Page 79 - Journal of Special Operations Medicine - Summer 2015

the team down (Table 3). This means that those soldiers, and Finishers (greater mean deviation of blood param-
who made up 72% of all the Nonfinishers, did not have eters) are at risk of developing rare but potentially life-
any distinct medical reason for dropping out. threatening exertion-related medical conditions such as
rhabdomyolysis and hyponatremia. Plain water did not
It is notable that there were larger mean values of the increase the risk of exercise-related hyponatremia. Hy-
measured parameters in the Finisher group, with the ex- pothermia prevention should be considered a key factor
ception of significantly higher leukocytosis in the Non- for success.
finisher group. These levels can probably be accounted
for by the fact that the Finishers experienced greater and The patterns of medical conditions developed and in-
longer-lasting physical exertion. Since all the soldiers were juries sustained during military exercises do not differ
in similarly good physical condition at the beginning of in principle from those at comparable civilian sporting
the exercise (they had successfully completed the training events under the climatic conditions the exercise was
program and passed the ergometry stress test for which conducted. The physical demands commanders request
the minimum was 3W/kg of body weight), psychological from their troops, therefore, are not likely to pose an
factors such as the capacity for enduring pain, willpower, exaggerated health risk.
motivation, and determination seem to play a fundamen-
tal role in bearing up against extreme physical exertion. The significantly higher leukocytosis found in the Non-
One possible explanation for this is that the psychologi- finisher group could be a sign of acute excessive stress
cal profiles of exceptional athletes often differ from those caused by an exertion peak and, therefore, could shed
of the average population, and a distinct psychological some light on the question of whether acute systemic fa-
factor can be assumed to play a role in whether a soldier tigue or other aspects like psychological reasons caused
passes or fails the exercise. 32–34 With regard to medical soldiers to drop out of an exercise. Further research
care, this means that the risk of complications must not be is needed to elucidate this aspect in a more detailed
underestimated even for soldiers who might have passed fashion.
the test. Some experience more severe physical reactions
to exertion than soldiers who do not finish the exercise, Acknowledgments
but are determined to tolerate and deny the physical con-
sequences of the exertion for a longer period of time. The The authors would like to thank the medical personnel
transition range to acute excessive exertion that forces a of Calw Medical Centre for their assistance in the col-
participant to stop seems to be very narrow, as evidenced lection of the data. We would like to thank NATO Spe-
by the extreme levels in parameters (CK, hyponatremia, cial Operations Headquarters for substantial support in
hypothermia) measured in the Nonfinisher group. This finalizing the article.
is why, irrespective of whether the test is passed, a close
watch must be kept for exertion-related complications, Disclosures
particularly in soldiers who are highly motivated and The authors have nothing to disclose.
have a high capacity for enduring pain.

Limitations References
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Medical Conditions in German SOF Selection 69