USAFSAN1-SR-88-1 NML13

PHYSICAL FITNESS PROGRAM~

AIRCREW G TOLERANCE

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This final report was submitted jointly by personnel of the Crew Technol-ogy Division, USAF School of Aerospace Medicine, Human System Division, AFSC,Brooks Air Force Base, Texas, under job order 79301439 and Naval AerospaceMedical Research Laboratory, Pensacola Naval Air Station, Pensacola, Florida.

When U.S. Govenment drawings, specifications, or other data are used forany purpose other than in connection with a definitely GoverIMrent-related pro-curement, the United States Govenirrment incurs no responsibility or any obliga-tion whatsoever. The fact that the Goverment way have formulated or in anyway supplied the said drawings, specifications, or other data, is not to beregarded by inplication, or otherwise in any manner construed, as licensingthe bolder or any other person or corporation; or as conveying any rights orpermission to manufacture, use, or sell any patented invention that ay in anyway be related thereto.

The Office of Public Affairs has reviewed this report, and it is releas-able to the National Technical Infornation Service, where it will be availableto the general public, including foreign nationals.

This report has beeni reviewed and is approved for publication.

LR. , D.V.M., Ph.D. QRON P. CR.ISMAN, LCUR, MSC, USNR

Project Scientist Proj ct Scientist

W. C. ALEXANDER, Ph.D J. D. GRISSFIT, Ph.D.Chief, Crew Tec 1 Dvision Head, Medical Sciences Department

ItA9i Q 44ion , USAF, MC JAMES A. BRADY, CAPT, MSC, USN

Commanding Officer

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6.. NAME OF PERFORMING ORGANIZATION 6b OFFICE SYMBOL 7a NAME OF MONITORING ORGANIZATIONUSAF School of Aerospace Medicin (if applicab~e)Naval Aerospace Med. Res. Lab Lk6c. ADDRESS (City, State, and ZIP Code) 7b ADDRESS (City, State, and ZIP Code)

Human Systems Division (AFSC) Pensacola NASBrooks AFB, TX Pensacola, FL78235-5301 32508-5700 _________________________

8a. NAME OF FUNDING/ SPONSORING 8b OFFICE SYMBOL 9 PROCUREMENT INSTRUMENT IDENTIFICATION NUMBER

USA c ol0 of Aerospace Medici (IAf ap/JicB~Nv1Apronicer Med. Res- .n a ________ __00____________________

Orr- ADDRESS (City, State, and ZIP Code) 10 SOURCE OF FUNDING NUMBERSHuman Systems Division (AFSC) Pensacola NAS PROGRAM IPROJECT jTASK 1WORK UNITBrooks AFB, TX Pensacola, FL ELEMENT NO INo.I NO ACCESSION NO7-8235-5301 32508-5700 62202F 7930 1 14 1 39

11 TITLE (include Security Classification)

Physical Fitness To Enhance Aircrew G Tolerance

12 PERSONAL A :P F~e" (Editors)ICrisman, Ronald P.; and Burton, Russell R.

13a. TYPE OF REPORT 113b TIME COVERED 14. DATE OF REPORT (Year, Month, Day) IS. PAGE COUNT

Final IFROM /jQ&TOIdLW31 1988, March 6016 SUPPLEMENTARY NOTATION

17, COSATI CODES 18 SUBjECT TERMS (Continue an reverse of necessary and identify by block number)FIELD GROUP SUB-GROUP G tolerance, G-tolerance enhancement, G-induced loss of

06 10 consciousness, Physical conditioning, Physical fitness, Weight0604 training, Weight lifting, Anaerobics, Aerobics, Exercise

19 ABSTRACT (Continue on reverse if necessary and identify by block number) II-1-

A physical fitness program of resistance training, such as weight lifting, directedtoward increasing strength and anaerobic capacity will increase C-duration tolerance.This tolerance increase is particularly useful for USAF/USN pilots flying high-performancefighters during aerial combat maneuvers. A weight-training program including exerciseequipment to be used by aviators to increase (and maintain this increase) their strengthand anaerobic capacity is described. Aerobics conditioning with precautions and limita-tions for G tolerance is discussed. Figures show recommended weight-training exercises.This special report is a combined U.S. Air Force and U.S. Navy effort that came from A 1987Joint-Service C-Tolerance Conference that was hosted by the Naval Aerospace Medical ResearchLaboratory, NAS, Pensacola, FL.

20 DISTRIBUTION/ AVA;LABILITY OF ABSTRACT 21 ABSTRACT SECURITY CLASSIFICATIONCMUNCLASIPIED UNL!MITED 0 SAME AS RPT C3 OTIC USERS Unclassified

22a NAME OF RESPONSIBLE INDIVIDUAL 22b TELEPHONE (Include Area Code) I22c OFFICE SYMBOL

Russell R. Burton: James A. Brady ~ 512-536-2446/904-452-3284 USAFSAM/VNB; NAMRL/0QODD Form 1473, JUNd 86 Previous editions are obsolete SECURITY CLASSIFICATION OF THIS PAGE

i UNCLASSIFIED

1997 Joint Service G-Ieawo Omxferevoe

Hosted by

Naval Aerospace Medical Research LaboratoryNaval Air Station

Pensacola, FL 32508-5700

Dr. J.D. GrissettHead, Medical Sciences Department

Naval Aerospace NaMedical Research Laboratory INavltNval Air Station DTIC

Pensacola, FL 32508-5700 ELECTE

S FEB 08 1989

U.S. NAVY U.S. AIR FORCEL4)R R.P. Crisman Dr. R.R. BurtonDirector, Physiology Section USAFSAM/CAoperational medicine Division Brooks AFB, TX 78235-5301Naval Aerospace Medical Research LaboratoryNaval Air StationPensacola, FL 32508-5700

89 2 7 056

Approved for pubbe Mw ; i

- istdbultoul Un1•irnt.-

PREFACE

The U. S. Air Force and the U.S. Navy have conducted research programsto identify methods that will reduce the incidence of G-induced loss ofconsciousness. These efforts have provided a basis for designing physicalfitness programs to better prepare the human body for operations in the high-Genvirornent associated with air combat operations in the Air Force and Navy.

