood states. These ex-
DEXA Measures Pre-SUSOPS Post-SUSOPS
perimental findings may be of interest to military and emer-
Total soft-tissue mass (kg)
gency rescue personnel who must schedule work:rest ratios;
Whole body 82.36 ⫾ 13.22 79.68 ⫾ 12.45* determine feeding schedules; and identify optimal physical-
Arms 11.44 ⫾ 1.72 10.68 ⫾ 1.72* training programs, appropriate selection and allocation of
Trunk 37.02 ⫾ 7.37 35.17 ⫾ 6.96*
Legs 28.78 ⫾ 5.03 28.68 ⫾ 4.27 manpower, and planning for personnel replacement.
Lean soft-tissue mass (kg) As performance is determined by both capability and
Whole body 66.12 ⫾ 9.57 64.62 ⫾ 8.84*
Arms 9.20 ⫾ 1.35 8.73 ⫾ 1.30* motivation, physical performance tasks were specifically
Trunk 29.43 ⫾ 4.80 28.24 ⫾ 4.22* chosen to provide insight into both the physical and psy-
Legs 23.33 ⫾ 4.22 23.43 ⫾ 3.79
Fat tissue mass (kg)
chological effects of this stress and their impact on perfor-
Whole body 16.24 ⫾ 6.26 15.06 ⫾ 6.62* mance. Our findings demonstrate that short-term military
Arms 2.24 ⫾ 1.05 1.95 ⫾ 1.15* operational stress adversely affect selected aspects of phys-
Trunk 7.60 ⫾ 3.28 6.93 ⫾ 3.48*
Legs 5.44 ⫾ 1.87 5.26 ⫾ 1.77 ical performance. An incremental and progressive decre-
Region % fat mass ment was observed for lower-body ballistic anaerobic per-
Whole body 18.54 ⫾ 5.08 17.67 ⫾ 5.69*
Arms 18.41 ⫾ 6.57 16.90 ⫾ 7.81 formance (D4 SUSOPS values were ~9% and ~15% lower
Trunk 19.29 ⫾ 5.29 18.31 ⫾ 6.10* than D1 SUSOPS values for mean power output and total
Legs 17.84 ⫾ 4.73 17.40 ⫾ 4.83
Bone mineral content (kg) work performed, respectively), whereas no changes were
Whole body 3.80 ⫾ 0.21 3.77 ⫾ 0.66* observed for upper-body anaerobic performance or grenade
Arms 0.53 ⫾ 0.09 0.52 ⫾ 0.09
Trunk 1.23 ⫾ 0.24 1.21 ⫾ 0.23*
throwing ability. Transient losses in performance were ob-
Legs 1.50 ⫾ 0.32 1.50 ⫾ 0.33 served for OC and RBL abilities, as these tests had declined
Skinfolds
Abdomen 18.24 ⫾ 6.26 17.23 ⫾ 6.07
at 48 h but had statistically recovered by the end of
Calf 8.10 ⫾ 3.52 8.78 ⫾ 3.69 SUSOPS. Performance on the wall-building task was sub-
Chest 9.58 ⫾ 5.08 9.22 ⫾ 4.40 stantially lower during SUSOPS. This study has demon-
Chin 5.54 ⫾ 2.32 6.75 ⫾ 3.78
Knee 9.07 ⫾ 2.74 8.83 ⫾ 3.03 strated that three of the four physically demanding perfor-
Mid-axillary 9.63 ⫾ 3.53 9.52 ⫾ 3.64 mance tests were negatively affected at some point during
Subscapular 15.47 ⫾ 5.41 15.65 ⫾ 5.27
Suprailiac 19.29 ⫾ 6.25 15.60 ⫾ 5.08* SUSOPS. However, it also underscores the resiliency of the
Thigh 13.0 ⫾ 4.62 12.57 ⫾ 4.07 body’s physical performance capabilities during short-term
Tricep 9.45 ⫾ 3.33 8.40 ⫾ 1.93
operational stress, as only one test (lower-body ballistic
Total 112.74 ⫾ 30.68 107.48 ⫾ 29.99* anaerobic performance) was significantly compromised af-
Data are presented as mean ⫾ SEM; * P ⱕ 0.05. ter 72 h of SUSOPS.
1818 Official Journal of the American College of Sports Medicine http://www.acsm-msse.org
 TABLE 4. Ballistic-testing anaerobic performance variables of the lower (squat jumps) and upper body (bench throws).
