Tag Archives: “Performance Triad”

Program teaches future sergeants major to boost Soldiers’ wellness

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By CLIFFORD KYLE JONES
NCO Journal

The new year will bring a crop of sergeants major with a new outlook on wellness.

Class 67 at the U.S. Army Sergeants Major Academy is taking part in the Executive Wellness Program, which is intended to merge information on the Performance Triad with resilience training to help new sergeants major become better Soldiers and leaders.

“We’re trying to bring those two together to help mitigate health issues and optimize readiness,” said Sgt. 1st Class Darin E. Elkins, noncommissioned officer in charge of the Executive Wellness Center at USASMA. “With the Performance Triad — sleep, activity, nutrition — we’re doing a baseline assessment.”

Students were screened about their personal habits, including questions about whether they got enough sleep, how many fruits and vegetables they ate, how much activity they engaged in, and whether they had any pain.

The baseline assessment took place in the fall, near the beginning of Class 67’s instruction. In addition to questions, each of the more than 600 students were run through physical drills such as short sprints, one-footed hops, and holding yoga positions to assess their speed, dexterity and flexibility — as well as identify any lingering pain. The students also underwent vital signs tests and used a machine to check their body fat composition, a more precise measurement than the commonly checked body mass index.

A student in the U.S. Army Sergeants Major Academy's Class 67 does a one-legged hop during an assessment for the Executive Wellness Program. (Photo by Clifford Kyle Jones / NCO Journal)
A student in the U.S. Army Sergeants Major Academy’s Class 67 does a one-legged hop during an assessment for the Executive Wellness Program. (Photo by Clifford Kyle Jones / NCO Journal)

As part of the assessments on each area of the triad, the students were coded as green, amber or red — green meaning doing well, amber indicating borderline performance in an area and red suggesting the Soldiers need to improve their sleep, activity or nutrition habits.

Immediately after the assessment, Soldiers met with a dietitian, a physical therapist and a clinical social worker to discuss their results.

At the final station of the assessment, Elkins said, wellness program representatives made sure all the students were signed up for RelayHealth, a Web portal that provides access and appointments to doctors and other health professionals, and knew how to use it and what resources the site provides.

The baseline assessment was just the start of the program, Elkins said. Throughout their time at USASMA at Fort Bliss, Texas, the students of Class 67 will be given further assessments and access to information and resources to help them improve their health and resilience and to teach their Soldiers to do the same when they return to their units as sergeants major.

“They all get a baseline, to know where they are,” Elkins said. “The idea is to have them identify those mitigating issues and then at the end of the school year or the class year, do another baseline to see if there are any changes: Did they learn anything? How can they use that information to take out to the operational Army when they leave here? How can they best optimize readiness for their Soldiers?”

“You build on (the baseline assessment) to change habits or to incorporate better habits,” he continued. “I’ve dropped modules in strategically throughout the school year.”

Elkins said 24 modules, each focusing on different aspects of the Performance Triad or resilience, are available electronically for discussion as part of Class 67’s coursework. The Executive Wellness Program also provides information guides, challenge guides and other technological resources to better teach the future sergeants major how to set wellness goals, eat for performance, enhance Physical Readiness Training and deal with sleep deprivation.

A student in the U.S. Army Sergeants Major Academy's Class 67 stretches in a yoga pose during an assessment for the Executive Wellness Program. (Photo by Clifford Kyle Jones / NCO Journal)
A student in the U.S. Army Sergeants Major Academy’s Class 67 stretches in a yoga pose during an assessment for the Executive Wellness Program. (Photo by Clifford Kyle Jones / NCO Journal)

Representatives from the Comprehensive Soldier and Family Fitness office at USASMA also took part in the Executive Wellness Program assessments. CSF2 will teach Class 67 the Master Resilience Training course, and Elkins said including the office in Performance Triad training will help teachers “bring it all together” when it comes to the effects of sleep, nutrition and activity on mental resilience.

Elkins said, “There are a lot of things Soldiers don’t know, especially when they’re 19, 20, 21,” about treating pain, behavioral health, using dietitians or receiving physical therapy.

“Some of the ownership needs to be on the individual,” Elkins said, “but they can’t own it if they don’t know what the resources are. So we try to help them identify some of the ailments, some of the things they’re not doing well. Now they can address that on their own.”