Dr. Russell Burton, USAF School of Aerospace Medicine, and LCDR Guy R.Banta, Naval Medical Research and Development Commar, were instrumental inestablishing a workshop to review the literature and make recommendations forphysical fitness programs that would be consistent with scientific data andpractical to implement in operational units. The Naval Aerospace MedicalResearch Laboratory (NAMRL) organized and conducted the workshop.

Representatives were selected frmn several disciplines, including lineaviators, who would have knowledge of research data related directly to G tol-erance, research related to the physiology of exercise, and the practicalaspects of inplesenting physical fitness programs in operational units. Theworkshop was held 21-23 July 1987 at NAMRL.

Dr. Burton conducted a comprehensive review and discussion of the lit-erature. MAJ Tony Giaccbe and LCDR Wayne Dickey presented the rationale anda critique for existing and planned Air Force and Navy programs. CPr BillKraemer and LT Donna Murdoch presented a specific fitness program for consid-eration. LCDR Ron Crisman discussed the problem of neck strains in a high-Genvironment and proposed a neck strengthening program. LT OL Lew Oppersonreviewed the benefits and detriments of aercbic training for tactical avia-tors. The remaining 1 1/2 days were used to discuss data and prepare thefirst draft of this report.

Additional USAF contributions to this docunent followed this workshop andwere provided by Drs. Whinnery and Krock, from USAF School of Aerospace Medi-cine and MAJ Boehme and LT CODL Green from 833rd Med Gp/SGT, Holloman AFB.

Each participant was invited to review and camment on both the first andsecond drafts. Participants from NAMRL and USAFSAM prepared the photographsand illustrations. USAFSAM provided the final editing. NARL was responsiblefor publication and initial distribution. Technical (computer set-up) andlogistical support was managed by NAMRL staff, in particular, HM1 David L.Cubert and HM2 Tyrone L. Green.

Acoosion For

NTIS GRA&I mooDTIC TA9 0;. na.;iunced []

,st j-7 t ti- on/

;nIV dltt7 Codes

V.,oec I, 1V I J

G-JIULERAIC WORKSHOP PARTICIPANTS21-23 July 1987

AIR FORCE

Joy de Arnond-KennedyUSAF ASD/ENECE/YPECWright-Patterson AFB, OH 45433-6503

Dr. Russell R. BurtonUSAFSAM/CABrooks AFB, TX 78235-5301

LT OL William L. Epperson, USAFUSAF AAML/BBWright-Patterson AFB, OH 45433-6573

MAJ Anthony J. Giaccbe, Jr., USAFHQ TAC/DOrLangley AFB, VA 23665

ARMY

CPT W. Kraemer, USADirector, Exercise BiochemistryExercise Physiology DivisionU.S. Army Research Institute of Environmtal MedicineNatick, M 01760-5007

MAT Madeline Rose, USAMilitary Nutrition DivisionUSARUEMNatick, MA 01760

COL David D. SchrakenbergCommanderUSARIEMKansas StreetNatick, MA 01760-5007

NAVY

LCDR Guy R. Banta, MSC USNProgram ManagerNaval Medical Research and Development Ommand(Code 404)Bethesda, MD 20814-5044

V1

NAVY

LCDR Ronald P. Crisman, MSC USNRDirector, Physiology SectionOperational Medicine DivisionNaval Aerospace Medical Research LaboratoryNaval Air StationPensacola, FL 32508-5700

CAPT F. R. Deane, MC USNForce Medical Officer(KT VAIRLANT (Code 018)NAS Norfolk, VA 23511

CAPTr J. R. DeGiorgio, USNRLATWING3PACNAS Lemoore, CA 93246

LCDR Wayne Dickey, MSC USNAercmedical Safety OfficerHMVAIRLANT (Code 018D)

HkS Norfolk, VA 23511-5188

Dr. Janies D. GrissettHead, Medical Sciences DepartmentNaval Aerospace Medical Research LaboratoryNaval Air StationPensacola, FL 32508-5700

CDR W. 0. King, USNOffice of Chief of Naval OperationsOP-596C5Navy DepartmentWashington, DC 20350-2000

CAPr Robert Knudsen, MC(FS) USNLA [WINGPACNAS Lewoore, CA 93246

LT J. T. Luz, MSC USNNaval Medical Clinic San DiegoBldg #473, APDNA.S MirararSan Diego, CA 92145

Mr. Scott G. MeyerPhysiology SectionOperational Medicine DivisionNaval Aerospace Medical Research LaboratoryPensacola, FL 32508-5700

vii

NAVY

LT Donna M. Murdoch, MSC USNRPhysiology SectionOperational Medicine DivisionNaval Aerospace Medical Research LaboratoryPensacola, FL 32508-5700

LT Janes P. Norton, MSC USNRNaval Health Research CenterSan Diego, CA 92138-9147

UNIVERSITY SCIENTISTS

Dr. Phillip D. GollnickProfessor and HeadDepartment of Veterinary Medicine, Pharmacology, and PhysiologyWashington State UniversityPullman, W 99164-6520

Dr. Charles M. TiptonProfessor and HeadDepartment of Exercise and Sports MedicineIna Gittings BuildingUniversity of ArizonaTucson, AZ 85721

Dr. Christian ZaunerProfessor and ChairDepartment of Health and Physical ExerciseOregon State UniversityCorvallis, OR 97331

VISITIN SCIENTIST (UNITED KINIDM

Dr. Mary Winsborough8031 Park LaneBethesda, MD 20814

CDNTIBI1KORS TO THIS REPORT NOT INVOLVEDIN THE G-TOLERAZCE WORKSHOP

Dr. Janes E. Whinnery Dr. Ronald BulbulianUSAFSAM/VNB Associate ProfessorBrooks AFB, TX 78235-5301 Exercise Physiology

University of KentuckyDr. Larry P. Krock Lexington, KY 40506USAFSAM/VNBBrooks AFB, TX 78235-5301 Lt Col John R. Green

833rd Med Gp/SGrMaj Michael P. Boehme Hollaren AFB, NM 88330-5000833rd Med Gp/SGTHollwman AFB, NM 88330-5000

viii

CONrENrS

Page

PREFACE .... ............................. *.. ................ v

PARTICIPANrS .............. * .......... ........... ... ....... .. .......... . Vi

FIGURES .................... ........ ... ... . *... ....... . . .. . . ... .. ... x

INTRODUr0C ION ......... .. ........................ e.....e....e....... o.... ..... e 1