Control Week SUSOPS Week
Parameter Day 1 Day 3 Day 4 Day 1 Day 3 Day 4
Bench throws
Mean power (W) 340.7 ⫾ 21.3a 350.7 ⫾ 25.1a 344.8 ⫾ 22.5a 355.7 ⫾ 24.2a 351.6 ⫾ 29.7a 365.9 ⫾ 27.6a
Peak power (W) 414.5 ⫾ 37.4a,b 416.5 ⫾ 35.2a,b 420.7 ⫾ 37.3a,b 448.6 ⫾ 41.2b,c 436.6 ⫾ 47.7b,c 462.4 ⫾ 45.9c
Mean velocity (m䡠s⫺1) 1.19 ⫾ 0.10a 1.23 ⫾ 0.11a 1.21 ⫾ 0.10a 1.25 ⫾ 0.12a 1.23 ⫾ 0.13a 1.30 ⫾ 0.12a
Peak velocity (m䡠s⫺1) 1.61 ⫾ 0.07a 1.67 ⫾ 0.08b,c 1.66 ⫾ 0.07b,c 1.68 ⫾ 0.08b,c 1.65 ⫾ 0.08a,c 1.65 ⫾ 0.07a,c
Work (J) 180.9 ⫾ 11.6a 191.1 ⫾ 10.6a 191.2 ⫾ 9.6a 186.2 ⫾ 10.5a 191.4 ⫾ 10.6a 188.5 ⫾ 10.2a
Minimum height (m) ⫺0.484 ⫾ 0.021a ⫺0.478 ⫾ 0.420a ⫺0.496 ⫾ 0.024a ⫺0.135 ⫾ 0.381a ⫺0.502 ⫾ 0.020a ⫺0.512 ⫾ 0.023a
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Maximum height (m) 0.146 ⫾ 0.012a 0.151 ⫾ 0.013a 0.151 ⫾ 0.009a 0.151 ⫾ 0.010a 0.151 ⫾ 0.011a 0.154 ⫾ 0.013a
Squat jumps
Mean power (W) 1501.2 ⫾ 91.1a,b 1446.7 ⫾ 104a,b 1488.6 ⫾ 99.7a,b 1523.5 ⫾ 83.9a 1434.3 ⫾ 94.9a,b 1406.2 ⫾ 122.1b
1724.8 ⫾ 117.8a 1633.6 ⫾ 118.4b 1701.7 ⫾ 120.4a,b 1714.3 ⫾ 114.1a,b 1661.9 ⫾ 112.3a,b 1665.6 ⫾ 127.0a,b
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Peak power (W)

Mean velocity (m䡠s⫺1) 1.27 ⫾ 0.05a 1.21 ⫾ 0.05a 1.24 ⫾ 0.05a 1.29 ⫾ 0.05a 1.23 ⫾ 0.05a 1.21 ⫾ 0.08a
Peak velocity (m䡠s⫺1) 2.00 ⫾ 0.12a 1.93 ⫾ 0.13a 1.96 ⫾ 0.12a 2.02 ⫾ 0.13a 1.96 ⫾ 0.13a 1.98 ⫾ 0.18a
Work (J) 825.2 ⫾ 55.5a,b,c 856.0 ⫾ 61.1a,b,c 860.6 ⫾ 57.8a,b 857.8 ⫾ 60.0a,b 806.3 ⫾ 53.8a,b,c 738.1 ⫾ 97.8c
Minimum height (m) ⫺0.529 ⫾ 0.03a,b,c ⫺0.562 ⫾ 0.03a,b,c ⫺0.557 ⫾ 0.03a,b,c ⫺0.547 ⫾ 0.03b ⫺0.526 ⫾ 0.03a,b,c ⫺0.523 ⫾ .030c
Maximum height (m) 0.147 ⫾ 0.023a 0.143 ⫾ 0.023a 0.140 ⫾ 0.019a 0.156 ⫾ 0.027a 0.147 ⫾ 0.027a 0.147 ⫾ 0.025a
Mean power (W), mean velocity (m䡠s⫺1), work (J), minimum height (m), and maximum height (m) represent the composite average over the entire 30 repetitions of the test. Peak
power (W) and peak velocity (m䡠s⫺1) represent the mean of the highest five repetitions during the test. Similar letters across days for a variable demonstrate statistical similarity,
whereas different letters denote statistical differences.
* P ⱕ 0.05; data are presented as mean ⫾ SEM.