Master Sgt. Decarlo Johnson, a student in Class 67, said he was all green after the assessment. He said he arrived at USASMA fairly familiar with the Performance Triad and tried to implement optimizing techniques already.

He was, however, new to the body fat composition testing machines.

“I was interested to see what my body fat composition was, and I think they should do that more for Soldiers with the machine,” Johnson said. “That’s a great machine to have. If you had that in the unit, Soldiers would be more aware of their body fat and what they need to do to maintain” their weight.

Even though the concepts of the Performance Triad and resilience were familiar to him, he was excited to see the Executive Wellness Program for new sergeants major.

A student in the U.S. Army Sergeants Major Academy's Class 67 does a standing a jump during an assessment for the Executive Wellness Program. (Photo by Clifford Kyle Jones / NCO Journal)
A student in the U.S. Army Sergeants Major Academy’s Class 67 does a standing a jump during an assessment for the Executive Wellness Program. (Photo by Clifford Kyle Jones / NCO Journal)

“It’ll definitely help,” he said of the wellness program. “We have Soldiers who are overweight who can benefit from the nutrition and sleep (information) if they have problems with sleeping. If you get your sleep right, nutrition might be better, so I think it’ll benefit a lot in the unit.”

Lt. Col. Cyndi McLean, a physical therapist from the Executive Wellness Office at USASMA, said Johnson’s realization that each aspect of the Performance Triad affects the others is exactly what the program is trying to teach.

“If you consider one aspect of that triangle, if you’re doing really well, you’re probably going to have some benefits carry over to the other aspects of that triangle,” she said. “If you’re not doing so well in one of those corners of the triangle, you might be having some negative detriments in the other areas as well. The intent is to make sure that you’re optimizing each of those categories to make sure that you’re being the best Soldier that you possibly can.

“In this setting, we’re not only asking them to look at that for themselves personally but professionally,” McLean continued. “These are the senior leaders who are going to be in charge of those formations in just a few months. They’re going to be those sergeants major. Are they making sure their Soldiers are optimizing their performance with regards to sleep, activity, nutrition?”

Wellness assessment at USASMA reveals common problem: not enough sleep

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By CLIFFORD KYLE JONES
NCO Journal

When representatives from the Executive Wellness Center assessed Class 67 at the U.S. Army Sergeants Major Academy recently, they found themselves doling out the same advice to many of the sergeants-major-to-be: Get more sleep.

Lt. Col. Cyndi McLean was one of three medical professionals who reviewed students’ responses to a questionnaire about healthy habits related to the three elements of the Performance Triad — activity, nutrition and sleep.

McLean is a physical therapist and said one problem area came up over and over again.

“I would love to say that it was activity,” she said, but many of the students’ biggest shortcoming was sleep.

“A lot of them don’t realize what optimal sleep is,” she said. “They don’t realize healthy hygiene habits. It’s something that is very fixable. I think that we all sometimes jump to more of a clinical or medical diagnosis: ‘I have sleep apnea.’ Well, maybe there’s some room for improvement there and some things that we can do to help you in that category and not just give it a test, give it a label, give it a diagnosis. We really want to help you through that process to truly optimize your sleep.”

A student in the U.S. Army Sergeants Major Academy's Class 67 has his body fat composition checked. (Photo by Clifford Kyle Jones / NCO Journal)
A student in the U.S. Army Sergeants Major Academy’s Class 67 has his body fat composition checked. (Photo by Clifford Kyle Jones / NCO Journal)

At the beginning of their school year, the more than 600 students of Class 67 took part in the first assessments of the office’s new Executive Wellness Program. The program is intended to bring the Performance Triad and resilience training together to help the senior noncommissioned officers become better Soldiers and leaders.

McLean said that not getting enough sleep can be the root of many other performance problems. If Soldiers sleep better, she said, they start to see benefits in other areas, such as improved eating and activity levels and reduced anxiety.

Lt. Col. Devvon Bradley, a licensed clinical social worker who also took part in the assessments, agreed that sleep is the linchpin for performance.

“It’s interesting because, in here, every time I see a sleep problem up front, it leads to the nutrition issues and then the activity at the end,” he said. “There are pain issues and there are also dietary issues, almost like a direct correlate. If there are no sleep issues up front, it’s less likely that there are nutrition problems and less likely that there are physical problems — pain issues — at the end.