Hardware Developments to Improve G Tolerance ......................... 1Educational Programs to Inprove G Tolerance .......................... 2Centrifuge Training to Inprove G Tolerance ........................... 2Physiologic Warn-up .............................................. 3Life-style Stressors ................................................. 3Nutritional (bnsiderat ions ........................................... 3Physical Clonditioning to Irprove G Tolerance ......................... 4

HIGH-INrENSITY MUSCUIAR CONDITIONING ........................ ... .... 0..... 5

Introduction ............................. 5Strength Conditioning Program .............. .......................... 6Endurance Resistance Training Program ............. ..... . 7

STRENGTH AND ENDURANCE EXERCISE P ............... 7

Stack Machine Weight Equipment ....................................... 9Strength Ephasis Workout ....................................... 9Endurance Emphasis Workout ...................................... 9

Free weight Equiphent ............ ...... ......... .......... 10Strength Emtphasis Workout ...................................... 10Endurance Emphasis Workout ...................................... 10

Hydraulic and Cam-type Equipment ..................................... 11Strength Emtphasis Workout ....................................... 11Endurance Emphasis Workout ...................................... 11

Program Interruptions ................................................ 12Maintenance Program .................................................. 12Preflight/Preengagenent Warm-up ......... * .... . .... .. ..... .... .... .... 12

AEROBIC CONDITIONING FOR FLYERS ............................. 13

Aerobic Fitness and G Tolerance ...................................... 13Suggested Programs ................................................... 14Alternatives to Running .............................................. 14

SU G = READ~IN S ................. .... ..... . . .. .. ... . ........ 15

ix

FIGURES

Figureo. Page

1. Stretching Exercises ........................ ................ . 172. Leg Press .. ...................... o . .. o_ . .......... 183. Bench Press ............................................... 194. Lat Pull ............. .... o..................... . . . . 205. Nlitary Press ...... o ...... o ............ ...... 216. Arm Curl.... _ _...... ............. . .. ........................ 227. .... t-u..po 23

8. Leg Raise......................... ........................ 249A. Neck Series. o .............. .o. .... ... ..... ...... 259B. Neck Series................................................... 269C. Neck Series ........ .... .......... .. ......... ... 279D. Neck Series................................... ....... .. 289E. Neck Series ........................ . .... ......... 2910. Leg Extension..... ............. ..................... o ... 3011. Leg Curl ............................... 3112. Shoulder Shrug ....................... ................ 3213. Seated Row ............................ o ... ............... 3314. Upright Row, ............... .......... . . .... 3415. Tricep Extension. ... .... .......... ... ........................ 3516. Squat........... ..................................... 3617. Bench Press......... ............... 3718. Pull-up ................... ............................ .... 3819. Arm and Chest Pull Over .......... ................................. 3920. ilitary Press................................... 40

24. Bar Di p............. 4425. Knee Flexion and Extensior. ....... ..... . . . .................. 4526. Chest Press and Row. .................... .. ......... 4627. Shoulder Press and Lat Pull ..................................... 4728. Abdati and Low Back ....................................... 4829. Neck Lateral Flexion....................................... 4930. Neck Extension and Flexion ................................. ... 50

x

PHYSICAL FITNESS PROGRAM TO ENHANCEAIRCREW G TOLERANCE

INTRODUCTION

This report provides a review of existing knowledge and descriptions ofphysical conditioning programs to enhance aircrew G tolerance. In addition,research findings on hardware and physiology in the high-G arena arediscussed.

The performance envelope of tactical jet aircraft nay exceed the avia-tor's physiological tolerance limits. Cbnsequently, the most vulnerable fac-tor in flying tactical jet aircraft to performance limits is frequently theaviator. New generation tactical jet aircraft are capable of rapidly reachingand sustaining 7-9 Gs; advanced design may raise the G capability even higher.This capability, together with increased maneuverability, survivability andweapon system accuracy, is critical in determining the winner during airccirbat.

Aviators can withstand G forces equal to or exceeding those of presentaircraft, but require assistance of mechanical and physiological countermea-sures to maintain blood flow to t" .e brain. The primary methods to increaseaviators' G tolerance are the anti-G suit and the anti-G straining maneuver(AGSM; also called the L-1 maneuver). The AGSM is used to increase blood flowto the brain through a voluntary isometric contraction of the body's entiremusculature and an increase of pressure within the chest by exhalation againsta closed glottis.

Hardware Developments to Improve G Tolerance

One of the factors placing aviators of high performance aircraft at riskfrom G-induced loss of consciousness (GOC) is ejection seats which orient thecrewmember in an upright position during high-G exposure. Until the advent ofnewer generation aircraft, e.g., F-15/18/16, previous aircraft G capabilitiesdid not warrant the use of tilt seats. Engineering constraints and restrictedaviator mobility and vision in a reclined position have limited seat-backangles to approximately 30 degrees from the vertical. However, it has beenfound that a 30 degree tilt seat does provide about one G improvement over thestandard seat.

Another method, assisted positive pressure breathing (APPB), has alsobeen tried using a chest counter pressure garment called a "jerkin." Whenpositive pressure is applied to the mask at an amplitude proportional to the Gforce, chest pressure is increased, directly increasing arterial blood pres-sure. Test flights at the Air Force Flight Test Center (Edwards AFB, CA) gen-erated a high degree of acceptance by both F-15 and F-16 pilots. The pilotsclaimed their G tolerance increased and fatigue levels decreased.

• • • w m | l | m |

No significant improvenents in the operational anti-G suit have been madesince its introduction during World War II. Research in the last decade hasshown that more ccnplete coverage of the legs by the anti-G suit enhances Gtolerance by reducing muscular fatigue during air ccbat maneuvers (AC).Improving leg coverage in an operational anti-G suit has been difficultbecause of problems in suit design. Currently, a single-bladder suit thatprovides corplete coverage appears to be the most prcmnising. P,3his designshould minimize fitting and sizing prcblens and provide better leg supportthan the current nultiple-bladder suits. Furthermore, it is expected toreduce fatigue from ACM by as much as 50%.

New concepts in anti-G valves have been explored, specifically, usingfaster inflation rates and electronic controls. Higher flow inflation valveshave been retrofitted into all F-16 aircraft and are programmed for other USAFtactical aircraft.

