Human Performance Optimization Research Articles

Continuous Assessment of Active-Duty Army Special Operations and Reconnaissance Marines Using Digital Devices and Custom Software: The Digital Comprehensive Operator Readiness Assessment (DcORA) Study.

Continuous exposure to extreme and chronic stress from uncontrollable events has been linked to increased psychological and physiological reactivity. Prolonged, frequent deployments may test coping skills over time, ultimately rendering Servicemembers vulnerable to mental health problems and suicide. This study develops a methodology for accurately collecting holistic health measures from Servicemembers using digital tools, including custom-built phone software and body-worn sensors. The secure research platform and mobile app continuously collect multiple health measures and, after data analysis, deliver continuously updated summary data back to the Servicemember. This system provides novel insights into the relationships between the measures while helping individuals track their progress toward self-established goals. Participants were given an iPhone (including the study app) and an Apple Watch. Participants tracked their data for more than 6 months and responded to baseline, daily, and weekly questions and assessments. Physiologic, psychologic, and cognitive assessment data across the Preservation of the Force and Family program (POTFF) domains were collected, displayed to the individual, and analyzed in aggregate. When coupled with custom-built software, this hardware can be elevated from a fitness tracker to a user-facing health monitoring, educational, and delivery system. This wearable system measured vital factors associated with the health and human performance of Servicemembers. In real-time, it engaged Servicemembers in health and human performance optimization practices to achieve a goal of prevention of physical or mental injury.

Nutrigenomics and nutrigenetics: Special emphasis on optimization of human health and animal performance

Environmental factors, food’s nutrients, and genetic makeup play an important role in phenotypic appearance of a trait via the principles of biological sciences. The nutritional genomics focuses on the interaction between bioactive food components and the genome, which includes nutrigenetics and nutrigenomics. The influence of nutrients on genes expression is called nutrigenomics, while the heterogeneous response of gene variants to dietary nutrients is called nutrigenetics. Nutrigenomics is providing the effects of ingested food’s nutrients on gene expression and gene regulation, i.e., diet-gene interaction in order to identify the dietetic components having beneficial or detrimental health effects. It elucidates that how DNA and genetic code influence the need for specific nutrients and also within specific quantities are required for maintaining good health throughout life. It is helpful to determine the personalized diet that means individual nutritional requirements based on the genetic makeup of the person as well as clarifies some etiological perspectives of chronic diseases like type-2 diabetes, cancer, obesity and cardiovascular diseases (CVD) because of associations between diet and chronic diseases. Rearing of farmed animals is a vital component of global food production systems, its impact on the environment, human health, animal welfare, and biodiversity is being increasingly challenged. Developments in genetic and genomic technologies have had a key role in improving the productivity of farmed animals for decades. The goal of discussing these issues is to get a better understanding of basic biological issues and to apply their knowledge to practical problems such as medicine, and improvement of animal performance. Therefore, this review article is focus on the role of genes and the use of genomic techniques in human health, as well as animals’ well-being and welfare.

A retrospective chart review to assess the impact of alpha-guided transcranial magnetic stimulation on symptoms of PTSD and depression in active-duty special operations service members.

Special Operations Forces service members (SOF) are regularly exposed to traumatic and concussive events, increasing the prevalence of symptoms of post-traumatic stress disorder (PTSD) and depression, shortening potential years of service. This retrospective chart review presents preliminary data on a Human Performance Optimization (HPO) program that provided an average of 30 sessions of individualized alpha frequency repetitive transcranial magnetic stimulation (α-rTMS) to active-duty SOF as to reduce symptoms of PTSD and depression following traumatic brain injury. Scores from the PTSD Checklist for DSM-5, PROMIS Depression short form and Perceived Deficits Questionnaire (PDQ) were reviewed. Significant reductions were noted after the HPO program in all clinical scales with an average 37% decrease in PCL-5 (p<.01), 11.3% reduction in PROMIS depression T-scores (p<.01), and 45.5% reduction in PDQ scales by session 30 (p<.01), with side effects matching those commonly reported in rTMS. Importantly, the average PCL-5 score decreased from 42.9 to 27 by end of the treatment program, which is below the clinical threshold of 33 for presence of PTSD. For those with depression symptoms scores greater than cut off clinical thresholds at baseline, 46% resolved following treatment. This data provides preliminary support for safe application of α-rTMS for symptom reduction in active-duty special operations military personnel.