Lower-, but not upper-body ballistic anaerobic mean
power was adversely affected by SUSOPS. These two novel
tests of anaerobic performance, utilizing repetitive and bal-
listic multi-joint movements, were conducted under near-
optimal loaded conditions (20,33) and were chosen in an
attempt to provide greater insight into characteristics of
mechanical power output (i.e., velocity and work) than
provided by other traditional anaerobic power tests such as
cycling, isokinetic dynamometry, or stair-climbing. Our re-
sults indicate that anaerobic power production was differ-
entially impacted based on the body region tested. Hackney
et al. (11) have also reported that lower-body anaerobic
power (assessed via a Wingate test) was lowered by 4.5 d of
continuous military operations. In contrast, Legg and Patton
(22) demonstrated that 8 d of artillery exercises with sleep
restriction (3 h·d⫺1) and energy restriction (1.9% loss of
body mass and 7.1% loss in fat mass) resulted in a decre-
ment of 7.3% for upper-body anaerobic power and a 14.3%
increase in lower-body anaerobic power. Knapik et al. (18)
also found reductions of upper-body strength and anaerobic
power but no changes in lower-body anaerobic mean power
production after 5 d of infantry maneuvers.
One likely explanation for the disparate results lies in the
specific activities in which the soldiers were engaged during
their sustained activity. In Legg and Patton’s study (22), the
soldiers were engaged in near continuous (~20 h·d⫺1) han-
dling and loading of shells and charges weighing 45 kg and
13 kg, respectively, whereas the soldiers in Hackney et al.’s
(11) and Knapik et al.’s studies (18) performed all maneu-
vers with loads weighing ~20 –29 kg. In the current study,
soldiers were involved in more generalized military activi-
ties without a particular emphasis on the upper body, as well
as nightly prolonged (e.g., 5 h) road marches with only
modest loads (⬍5 kg). Thus, the heavy use of the upper

FIGURE 1—Changes in obstacle course time (s) to completion during FIGURE 2—Changes in repetitive box lifting ability in work (J) done
days 1, 3, and 4 of the control and SUSOPS week. Similar letters denote during days 1, 3, and 4 of the control and SUSOPS week. Similar
statistical similarity, whereas different letters denote statistical differ- letters denote statistical similarity, whereas different letters denote
ences (P < 0.05). Data are presented as mean ⴞ SEM. statistical differences (P < 0.05). Data are presented as mean ⴞ SEM.

PHYSICAL PERFORMANCE AND MILITARY OPERATIONS Medicine & Science in Sports & Exercise姞 1819

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FIGURE 3—Changes in wall-building task performance during days
1, 3, and 4 of the control and SUSOPS week. Similar letters denote
statistical similarity, whereas different letters denote statistical differ-
ences (P < 0.05). Data are presented as mean ⴞ SEM.
body in Legg and Patton’s study (22) and of the lower body
in the current study likely contributed to an “overuse phe-
nomenon.” Repeated microtrauma of musculature without
adequate time for recovery can lead to compromised neu-
romuscular performance (8). Upon initial consideration, the
findings of Knapik et al. (18) might seem counterintuitive;
however, previous studies have shown that load carriage
places demands on the upper-body musculature, and in
extreme cases, can involve nerve damage of the upper-body
musculature resulting in rucksack palsy (3). The involve-
ment of the upper body in load carriage is further evidenced
by data illustrating significant improvements in load car-
riage after periodized resistance training of the upper body
(20).
Another possible explanation for dissimilar findings in
anaerobic performance among studies could be related to
learning and training influences on unfamiliar task perfor-
mance. Our study design dedicated 1 wk to test familiariza-
tion and practice during which subjects performed two max-
imal effort practice trials followed by a control week. To our
knowledge, other studies examining the effects of short-
term operational stress have not instituted such internal
control measures, thereby potentially masking the negative
effects of operational stress with possible simultaneous im-
provements in performance due to learning and/or training.
A simple test such as grip strength and grip endurance may
avoid the need for repeated practice sessions but has been
shown to be insensitive to large losses of muscle mass
observed after 62 d of severe military operational stress
(e.g., U.S. Army Ranger training) (15). Our finding of a
decline in power production using a jumping test under
loaded conditions suggests that a jumping test might have
merit as a field-expedient means to assess soldier perfor-
mance in future studies.
Repetitive box lifting (RBL) ability and OC time to
completion exhibited similar temporal response patterns
1820 Official Journal of the American College of Sports Medicine
during SUSOPS. These tests were chosen based on their
high degree of military relevance and ability to assess per-
formance at opposite ends of the energy spectrum. Perfor-
mances in both of these tests were lower than D1 SUSOPS
values on D3 (⫺8.3% and ⫺6.8% for the RBL and OC,
respectively) but had statistically recovered by the end of
SUSOPS. Although the 6% reduction for RBL ability on D4
was not statistically different than D1 values, this percent
decrease did exceed the coefficient of variation for the test
(29).