Educational Programs to Inprove G Tolerance

In 1984, Tactical Air Cormend (TAC) ccruenced a "spread the word" cam-paign to heighten the awareness of GLOC am-ong tactical aircrew. Among theseefforts were initial briefings at wing and squadron level on the physiologyand prevention of GLOC episodes and the institution of annual "G awareness"briefings to be conducted during the Instrument Refresher Course. Addition-ally, TAC published TACP 51-17 entitled "G-awareness for Aircrews" whichaddressed the pDcblem of GLOC and several methods of coping, especially guid-ance on physical conditioning. Unfortunately, TACP 51-17 did not receivewidespread distribution amng TAC aircrews. However, it is certain that thetraining efforts heightened the awareness of fighter aircrews and made themrmch rore sensitive to the GLOC issue.

Centrifuge Training to Improve G Tolerance

Aviators should have sufficient instruction and opportunities to cor-rectly perform the AGSM. The most effective and safest method of teaching theAGSM is to use the centrifuge. The USAF has demonstrated centrifuge useful-ness and aviator acceptance. Presently, the USAF uses their research centri-fuge (Brooks AFB, TX), the Dutch Air Force centrifuge (Soesterberg, theNetherlands) and the Japanese Air Self Defense Force centrifuge (Tachikawa,Japan) for training. Physiological theory of GLOC and AGSM are explained toaviators before they receive practical experience and instruction during rapidonset (6 G/s) centrifuge runs up to 9 Gs for 15 s. At Holloran AFB, the USAFis building a centrifuge solely for aircrew training. This base is used forLead-In Fighter Training (LIFT) for all aircrew members entering the tacticalinventory. All airciew members who will fly fighter, attack, recce and For-ward Air Control (FAC) aircraft will eventually experience this G training.The Navy presently operates a centrifuge (Naval Air Develoruent Center, PA),which is used for research and not pilot training. They expect to have eastand west coast training centrifuges operational by 1992.

. . . ., , i I I I2

Physiologic Warm-up

G-awareness turns have been made a mandatory part of almost all fightersorties in the USAF Tactical Air Forces. While these were originally insti-tuted to allow the aircrews to get a "feel" for the Gs and gauge theirresponse and the aircraft's response, a side benefit of phy-ological "warm-up" is also realized. Synpathetic reflexes are stimulated and remain so forseveral minutes after sudden exposure to nderate Gs. Subsequently, the air-crew have a small "leg up" on the Gs when they enter an engagement. Current-ly, there is no standardization of the number of turns to be completed nor ofthe amount of G to be pulled in each turn. It has been postulated that themaneuvers need to be at least in the 3-5 G range for the appropriate responseto occur.

Life-style Stressors

Life-style can have a significant effect on G tolerance. Smoking, alco-hol, diet, illness (especially requiring bed rest), medication (particularlyself-inedication), and dehydration are some of the factors which can affectphysiological performance. Illness and/or miedications often interact withbody processes in unpredictable ways in the flight environment. Flight sur-geons should be consulted on these matters. Because the AGSM requires rapidiovement of air through the lungs, smoking (known to increase airway resis-tance) should be kept to a miinnum with complete abstinence being advised.Alcohol is kn to adversely affect flight performance by interfering withmental, physiologic (hypoglycemia and ionic irbalance) and physical functions.Dehydration, known to reduce G tolerance, is cammon the day following a nightof excessive alcohol consunption. Severe "hangover" can also adversely affectflight performance. Although the Navy and USAF prohibit alcohol consunption12 h prior to preflight brief, no alcohol 24 h before flight is advisable. Inaddition, recent experience with flight simulators suggests that a 48 h periodof moderation before flying is also indicated for peak performance.

The state of hydration is particularly inportant to aircrew members. Ifmissions are flown during hot conditions, the aviator should prehydrate byconsuming a minimum of one pint of water before flying. Rehydration afterflight should provide 1 pint of water per pound of body wight lost. The sen-sation of thirst is not an adequate indicator of dehydration; therefore, avia-tors may have to force thenselves to drink.

Nutritional Considerations

Sources of energy for optimal performance are enhanced by proper nutri-tion and physical conditioning. Energy stores available to the body are notprixarily obtained from the preflight meal, but result frm the previous dietand activity patterns.

Contrary to popular belief, a diet high in protein is not essential todevelop muscle strength during this conditioning program. Total calories areimportant to ensure that protein in the diet is available for purposes of rmus-cle dcvelopTent and maintenance. About 50-60% of dietary calories should be

3

derived from camplex carbohydrates such as pasta, breads and potatoes. Fruitsand vegetables should also be proninent in the diet.

To perform at their best, aircrew must be well-rested, properly nourishedand sufficiently hydrated when beginning a mission. An adequate recovery andreplenishment period must be planned and taken after each sortie involvinghigh-Gs, or after exercise. To ensure that adequate recovery has occurred, aminimum of 3 h or more is reccmiended between the end of strenuous exerciseand the beginning of flight.

Physical Conditioning to Inprove G Tolerance

Physical training for air combat is similar in many respects to thetraining required for athletic competition. Maximum performance during ath-letic competition requires a specific physical conditioning program, which ischaracteristic of the strength and endurance requirements for tha event(exercise specificity). Training for a 100-m sprint is considerably differentfrom marathon training. Sprints, or short-duration, high-intensity events,require relevant muscle groups to quickly provide large quantities of energyfor brief periods of time. Conversely, distance running or long-durationevents require relevant muscle groups to deliver a continuous energy supplyfor long periods of time. Thus, muscle groups respond to the stimulation ofthese two training procedures differently. Physiological adaptations occurthat enable the muscles to accomplish specific tasks more effectively. In thesprinter, adaptive changes enable stored fuels to be quickly utilized by abiochenical process that does not require the immediate presence of oxygen.Training for this type of exercise response is called "anaerobic" (withoutoxygen). In the distance runner, adaptive changes enhance the capacity forstored fuels to be used by a biochemical process that requires the presence ofoxygen. This exercise training is termed "aerobic" (with oxygen).

