Page 76 - Journal of Special Operations Medicine - Summer 2015

of the Nonfinishers showed serious muscle damage. Figure 1 Mean body temperature of Nonfinishers and
The two highest levels were detected in the Nonfinisher Finishers.
group (8,150U/L and 12,400U/L).

Markers of General Physical Exertion
The leukocyte count and CRP levels, both inflammation
markers, as well as the relative loss of body weight were
defined as surrogate parameters to show the effects of
general stress on the body (Table 2). While participants
in both groups lost weight, weight loss was significantly
greater in the Finisher group than in the Nonfinisher
group. The Nonfinishers had borderline elevated CRP
levels, while the Finishers had significant increase in
CRP levels compared to the Nonfinishers. In contrast,
the Finishers only had mild leukocytosis, while the Non-
finishers had a significantly elevated leukocyte count
compared to Finishers.

Table 2 Markers of General Physical Exertion Notes: *Significant difference between Finishers and Nonfinishers
(p ≤ .05).
Loss of Body CRP mg/dL Leukocytes G/L Bars represent standard deviation. n, mean data point.
*,†
*,†
Weight kg (ref.: <0.5 mg/dL) (ref.: 4–10 G/L)
*,†
Finishers −7.8 ± 2.4 1.09 ± 1.31 9.2 ± 2.7
Table 3 Reasons for Soldiers Not Finishing the Exercise
Nonfinishers −2.4 ± 2.6 0.47 ± 0.42 11.3 ± 2.6
Reason for Participants Not Finishing Frequency, No.
Notes: CRP, C-reactive protein; ref., reference; SD, standard deviation.
*Data given as mean ± SD. Injury 4
† Significant difference between Finishers and Nonfinishers (p ≤ .05).
Unknown 2
Temperature Quitting voluntarily 7
Air temperatures in the exercise area ranged from −1°C Internal illness 2
(30.2°F) to 18°C (64.4°F) during the exercise period, Too slow for the team 14
with no precipitation and 8 to 10 hours of sunshine per
day. A body temperature of 35°C (95°F) was defined Total 29
as the threshold for hypothermia, higher than 38°C
(100.4°F) 10,11 for hyperthermia, and higher than 40°C soldiers, as their documentation forms could not be
(104°F) with additional neurologic symptoms for heat filled in adequately during the exercise. What can be said,
stroke. 4,5 however, is that they did not drop out for medical rea-
sons necessitating hospitalization. The injuries that four
The body temperatures of 13 Nonfinishers and 21 Fin- soldiers sustained were minor injuries to the musculoskel-
ishers were measured, whereas the medical staff did not etal system (ankle sprain, foot contusion, preexisting and
take the tympanic temperature of 17 soldiers (33.3%) acutely exacerbated irritation of the extensor tendons of
due to a cold environment. Hypothermia was only the foot, cervicalgia) and did not necessitate hospitaliza-
detected in the Nonfinisher group (34.1°C [93.4°F], tion. Medical illnesses that caused participants to drop
34.6°C [94.3°F], and 34.7°C [94.5°F]), with one soldier out were vomiting and exercise-associated postural hy-
showing symptoms of the condition (34.6°C [94.3°F]). potension, though none of them necessitated hospitaliza-
A hyperthermic temperature was only measured in one tion. The instructors accompanying the teams withdrew
soldier in the Finisher group (38.1°C [100.6°F]), but 14 soldiers because they could no longer keep up with
the soldier did not show any of the clinical signs associ- their teams or perform the additional tasks. The soldier
ated with hyperthermia. Mean body temperatures in the who showed clinical signs of hypothermia quit volun-
Nonfinisher group were significantly lower than in the tarily before he was examined by medical staff, which is
Finisher group (Figure 1). why it is not listed as a medical reason for dropping out.

Reasons for Soldiers Not Finishing the Exercise
Table 3 lists the reasons for soldiers not finishing the Discussion
exercise. It was possible to identify a specific reason The exercise involved the typical exertion experienced
for 27 of the 29 Nonfinishers dropping out. No defini- by soldiers while marching and carrying personal equip-
tive reason for dropping out could be identified for two ment for long periods of time, though it was made more

66 Journal of Special Operations Medicine Volume 15, Edition 2/Summer 2015