Page 112 - JSOM Winter 2017

Table 1 Descriptions of Selected ITC Training Phases Body Mass and Energy Balance
Training Phase, Food Body mass was measured under the same experimental condi-
No. of Days Task Availability tions (i.e., after an overnight fast, morning void, and seminude)
Survival, Evasion, Resistance, and Escape School before and after each training phase by having all study volun-
12 Academic instruction on DFAC, local teers use an electronic, calibrated scale (model PS6600; Befour,
survival, evasion, resistance, economy http://befour.com/). Total daily energy expenditure (TDEE; via
and escape techniques in a doubly labeled water), energy intake (EI), and energy balance
classroom setting (EB = EI − TTDEE) were assessed in a random subset of the
7 Simulated evasion, resistance, Minimal a original 20 volunteers during SERE (n = 10), RS (n = 12), CQB
and escape environments in (n = 9), and DB (n = 13). Subset analyses were intended for 15
field settings
Raider Spirit volunteers per phase; however, the sample sizes were smaller
because of study attrition (SERE and RS), and because volun-
9 Simulated raids and ambushes Field rations b teers were tasked with other duties during CQB.
in field settings
Close Quarter Battle For TDEE assessments, volunteers provided a urine sample af-
19 Weapon qualification and close- DFAC, local ter an overnight fast to determine background abundance of
quarter shoot house training at economy 18 2
firing range O and H before ingesting the doubly labeled water (0.285g
18
2
Derna Bridge H O/kg total body water [TBW] and 0.15g H O/kg TBW;
2
2
Sigma-Aldrich, https://www.sigmaaldrich.com/). Volunteers
23 Training a local guerrilla force DFAC, local
and simulated irregular warfare economy, field remained fasted for the next 4 hours and provided urine sam-
operations in field settings rations b ples at 4 hours and 6 hours to determine TBW. Second-morn-
This is a general overview of each training of the four selected train- ing void urine samples were then collected daily during each
ing phases of ITC. DFAC, dining facility; ITC, Individual Training training phase. Enrichments of H and O were measured
2
18
Course; MRE, Meals, Ready-to-Eat. using isotope ratio mass spectroscopy (Finnigan Mat 252;
a Participants subsisted on one ration of MRE, an uncooked chicken Thermo Fisher Scientific, https://www.thermofisher.com). The
and rabbit that the Marines eventually had to cook, root vegetables, 2 18
2 cups of rice, and two pieces of bread during the 7 days of training. H and O isotope elimination rates were calculated by linear
b Field rations consisted of MRE (approximately 1,300kcal/ration). regression using the isotopic disappearance rates in the urine
samples collected during each training phase. 1,4,6,7
into a 12-day academic phase and a 7-day field phase. The
academic phase consists of worldwide survival, evasion, and EI was evaluated by trained registered dietitians using 24-hour
recovery principles; and resistance and escape techniques, in- dietary recalls every third day in garrison. When subsisting
cluding food and water procurement, signaling, evasion shel- primarily on combat rations during field training, EI was as-
ter, fire craft, survival medicine, and navigation principles. sessed using ration-specific food logs every third day. 1,6,7 For
These techniques are applied during the field training phase, SERE, EI was estimated by quantifying all the food items (i.e.,
during which students conduct evasion training, traversing one combat ration [MRE], an uncooked chicken and a rabbit
rough terrain while carrying an additional 20–30kg pack for the Marines had to cook, root vegetables, 2 cups of rice, and
up to 16 h/d. Students are then captured and exposed to sig- two pieces of bread) provided to participants by cadre and
nificant psychological and physiological stress during mock averaged over the 7-day period. In addition, TDEE, EI, and
captivity to enhance survivability skills and to develop coping EB measurements were separated into academic and fielding
strategies in the event of enemy capture. Food availability is phases because SERE comprised 12 days of academic training
highly restricted during the field phase of SERE because near- and 7 days of field training (the academic phase of RS was too
complete starvation is an intentional stressor uniformly ap- short for accurate assessments of TDEE; therefore, only TDEE
plied to all students. for the field phase is presented.

RS is a 12-day exercise comprising a 3-day academic planning Dietary Patterns and Quality
phase and a 9-day field phase designed to prepare a CSO for Dietary patterns and quality were assessed at the start and
the metabolic demands and psychological stressors of a mis- end of ITC by using the full-length, 100-item semiqualita-
sion. During the field phase, the students are highly active, ex- tive, 3-month version of the Block 2005 Food Frequency
ecuting task-oriented operations, including reaction to enemy Questionnaire (FFQ; Nutrition Quest, http://nutritionquest
movement and to extraction while carrying a 20–30kg pack. .com/). These data were used to calculate the Healthy Eat-
8,9
Students have limited time to sleep and are provided only two ing Index-2010 (HEI-2010), a measure of diet quality in terms
combat rations per day (meals, ready-to-eat [MREs]; Ameri- of conformance to the 2010 Dietary Guidelines for Ameri-
qual, Evansville, IN; approximately 1,300 kcal/ration). CQB cans. 10–12 Total HEI-2010 scores are based on 12 components
is a 19-day weapons qualification and CBQ training exercise that range from 0 to 100 (100 being the best).
designed to ensure that CSOs can engage and neutralize tar-
gets at close proximity in an enclosed space. Students spend Statistical Analysis
approximately 10 h/d training, have regular access to the local Shapiro-Wilk tests of normality confirmed that all data were
military dining facility, and also can consume food they pro- normally distributed. Mixed-model analysis of variance, with
cure through the local economy. DB is the ITC culmination ex- participant as the random factor, was used to assess differ-
ercise that lasts 23 days, during which students are expected to ences in TDEE, EI, and EB among training phases (i.e., SERE,
apply the skills developed over the past 9 months to complete RS, CQB, and DB). A two-way repeated measures analysis of
a mock mission. During DB, students rely on combat rations variance was used to determine changes over time (i.e., be-
(MRE), food from the local dining facility, and food items they fore and after) and among the four training phases for body
procure through the local economy during the training. mass. Bonferroni adjustments were used for multiple pairwise

110 | JSOM Volume 17, Edition 4/Winter 2017