During air ccnbat maneuvers! aircrews undergo high-G forces for shortdurations. The muscles involved in the AGSM expend energy at a rate analogousto those of the sprinter or weight lifter. Researchers have used aerobic andanaerobic subject training protocols to measure G tolerance during centrifugetesting before and after training. Results from these studies show thatanaerobic weight training enhances the ability of subjects to perform the AGSMmore effectively, allowing them to withstand increased G force longer duringcentrifuge testing. In addition, aerobic training was not demonstrated tobenefit G tolerance. Consequently, anaerobic training should be given higherpriority than aerobic training in a physical fitness program for aviators.

Besides GLOC, aviators should also be aware that neck injuries occur withincreased frequency as high-G exposure increases. A recent Navy survey of G-induced neck injury in F/A-18, A-4, and A-7 pilots was completed at the LightAttack Wing, Pacific (NAS Lenoore, CA). The Navy found that 74% of F/A-18,58% of A-4, and 30% of A-7 aviators surveyed reported some neck pain associ-ated with high-G maneuvers. Twelve of 89 pilots were tenporarily removed franflight status for an average of 3 days because of injury. Age was not a con-tributing factor to the incidence of neck pain in this survey. The USAF cam-pleted a similar survey with five wings at three TAC bases involving 437 F-5,F-15, and F-16 pilots. Neck injury rates of about 45% over a 3-nonth period

4

of time were found in F-15 and F-16 pilots. Major injuries of 13% were

reported for the F-16 pilots and were greatest in pilots over 40 years of age.

Specific recunmendations resulting fran the USAF neck injury survey were:

1. Neck exercise program2. Neck stretching or G warm-up before air ccmbat maneuvers3. Cautious return to high-G after a long layoff4. Minimize neck movement under high-G loads5. Maintain good physical condition, nutrition and rest

During flight events that require visual scanning aft of the aircraftcoupled with high-G maneuvers, the head and neck can be rapidly subjected tolarge increases in force. When high force loads on the head and neck exceedthe ability of the muscles to maintain the position of the head, injury to theneck can result. This situation intensifies when the neck muscles becamefatigued. Therefore, a neck conditioning program must involve all musclegroups to increase their force generation capacity and to increase their timeto fatigue. This involvement would significantly enhance the ability of theneck nuscles to resist injury during conditions of high-G loading.

HIGH-INENSITY MJSCUAR ONDITIONING

Introduction

Effective countermeasures must be pursued to cabat the prcblems associ-ated with high-G exposure. One of these countermeasures is participation inan exercise conditioning program designed to increase muscular strength andendurance and enhance cockpit mobility. The rationale behind this reccmmenda-tion is that increased muscular strength and endurance will allow the pilot toperform the AGSM with less relative muscular effort so that less relative sub-jective effort is required to maintain vision and consciousness during ACK.This is extremely important as the distraction of concentrating on performanceof the AGSM will erode the pilot's ability to maintain situation awareness(SA). In combat, this may be fatal. Exercise programs that increase muscularstrength and endurance under load (anaercbic capacity) are more likely to meetthese cbjectives.

Before any specific program is undertaken, sae basic exercise principlesmust be understood:

1. Exercise specificity. For optimal improvement in G tolerance,the exercise program must focus on the respiratory and skeletal muscle move-ments that are similar to the straining and tensing maneuvers required toresist high-G forces. To simulate the AGSM, a full breath should be takenbefore the lifting phase during a resistance effort. As the weight is raised,straining should continue against a partially closed glottis during the lift.

2. Exercise intensity. The exercise must tax the specific musclegroups involved. For maximal benefits in strength, the load should be 80-90%of the maxinum weight that can be lifted one time (one repetition maxinum or1 RM).

5

3. Exercise duration. The conditioning program must be performedwith 5-10 repetitions per set with 2 or more sets per exercise period.

4. Rest periods. Specific rest periods should be adhered tobetween sets and between exercises, depending on the program specifications.The duration of the rest period will affect the exercise program loads and thephysiological stress of the workouts.

5. Exercise frequency. A minimum of 24 hours should elapsebetween exercise sessions. Seldom should more than four training sessions beccipleted in a 7-day period. For conditioning to improve G tolerance, bothstrength and endurance exercises must be performed. Perform exercise programon alternate days, e.g., strength on Monday, endurance on Tuesday, rest onWednesday, strength on Thursday, and endurance on Friday.

6. Exercise order. Muscle groups most useful in performing theAGSM should be exercised first.

7. Warm-up and cool-down. The daily conditioning program shouldbegin with a gradual warming up and stretching session of 5-10 min. Also,approximately 5-10 min of whole-body stretching should be performed afterexercising to minimize soreness.

8. Program assessment. The effectiveness of any training programshould be periodically assessed by examining some quantifiable performanceparameter. In these reccnuended programs, progress can be evaluated by can-paring changes of weight lifted during the specified number of repetitions foreach exercise session. Participation in a 12-week conditioning program shouldresult in a 10-20% improvement for most of the exercises.

9. Exercise timing. The demands of exercise on the cardiovascularand metabol ic systems are such that 3+ h should elapse before assuming flightduties involving high-G. This timing is particularly inportant as intenseexercise can lead to temporary fatigue due to exhaustion of stored musclefuels, noticeable muscle treuor and possible postexercise hypotension (lowblood pressure).

10. Conditioning. The benefits gained fram a conditioning programcan be lost rapidly. After 2 weeks or more of inactivity, the aviator shouldresume an exercise program at an intensity level between 80-90% of the weightused at the time of interruption.

Strength Conditioning Program

The strength conditioning exercise session should begin with a shortperiod (5-10 m/n) of wexm-up and stretching. Stretching movemnts should fol-low warm-up exercises and involve all muscle groups that will be used duringthe strength develcprent session. Recaniended stretching exercises are illus-trated in Figure 1 (hamstring, shoulder, neck and trunk stretches).

Rest periods should occur between sets and between exercises, i.e.,between each series of a given exercise, as well as in the transition period

6

between specific exercises. Rest periods zhoulu be between 2-3 mi and atleast equal to the amount of time spent in performing the set.

The resistance for each exercise is the load which can be achieved forthe indicated number of prescribed repetitions, called "repetition naximn' or"RM" load. For example, if one can "curl" 100 lb for 10 repetitions but nomore, the exercise is a 10 RM movement. When the aviator can perform one ormore repetitions beyond the specified limit, zr:e weighL or resistance shouldbe added. In the nuscle strength conditioning program, repetitions for thevarious exercises will range from 5-10, depending on the exercise.