Total Force Fitness Education: A Critical Enabler ofHuman Performance Optimization.

Military health education has historically been focused on conveying the consequences of risky behaviors, informing about external resources, and addressing disease through mitigation and prevention. Total Force Fitness (TFF) and Human Performance Optimization (HPO) provide a broad and holistic framework for preventing health issues and bolstering performance. The Consortium for Health and Military Performance convened a workgroup at the TFF Summit in 2021 to discuss the current state of TFF/HPO in military health education efforts and to identify areas for improvement. An education workgroup of 42 attendees gathered to discuss the current state of TFF/HPO-based health education in the military. Four questions were posed to all members for discussion. Notes were taken and consolidated to obtain feedback and promote discussion from the attendees in a larger audience at the TFF Summit. The education workgroup identified several education formats, goals, initiatives, and opportunities for improving the development and dissemination of TFF/HPO-based health education throughout the Services. Workgroup members reached a consensus on health education formats (development, dissemination, and audience) and that the primary goal of education is knowledge dissemination and increasing awareness. They also identified several stellar examples of existing TFF/HPO initiatives and explored how health education can increase impact and be more sustainable. The workgroup outcomes were shared with the TFF Summit audience to generate further discussion and to outline action items. Seven action items were identified to improve the development and dissemination of TFF/HPO resources and ensure productive and effective initiatives and programs throughout the Department of Defense. The TFF Summit outlined several actionable items that would improve the development and dissemination of TFF/HPO-based health education throughout the Department of Defense's initiatives and programs. A broader approach to military health education that uses a TFF/HPO framework will directly impact the health and performance of the force. Ultimately, embedding TFF/HPO information into the fabric of military health education would shift the focus toward a holistic, proactive, preventive, and performance-based culture.

Total Force Fitness Standardization: Leveraging Policy and Metrics to Inform and Accelerate Implementation.

Total Force Fitness (TFF) metrics inform leaders at every level as they develop and evaluate policies, practices, and programs that enable soldiers, airmen, sailors, marines, guardians, and operators to achieve human performance optimization in all eight domains as defined by the TFF framework. The Standardization Workgroup was a facilitated discussion breakout session among a group of uniquely informed and engaged attendees who were invited to be part of the TFF summit that was hosted in Bethesda, Maryland, on September 14 and 15, 2021. The Standardization Workgroup explored the 2018 TFF shift in perspective to consider human performance optimization in the context of a military unit's fitness for missions and identified several challenges, opportunities, and action items for improving the implementation and sustainment of TFF throughout the services. Key opportunities and recommendations synthesized from the workgroup discussion include the following: Creating true ownership of TFF by an entity with authority and engagement across the services; creating divisions of labor and assigning champion organizations with distinct areas of responsibility related to metric development, data accessibility, line-leader decision support, and data-driven policy and program review; leveraging and expanding the use of data repositories, secure data clouds, and artificial intelligence platforms to support a robust and integrated learning health and performance system; and prioritizing the operational line-leader stakeholder engagement at every stage of metric development and refinement as they are ultimately responsible for and have direct influence over the fitness of the individual service member and readiness to deploy of the military unit.

Total Force Fitness: Making Holistic, Integrated Whole-Person Research a DoD Priority.

Total Force Fitness (TFF) was conceived as a holistic framework for building and sustaining Human Performance Optimization for Warfighters and their families. As such, TFF research must also be holistic in nature. During the research breakout, group barriers and challenges to TFF research were discussed, and critical research focus areas were prioritized. The top approaches discussed were (1) using big data to identify best practices and health trajectories; (2) applying community-based participatory research principles to military units; (3) focusing on "Whole-Person," integrative research (physical, behavioral, spiritual, and biological) across the Department of Defense; and, finally, (4) prioritizing key opportunities to advance TFF across the active duty and Reserve/Guard enterprises and their families. The research group noted that coordinated action would be needed to move the prioritized agenda forward. Finally, translating research into action is essential because TFF is a way of honoring our service members as whole persons with careers, goals, and families.

Partnerships to Facilitate Total Force Fitness.