An enhanced level of motivation and effort on the last day
of the study (end spurt effect) (2) may account for the
observed rebound in performance observed for these two
tasks. Another partial explanation could reside in the fact
that on the last night of the scenario, the rate and distance of
the road march was considerably reduced (i.e., 14.5 km for
D1 and D2 vs 10.6 km for D3) and the terrain traversed was
less treacherous (i.e., field vs urban). Regardless of the
mechanism behind the performance rebound, the differential
response of lower anaerobic power further demonstrates this
test to be sensitive to short-term military operational stress.
The 10-min RBL test required aspects of both aerobic
capacity and muscular strength/endurance and was 8.3%
and 6% lower than SUSOPS D1 on SUSOPS D3 and D4,
respectively. Declines in maximal oxygen consumption
(~10%) after military operational stress has been reported by
others (13) but is likely not a factor in RBL performance, as
this activity requires only ~70% maximal oxygen consump-
tion. It is possible that glycogen depletion and/or a reduced
mechanical efficiency contributed to the lowered RBL per-
formance (1,10,17,19). Various facets of agility, speed,
strength, power, and motor coordination are required during
the OC. Earlier work from the Minnesota Starvation study
suggested that periods of starvation led to a loss of motor
function (13); however, our data suggest that tests involving
those skills (e.g., soldier mobility on the OC, grenade throw,
and rifle marksmanship) most critical to survivability on a
battlefield are fairly well maintained. Rognum et al. (31)
have shown that performance on a 1-km assault course did
not differ between two groups receiving either a high- or
low-energy diet during 107 h of military operational stress.
It is perhaps a reassuring finding that well-learned soldier-
related skills are well maintained during short-term military
operational stress.
In contrast to the modest changes in performance on tasks
primarily limited by physical capability, there was a 25%
reduction in wall-building performance. The larger perfor-
mance decrement with the wall-build task is likely due to the
persistence component of the task. The wall-build task was
a repetitive, monotonous task with no extrinsic verbal en-
couragement. The other physical tasks were of short dura-
tion and may have been influenced by high levels of extrin-
sic motivation (i.e., verbal encouragement). The wall-build
results suggest that prolonged and monotonous tasks will be
compromised by prolonged work, sleep deprivation, and
underfeeding. A practical implication is that whereas this
multi-stressor environment produces only modest decre-
ments in physical capability, the reductions in persistence
http://www.acsm-msse.org
 TABLE 5. Military skill tasks during the control and SUSOPS weeks.
Control Week
Parameter Day 1 Day 3
Grenade throw
Distance from target 3.2 ⫾ 0.6 3.1 ⫾ 0.5
% of targets hit 87.7 ⫾ 8.1 83.1 ⫾ 7.5
Marksmanship
No. of targets hit 36.1 ⫾ 4.8 36.9 ⫾ 3.7
No significant (P ⱕ 0.05) differences were observed across trials; data presented as raw scores ⫾ SEM.
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suggests extrinsic motivation in terms of verbal encourage-
ment to persevere will increase worker productivity.
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Mood profile has been linked to physical performance
(23,28). During SUSOPS, those individuals reporting the
highest levels of fatigue and confusion were those most
likely to build the fewest walls. Mood is a leading indicator
of physical performance. Mood disturbances often precede
physical performance decrements especially if extrinsic mo-
tivation to succeed is present (28). However, eventually as
is the case with the phenomenon of physical staleness re-
sulting from overtraining, performance decrements follow
mood disturbances. Furthermore, once an individual’s phys-
ical state has been compromised, often mood will improve
whereas performance decrements will linger (23). Based on
the mood changes observed during this SUSOPS, it is pos-
sible that the performance decrements would have been
larger if the sustained operations scenario had lasted longer.
As expected, the energy deficit experienced during the
study resulted in significant losses of both fat-free mass and
fat mass. The 3.1% loss in fat-free mass was likely attributed
to a water loss and less to actual contractile tissue. Region-
ally, the arms (0.47 kg) and trunk (1.2 kg) but not the legs
lost fat-free mass. The maintenance of leg fat-free mass is
notable, as it rules out loss of muscle tissue as an explana-
tion for the decrement in lower-body anaerobic perfor-
mance. Our finding that fat was preferentially lost from the
arm and trunk regions is in agreement with a previous
finding (26) and suggests that femoral adipose tissue is
resistant to fat mobilization.
As SUSOPS was a combination of multiple stressors, it is
difficult to ascertain the precise contributions for the singu-
lar effects of physical exertion, sleep deprivation, energy
restriction, and psychological stress on the outcome vari-
ables in this study. Sleep deprivation has been previously
shown to have more of an effect on cognitive rather than
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In summary, this study has demonstrated that whereas
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