A "set" refers to the number of repetitions completed. In the musclestrength conditioning program, sets for the various exercises will range from2-5. The exercises are listed in the text in the order they should be exe-cuted. Repetitions should be performed in 3-5 s, and respiratory strainingshould be done against a partially closed glottis during the contraction.Exhale on the extension.

Following all workouts, a 5-10 min cool-down period of static stretchingexercises should be done to minimize muscle soreness. The stretching exer-cises illustrated in Figure 1 are appropriate for this purpose.

Endurance Resistance Training Program

A 5-10 min warm-up and stretching period similar to that described for astrength conditioning workout should precede each muscle endurance condition-ing session. See Figure 1 for exanples.

NLrcular endurance workouts are characterized by paired exercises. A setof the first exercise is performed, and without rest, a set of the secondpaired exercise is performed. For exanple, one might perform 10 repetitionsof the bench press imediately followed by 10 repetitions of the shouldershrug. This resistance training is known as a "super set." A super set isfollowed by a 30-60 s rest, whereupon a second super set is done. Two tothree super sets per pair of exercises are used in this program. The numberof repetitions per exercise set ranges from 10-20, depending on the exerciseperformed.

Paired exercises represent components of the high-intensity nuscularendurance resistance training program. The specific order of the exerciseswithin each super set should be maintained.

STRENGM AND ENDRANCE EXERCISE PROG AMS

The strength and endurance exercise programs have been divided intoworkouts using several different types of training equipment: stack machineweight equipment, free weight equipment, "Nautilus" cam-type achines andhydraulic equipment.

It is possible to shorten the time required to accomplish this exerciseprogram yet achieve much of the positive benefit of strength training by usinga modified or shortened version. The inportant point is to regularly engage

7

in sane strength enhancing exercise. A shortened exercise program can beaccomplished by either (a) reducing the number of different types of specificexercises using the recamnended numbers of sets or (b) performing all of theexercises but conapleting only 2 sets of each.

If a (the former) shortened version is to be accomplished, the exerciseorder is different fron that recanmended for the total program (see exercisepriorities listed under the short version). This exercise order places eapha-sis on muscle groups thought to be most useful for pilots and ontributive toenhanced G tolerance. The shortened programs provide a means for a crem~enberto tailor an exercise program for a specific time schedule and maximize thebenefits for a given tine expenditure. We strongly recamend that if tinepermits, the total program be accoplished.

8

Stack Machine Weight Equipment

The exercises carprising the muscular strength workout for multistationweight stack machines are as follows:

Strength Emrphasis Workout

Warm-up: 5-10 min, see Figure 1

Rest period: 2 min between sets

Exercise Sets / Reps F Short Version

1. Leg press 4/ 5 @ 5 RM* 2 5**2. Bench press 4/ 5 @ 5 RM 3 33. Lat pull 3/ 5 @ 5 RM 4 44. Military press 3/ 8 @ 8 RM 5 65. Armcurl 3/ 6 @6 RM 6 76. Sit-up 2 /10-20 7 1

Leg raise 2 / 10-15 87. Neck series (with 3 / 6 @ 6 RM 9A-9E 2

self or partner)

* RM = xepetition maximumr level, the amount of weight that can be liftedfor only that specific number of repetitions in good form.

** Exercise priority; e.g., sit-up or leg raise first followed by neckseries, etc.

Cool-down: 5-10 min, see Figure 1

Endurance Erphasis Workout

Warm--up: 5-10 min, see Figure 1

Rest period: 30-60 s between super sets and exercise segments

Exercise Super sets / Reps Figure Short Version

1. Leg extension/leg curl 3 / i0@ 10 RM 10, 11 52. Bench press/shoulder 3 / 10 @ 10 RM 3, 12 3

shrug3. Lat pull/seated row 3/ 10 @ 0 RM 4, 13 44. Military press/upright 3 1 10 @ 10 RM 5, 14 6

row5. Tricep extension/arm curl 3 / 10 @ 10 RM 15, 6 76. Sit-up/leg raise 2 / 10-20 7, 8 17. Neck series (with self 3 / 12 @ 12 RM 9A-9E 2

or partner)

Cool-down: 5-10 min, see Figure 1

9

Free Weight Equipnent

The conditioning program can be perfonred using free weight or stackmachine wights with mninal exercise ndification, i.e., squat for leg press.Sone locations will have only free weights. In these situations, the sameworkout schedule as listed previously for the machine weight should be used.A spotter must always be used in a free weight program because control ofheavy weights can be difficult when fatigued. The exercises and the orderthey should be performed are listed next. The free weight exercises arelisted opposite the equivalent machine weights.

Strength Emphasis Workout

Machine Weights Free Weights Figure Short Version

1. Leg press Squat 16 52. Bench press Bench press 17 33. Lat pull Pull up (arm and 18 4

chest pull over) 19 44. Military press Military press 20 65. Arm curl Am curl 21 76. Sit-up/leg raise Sit-up/leg raise 7, 8 17. Neck series Neck series 9A-9E 2

Endurance Emhasis Workout

Machine Weights Free Weights Figure Short Version

1. Leg extension Squat 16 5Leg curl

2. Bench press Bench press 17 3Shoulder shrug Shoulder shrug 12

3. Lat pull Pull up (arm and 18 4chest pull over)

Seated row Bent-over row 224. Military press Military press 20 6

Upright row Upright row 235. Anm curl Arm curl 21 7

Tricep extension Bar dip 246. Sit-up Sit-up 7 1

Leg raise Leg raise 87. Neck series Neck series 9A-9E 2

The weights lifted should be increased when the cremedrber can performmore than the specified nuzber of repetitions in a set with a given resis-tance. Sufficient weights should be added to reduce the nurber of repetitionsto the minimxn.

10

H% raulic and Cam-type Equipuent

If hydraulic equipment is used, the general conditioning principleslisted earlier will apply, but the mchbanics of implementation will be sane-what different. Suggested dial settings for the strength and endurance enpha-sis workouts are listed next. Repetitions should be perfomed as rapidly aspossible.