Total force fitness (TFF) is a multi-domain framework designed to assess, promote, and sustain human performance optimization across a service member's career arc. During the September 2021, TFF Summit sponsored by the Consortium for Health and Military Performance (CHAMP), a working group explored partnerships that could facilitate effective implementation and sustainment of TFF principles. Many potential partners were identified, both internal and external to the DoD. This report highlights some positions and organizations that provide the highest yield for successfully inculcating TFF across the services.

Total Force Fitness Summit 2021: Maximizing the Health and Well-being of Service Members and Their Families.

Total Force Fitness (TFF) is a multidomain, holistic framework that provides the Department of Defense (DoD) with the capability to assess, promote, and sustain human performance optimization across the full spectrum of components key to meeting mission requirements. On September 14 and 15, 2021, in Bethesda, MD, The Consortium for Health and Military Performance convened a second TFF Summit with the goal of promoting the mission of optimizing the health and well-being of our service members across their careers. Participants included scientists, clinicians, educators, public health professionals, and military leaders from all the services. The current operating picture of TFF within the DoD was described, and then working groups were convened to address issues related to (1) delivering full spectrum health and performance services; (2) advocacy, awareness, and empowerment; (3) research; (4) education; and (5) standardization, branding, and metrics. The outcomes of the summit included recommendations that operational leadership and a consolidated and joint approach are required for TFF to be successful, and TFF must be regarded as an integral part of the National Defense, Security, and Military Strategy. To that end, TFF should be aligned within OUSD(P&R), not the Military Health System, so it extends beyond the medical setting and fully supports mission readiness and performance. Importantly, we must be proactive and teach new recruits about the TFF holistic approach to sustain optimal performance across their careers.

Effects of the number of competing responses on neural signatures of pre- and post-response conflict

The optimization of human performance requires the continuous monitoring of behavioral conflicts. According to conflict monitoring theory, the dorsal anterior cingulate cortex registers response conflict which is reflected by two electrophysiological signatures, the N2 and the Ne/ERN. The theory assumes that, if a stimulus activates an incorrect response that competes with the correct response, pre-response conflict on correct trials (reflected by the N2) is enhanced but post-response conflict on error trials (reflected by the Ne/ERN) is reduced. Here, we asked whether response conflict depends on the number of competing incorrect responses activated by a stimulus, that is, whether the N2 is further enhanced and the Ne/ERN is further reduced if two incorrect responses are activated as compared to one. To this end, we used a modified flanker paradigm, in which the two flankers were associated either with the same incorrect response or with different incorrect responses. Our results indicate an increased N2 on correct trials and a reduced Ne/ERN on error trials in the latter as compared to the former condition. These results confirm central predictions of conflict monitoring theory and demonstrate that response conflict is directly related to the number of competing incorrect responses.

Building a transdisciplinary expert consensus on the cognitive drivers of performance under pressure: An international multi-panel Delphi study.

The ability to perform optimally under pressure is critical across many occupations, including the military, first responders, and competitive sport. Despite recognition that such performance depends on a range of cognitive factors, how common these factors are across performance domains remains unclear. The current study sought to integrate existing knowledge in the performance field in the form of a transdisciplinary expert consensus on the cognitive mechanisms that underlie performance under pressure. International experts were recruited from four performance domains [(i) Defense; (ii) Competitive Sport; (iii) Civilian High-stakes; and (iv) Performance Neuroscience]. Experts rated constructs from the Research Domain Criteria (RDoC) framework (and several expert-suggested constructs) across successive rounds, until all constructs reached consensus for inclusion or were eliminated. Finally, included constructs were ranked for their relative importance. Sixty-eight experts completed the first Delphi round, with 94% of experts retained by the end of the Delphi process. The following 10 constructs reached consensus across all four panels (in order of overall ranking): (1) Attention; (2) Cognitive Control-Performance Monitoring; (3) Arousal and Regulatory Systems-Arousal; (4) Cognitive Control-Goal Selection, Updating, Representation, and Maintenance; (5) Cognitive Control-Response Selection and Inhibition/Suppression; (6) Working memory-Flexible Updating; (7) Working memory-Active Maintenance; (8) Perception and Understanding of Self-Self-knowledge; (9) Working memory-Interference Control, and (10) Expert-suggested-Shifting. Our results identify a set of transdisciplinary neuroscience-informed constructs, validated through expert consensus. This expert consensus is critical to standardizing cognitive assessment and informing mechanism-targeted interventions in the broader field of human performance optimization.