Strength Emhasis Workout

Warm-up: 5-10 min, see Figure 1

Perform 4 sets: 1 set at each dial setting of 3, 4, 5, 6

Work period: 20 s per set

Rest period: 2 min between sets

Cool-down: 5-10 min, see Figure 1

Endurance Emphasis Workout

Warm-up: 5-10 min, see Figure 1

Perform 4 sets: 1 set at each dial setting of 3, 4, 5, 6

Work period: 30 s per set

Rest period: 30-60 s between sets

Cool-down: 5-10 min, see Figure 1

The exercises to be performed are listed in sequence below and depend onequipment available:

Exercise Figure Short Version

1. Knee flexion and extension 25 52. Chest press and row 26 43. Shoulder press and lat pull 27 74. Chest press and row 26 65. Abdominal and low back 28 16. Neck lateral flexion 29 37. Neck extension and flexion 30 2

11

Program Interruptions

To minimize the effects of interruptions on an exercise program, the fol-lowing guidelines apply. The aviator should arrange a schedule to obtain aminimum of 5 weeks of uninterrupted conditioning. In this time, sufficienttraining adaptation will have occurred to initiate gains in muscular strengthand endurance. During interruptions, the participant should continue thetraining program by whatever reans available (see previous sections) at leasttwice weekly to maintain previous gains. If standard exercise equipment isnot available, the aviator should devote the exercise time to push-ups, sit-ups, leg raises, chair presses, back arches, neck flexion and extension move-ments, and isometric contractions of the major nuscle groups.

The RM load used for each exercise will decrease during nontraining peri-ods. Consequently, RM load determinations before resuming exercise can beused to select the proper load to begin the program after an interruption. Ifthe break in conditioning is 2 weeks or more, the participant will probablyreturn to the conditioning program using 80-90% of the load employed duringthe conditioning session inmmediately before the break.

Maintenance Program

After successful campletion of the 12-week strength and endurance exer-cise program, aircrew members should continue exercising to maintain thestrength and endurance gains acquired.

A 10-20% increase in strength and endurance should be achieved from theprescribed exercise program. To maintain this new fitness level, the recn-mended schedule should include a minimun of 2-3 workouts evenly distributedover 7 days. These workouts should be a cobination of the different pro-grams. As a general rule, two consecutive strength workouts per week are notreccamended in the maintenance program.

The purposes, guidelines, and precautions outlined in previous sectionsapply to the maintenance conponent. Again, the workouts should not be per-formed on consecutive days and should represent ccrplete workouts of an inten-sity equal to that performed when the program was coupleted.

Pref 1 ight/Preengagement Warm-up

To take full advantage of any physical conditioning program requires ade-quate preparation for the in-flight stress. Preparation for maximm G stressin an air combat engagement should include muscular warm-up in the immediateprestress period. Like athletes, aircrew should warm up before maximum exer-tion. These techniques 'not only reduce the risk of injury, but serve toenhance flying performance. For beneficial effects, the exercises shouldinclude those muscle groups that are specifically active in high-G maneuvers.Ideally, warm-up and stretching should begin 30 min before G exposure andtaper to 5 min before the actual engagement. Since conditions are seldomideal to permit this type of warm-up schedule, the minirun recommendations areas follows:

12

1. After preflight briefing, while in Life Support, performstretching movemrents, trunk rotations, and neck rotations in all directions.

2. During aircraft inspection, perform front and back stretching,neck rotation, and neck stretching.

3. During taxi or while waiting for takeoff, perform neck stretch-ing against resistance. This procedure requires neck flexion against theresistance provided to the head by the hand and involves movements in the fourmajor directions. This procedure should simulate the novements anticipated inaerial ccnbat maneuvers. Care should be taken to avoid applying too muchresistance as it could be painful or cause muscle strain.

4. Before engagenent, perform several moderately intense AGSM andseveral maximal neck stretches.

AEROBIC 0ONDITIONIN FOR FLYERS

Aerobic conditioning occurs when exercise is performed at submaxinalintensity for extended periods of time with the intention of improving thefunction of the cardiovascular system. This effect occurs when a person exer-cises several tines a week at an intensity that can maintain the heart ratein a "target" range for at least 20-30 min. The target range is determinedthrough calculation of the maximum rate (220 minus age) and multiplying by 60and 80%. For example, a 20 year old has a calculated maximum heart rate of200 and his exercise target range is 120-160 beats/min. Alternately, thecrewmenber may rely on his breathing rate to gauge his heart rate. Breathingshould be accelerated, but not to the point of discomfort or where it wouldinterfere with speech.

Aerobic Fitness and G Tolerance

Scientists in the aviation physiology ccrminity believe that high levelsof aerobic conditioning will not directly enhance the ability of an individualto reach higher G levels. In a broader sense, the influences of aerobic fit-ness on repeated high-G exposure during a single mission, nultiple missions inone day, or multiple daily missions have yet to be adequately assessed.

For aircrew involved in flying fighter aircraft, excessive tine devotedto aerobic training, e.g., preparation for such events as a marathon, biathlonor triathlon, may be detrimental to G tolerance. Ongoing research suggeststhat effectiveness of the blood pressure control system can be reduced inendurance trained athletes, but this effect has not been confirmed in high-Gstudies. Some subjects with high levels of aerobic fitness have shownincreased incidence of irregular heart rate (cardiac arrhythmias, same ofwhich can adversely affect +Gz tolerance) during exposure to centrifuge testsat the USAF School of Aerospace Medicine. Preliminary research findingsindicate that incapacitation and recovery tine fron GLOC is prolonged inexcessively aerobically fit individuals. Other studies suggest that certainindividuals with high levels of aerobic fitness can have an increased suscep-tibility to motion sickness. For these reasons and because of the benefits ofaerobic conditioning, only a moderate aerobic training program is suggested.

13

Suggested Programs

The basic elerent of aerobic conditioning is large muscle exercise thatproduces a sustained heart rate in a target zone (see preceding section).While several exercises can be perfonred to produce aerobic conditioning, run-ning is the most ccrmcon.

A running program of 20-30 min, 3 times per week, is suggested as ade-quate for maintaining good cardiovascular fitness while avoiding the possibleadverse effects of excessive aerobic training. For aircrew who desire to runmore, the maxnn program suggested is 3-5 mi per day, no more than 4 timesper week. If more than 9 mi per week, the running nust be integrated with thereccrmrended weight training program to achieve optimal results in a high-Genvironment. For the competitive minded, a 5 km (3.1 mi) race should be thelongest event undertaken in any given week.