Modeling the Design Characteristics of Woven Textile Electrodes for long-Term ECG Monitoring.

An electrocardiograph records the periodic voltage generated by the heart over time. There is growing demand to continuously monitor the ECG for proactive health care and human performance optimization. To meet this demand, new conductive textile electrodes are being developed which offer an attractive alternative to adhesive gel electrodes but they come with their own challenges. The key challenge with textile electrodes is that the relationship between the manufacturing parameters and the ECG measurement is not well understood, making design an iterative process without the ability to prospectively develop woven electrodes with optimized performance. Here we address this challenge by applying the traditional skin-electrode interface circuit model to woven electrodes by constructing a parameterized model of the ECG system. Then the unknown parameters of the system are solved for with an iterative MATLAB optimizer using measured data captured with the woven electrodes. The results of this novel analysis confirm that yarn conductivity and total conductive area reduce skin electrode impedance. The results also indicate that electrode skin pressure and moisture require further investigation. By closing this gap in development, textile electrodes can be better designed and manufactured to meet the demands of long-term ECG capture.

Optimizing Brain Health of United States Special Operations Forces.

United States Special Operations Forces (SOF) personnel are frequently exposed to explosive blasts in training and combat. However, the effects of repeated blast exposure on the human brain are incompletely understood. Moreover, there is currently no diagnostic test to detect repeated blast brain injury (rBBI). In this "Human Performance Optimization" article, we discuss how the development and implementation of a reliable diagnostic test for rBBI has the potential to promote SOF brain health, combat readiness, and quality of life.

Hydration: Tactical and Practical Strategies.

Full-spectrum Human Performance Optimization (HPO) is essential for Special Operations Forces (SOF). Adequate hydration is essential to all aspects of performance (physical and cognitive) and recovery. Water losses occur as a result of physical activity and can increase further depending on clothing and environmental conditions. Without intentional and appropriate strategic hydration planning, Operators are at increased risk for degradation in performance and exertional heat illness. The purpose of this article is to highlight current best practices for maintaining hydration before, during, and after activity, while considering various environmental conditions. Effective leadership and planning are necessary for preparing Operators for successful military operations.

Human Performance Optimization (HPO) for the Warfighter—Keeping It Simple in a Complex Age: A Narrative Review

ABSTRACT For the past 2 decades, western Armed Forces have been almost continuously engaged in combat operations worldwide. Over this period, changes to the character of conflict, combined with technological advancements, have resulted in a contemporary military operational environment that is arguably more volatile, uncertain, complex, and ambiguous than ever before. However, although the character of conflict may have changed, it fundamentally remains a human endeavor that places unique and intense physiological, psychological, and cognitive demands on the warfighter. As a result, there has been an increased emphasis in military and scientific circles on the concept of human performance optimization. In addition, the concept of the tactical athlete as a categorization for military personnel and those who work in extremis settings has developed within the professional strength and conditioning community. Therefore, the following narrative review aims to outline the concept of human performance optimization, review the demands of the modern operational environment, and provide strength and conditioning practitioners working with military personnel with evidence-based recommendations to optimize the physiological, psychological, and cognitive performance of the warfighter.

Evoluția conceptului de optimizare a performanței umane și aplicații în domeniul militar

"In these times, dominated by accelerated cognitisation and sophisticated automation, rapid development of computers and multiplication of forms of communication, the human factor seems to have a secondary role. From our point of view, this is just an appearance, because the new cognitive instruments do not replace, but mirror and simulate aspects of people’s higher psychic functions, acting as a multiplier for talented, educated and original minds. The concept of Human Performance Optimization (HPO) represents a systematic effort to use the latest technologies and knowledge to achieve the maximum performance of individuals, teams and/or organisations. At the same time, HPO is an ethical way to optimize technological synapse between the forms of artificial and human intelligence."

Human Performance Optimization Concept Development and Applications In The Military Field

"In these times, dominated by accelerated cognitisation and sophisticated automation, rapid development of computers and multiplication of forms of communication, the human factor seems to have a secondary role. From our point of view, this is just an appearance, because the new cognitive instruments do not replace, but mirror and simulate aspects of people’s higher psychic functions, acting as a multiplier for talented, educated and original minds. The concept of Human Performance Optimization (HPO) represents a systematic effort to use the latest technologies and knowledge to achieve the maximum performance of individuals, teams and/or organisations. At the same time, HPO is an ethical way to optimize technological synapse between the forms of artificial and human intelligence."