Persons unaccustcrred to aerobic conditioning should begin the program byinitially running short distances at a slow pace. The time and distance ofrunning should then progressively be increased until the desired level of con-ditioning is attained.

Alternatives to Running

Aerobic exercises, e.g., rowing, cycling, swinning, cross-country skiing,aerobic dance, walking, etc., also use large muscle groups in a continuousfashion. These activities should be perforned at an intensity that willachieve the targeted heart rate for at least 20 min. For lower intensityexercise, such as brisk walking, a longer duration may be necessary. Forexaimple, a 20-year-old man might achieve a heart rate of only 110 beats/min.In his case, he might extend the walking time to one hour to achieve benefit.However, a 40-year-old man with a heart rate of 110 is working in his targetzone and need not unnecessarily extend his walking time.

14

SUGGESED READIN33S

AFP 50-56. U.S. Air Force aerobics physical fitness program. 17 Jul 1974.

Astrand, P-O, and Rodahi, K. Textbook of w;ork physiology: Physiologicalbases of exercise, (2nd Ed), New York: McGraw Hill Book Co, 1977.

Astrand, P-0, and Rhyming, I. A ncatogram for calculation of aerobic capacity(physical fitness) fran pulse rate during suhn-aximal work. J Appl Physiol7:218-221 (1954).

Blcmquist, C.G., and Stone, H.L. Cardiovascular adjustnents to gravitationalstress, the cardiovascular system. In: Handbook of Physiology, Section 2,Vol. 3, Peripheral circulation and organ blood flow. Ed. Shepherd F.T.,Abboud, F.M. Bethesda, MD: Am Physiol Soc 1050-1063 (1984).

Bonde-Peterson, F., Christensen, N.J., Henriksen, 0., Nielsen, C., Norsk, P.,et al. Aspects of cardiovascular adaptation to gravitational stresses.The Physiologist. Suppl S-7-S10 (1980).

Burton, R.R., and Whinnery, J.E. operational G-induced loss of consciousness:Scrething old, saething new. Aviat Space Environ Med 56:812-817 (1985).

Cooper, K.H. The aerobics way. New York: Bantam Books, 1977.

Cooper, K.H. The aerobic program for total well being. New York: BantamBooks, 1983.

Epperson, W.L., Burton, R.R., and Bernauer, E.M. The effectiveness of spe-cific weight training on sinulated aerial carbat maneuvering G-tolerance.Aviat Space Environ Med 56:534-539 (1985).

Fisher, M.G.P., and Atkinson, D.W. Fasting or feeding? A survey of fast-jetaircrew nutrition in the Royal Air Force Strike CJZnd. Aviat SpaceEnviron Med 51:1119-1122 (1980).

Fleck, S.J., and Kraemer, W.J. Designing resistance training program.Champaign, IL: Human Kinetics, 1987.

Greenleaf, J.E., Brock, P.J., Harnes, R.F., Rositano, S.A., Montgcrery, L.D.,and Keil, L.C. Effect of hypovolemia, infusion, and oral rehydration onplasma electrolytes, ADH, Renin Activity, and +Gz tolerance. Aviat SpaceEnviron Med 48(8):693-700 (1977).

Greenleaf, J.E., Matter, M., Jr., Douglas, L.G., Rayornd, S.A., Bosco, J.S.,Averkin, E.G., St. John, R.H., Jr. Effects of acute and chronic hypohydra-tion on tolerance to +Gz acceleration in man. NASM4 X. 1285:1-39 (1966).

Greenleaf, J.E., Stinnett, H.O., Davis, G.L., Kollias, J., and Bernauer, E.M.Fluid and electrolyte shifts in women during +Gz acceleration after 15 daysbed rest. J Appl Physiol 42:67-73 (1977).

15

Houghton, J.O., McBride, D.K., and Hannah, K. Performance and physiologicaleffects of acceleration-induced (+Gz ) loss of consciousness. Aviat SpaceEnviron Med 56:956-965 (1985).

Knudson, R., McMillan, D., Doucette, D., Seidel, M. A ccuparative study ofG-induced neck injury in pilots of the F/A-18, A-7, and A-4. Subrdtted toAviat Space Environ Med (1987).

Lesmes, G.R., Costill, D.L., Coyle, E.F., Fink, W.J. Muscle strength andp c~wer changes during maximal isokinetic training. Medicine and Science inSports 10:266-269 (1978).

Position paper, American Dietetic Association. Nutrition for physical fitnessand athletic performance for adults. J Am Diet Assoc 87:933-936 (1987).

TACP 51-17. G Awareness for aircrew members. USAF pamphlet available throughthe publications distribution system, USAF, 12 Sep 1986.

Tesch, P.A., Hjort, M.D., Balldin, U.I. Effects of strength training on G-tolerance. Aviat Space Environ Med 54:691-695 (1983).

Tipton, C.M. Consideration for exercise prescriptions in future spaceflights. Med Sci Sports Exerc 15:441-444 (1983).

Vanderbeek, R.D. TAC neck injury study. Ltr rpt dated 25 Jun 1987, USAFSAWEDK, Brooks AFB, TX.

Whinnery, J.E. Acceleration-induced atrioventricular dissociation: hemody-namic consequences. Aviat Space Environ Med 53:432-434 (1982).

Whinnery, J.E., Laughlin, M.D., and Hickman, J.R., Jr. Concurrent loss ofconsciousness and SIND-arterial block during +Gz stress. Aviat SpaceEnviron Med 50:635-638 (1979).

Whinnery, J.E., Laughlin, M.H., and Uhl, G.S. Coincident loss of conscious-ness and ventricular tachycardia during +Gz stress. Aviat Space EnvironMed 51:827-831 (1980).

Wilrure, J.H. Athletic Training and Physical Fitness. Physiological princi-ples and procedures of the conditioning process. Newton, MA: Allyn andBacon, Inc.,1977.

16

STRETCHING EXERCISES

BEFORE AND AFTER WEIGHT TRAINING

2 3 4

5 6 7

8 9 10

Figure 1. Stretching Exercises. Performed before and after each exerciseworkout. Full range of motion and slow, consistent movement

throughout the stretching exercise should be concentrated on tothe threshold of pain.

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