Omega-3 Fatty Acids: Benefits for Performance and Recovery.

Full-spectrum human performance optimization (HPO) is essential for Special Operations Forces (SOF). Nutrition is one part of HPO and is important for all aspects of performance. One area of increased interest in this regard is omega-3 polyunsaturated fatty acids (omega-3). Research has indicated that Servicemembers (SM), including SOF, do not eat the recommended 2 to 3 servings per week of fatty fish and have low omega-3 levels. Therefore, alternative approaches are warranted. The purpose of this article is to highlight the potential mental and physical health and performance benefits of omega-3. Consuming omega-3 on a regular basis would not only be beneficial for the health of SOF but also for their training and overall performance.

A Comprehensive Method of Assessing Body Composition Using Kinanthropometry in Human Performance Training.

Nutrition is an essential component of Human Performance Optimization in Special Operations Forces (SOF) to enhance physical and mental performance, unit readiness, and mission success. Body composition is frequently used to monitor individual nutrition progress; however, using body fat percentage is limited both by the accuracy of the assessment method and its association with SOF relevant performance outcomes. Lower body fat and/or body mass index have generally, but not universally, been correlated with higher levels of physical performance, yet they poorly predict performance in military relevant tasks. As a complement to body fat, many performance dietitians in the SOF Human Performance Programs utilize the International Society for Advanced Kinanthropometry (ISAK) profile to assess body composition, proportionality, ratio of muscle to bone, and somatotype in combat Operators. Kinanthropometry is the study of human size, shape, proportion, composition, maturation, and gross function, and it is a helpful tool for monitoring nutrition and training progress in athletes and active individuals. The ISAK profile has been well established as an international method for talent identification, distinguishing characteristics between athletes across and within elite sports, and identifying predictors of sport performance that can be applied in the military setting. While some SOF dietitians are utilizing the ISAK profile, the challenge lies in translating sport data to military relevant outcomes. We present a series of four case studies demonstrating the utility of this method as a portable comprehensive assessment for cross-sectional and longitudinal body composition tracking in a military setting.

Advancing the Practice of Contemporary Military Performance Psychology:A Full-Spectrum Approach to Psychological Health and Readiness.

The Department of Defense (DoD) continues to emphasize operational readiness, lethality, and optimal performance. Performance psychology is a critical aspect of and central dimension to human performance optimization in support of Preservation of the Force and Family (POTFF) and Total Force Fitness (TFF). The delivery of performance psychology services must continue to evolve to maximize its potential for enhancing combat performance and supporting psychological readiness in warfighters across all branches of service. The authors (1) provide a brief history of the evolution of military psychology; (2) explore how performance psychology complements and broadens approaches to support warfighter health and readiness; and (3) present a set of strategies to advance performance psychology services toward an aspirational model. Such strategies will more effectively promote best practices to better target operational performance, complement existing health and medical service delivery, and encompass a systems approach to sustainable training. Moreover, these strategies aim to increase return on investment of psychological readiness efforts for warfighters across all branches of service.

Applications of Pose Estimation in Human Health and Performance across the Lifespan.

The emergence of pose estimation algorithms represents a potential paradigm shift in the study and assessment of human movement. Human pose estimation algorithms leverage advances in computer vision to track human movement automatically from simple videos recorded using common household devices with relatively low-cost cameras (e.g., smartphones, tablets, laptop computers). In our view, these technologies offer clear and exciting potential to make measurement of human movement substantially more accessible; for example, a clinician could perform a quantitative motor assessment directly in a patient’s home, a researcher without access to expensive motion capture equipment could analyze movement kinematics using a smartphone video, and a coach could evaluate player performance with video recordings directly from the field. In this review, we combine expertise and perspectives from physical therapy, speech-language pathology, movement science, and engineering to provide insight into applications of pose estimation in human health and performance. We focus specifically on applications in areas of human development, performance optimization, injury prevention, and motor assessment of persons with neurologic damage or disease. We review relevant literature, share interdisciplinary viewpoints on future applications of these technologies to improve human health and performance, and discuss perceived limitations.