Lt. Col. Cyndi McLean, a physical therapist, speaks with a student in the U.S. Army Sergeants Major Academy's Class 67 during an assessment by the Executive Wellness Program. (Photo by Clifford Kyle Jones / NCO Journal)
Lt. Col. Cyndi McLean, a physical therapist, speaks with a student in the U.S. Army Sergeants Major Academy’s Class 67 during an assessment by the Executive Wellness Program. (Photo by Clifford Kyle Jones / NCO Journal)

“The connection between sleep, activity and nutrition? There’s no doubt in my mind about it,” he continued. “It’s a triad, and each one contributes to the other. If you can help one, you can help the others. It looks like sleep is in the lead, in terms of if you fix it first, you have a better chance of fixing the other stuff.”

McLean said that sleep issues not only lead to problems in other areas but also noted that not sleeping well can make it harder to resolve Soldiers’ other problems.

“If I see that you have a pain issue, but you’re not willing to address your sleep habits, I’m not going to be able to get you as good as I possibly could,” she said. “Your prognosis is going to be on the lesser side. Once those people open up (about sleep), it’s amazing how much of their chronic pain, their aches, their issues like that get better as well.”

As McLean, Bradley and registered dietitian Capt. Michelle Stone reviewed Class 67’s questionnaires, the future sergeants major were categorized as green, amber or red in each of the three Performance Triad areas.

“What I’m seeing on people’s faces is the lightbulb going on,” Bradley said.

Lt. Col. Devvon Bradley, a licensed clinical social worker, left, speaks with a student in the U.S. Army Sergeants Major Academy's Class 67 during an assessment for the Executive Wellness Program. (Photo by Clifford Kyle Jones / NCO Journal)
Lt. Col. Devvon Bradley, a licensed clinical social worker, left, speaks with a student in the U.S. Army Sergeants Major Academy’s Class 67 during an assessment for the Executive Wellness Program. (Photo by Clifford Kyle Jones / NCO Journal)

Many of the NCOs didn’t realize they were red in the sleep category, he said, and now they not only know they have a problem but also know where to get help.

Sgt. 1st Class Darin E. Elkins, the NCO in charge of the Executive Wellness Center, coordinated and led the assessments, and he saw the same lightbulbs turn on.

“Once you identify an area where you’re not doing well, you think, ‘Oh, I didn’t realize that. Oh, I didn’t realize that taking in two or three cups of coffee or energy drinks at 6 p.m. is impacting my sleep, which is impacting my cognitive abilities, which is impacting my output,’ ” Elkins said. “Once we’ve identified it for them and say here’s a way to better optimize these things that they’re doing, then they can start making the changes. If you always do what you’ve always done, you get the same outcomes.”

The assessments were just the beginning of the program. Throughout the school year, the students of Class 67 will be given more training on the Performance Triad and resilience, and Bradley expects their personal realizations and training will pay dividends well beyond these particular NCOs.

“They’re leaders in the Army,” Bradley said, “so when they go back out to their units, they will push the same message of science and wellness.”

Commentary: The Army has a sleep problem. Here’s how to fix it

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NCO Journal staff report

Army Maj. Jeff Jager and Former Marine Corps Sgt. Aaron Kennedy say the Army has a sleep deprivation problem in a commentary published in the Army Times.

“Studies show sleep deprivation offers effects equal to drinking alcohol, and continued lack of sleep has the potential of being even more deadly,” Jager and Kennedy write. “We would never allow a drunken Soldier to lead an ambush, so why do we consider it acceptable or even admirable to send one with lack of sleep into life-threatening situations?

“The Army’s culture of sleep deprivation begins during basic training, although the Center for Initial Military Training has taken steps recently to incorporate additional sleep into the platform,” the continued. “It continues through the first unit of assignment, where we interrupt sleep with training and other duties until going without rest becomes ingrained in our Soldiers.”

Jager and Kennedy note that the Army is attempting to address sleep problems with its Performance Triad, but a survey they conducted of active-duty and reserve-component Soldiers found that nearly 42 percent had never heard of the triad and that 18 percent didn’t agree with it. They offer some suggestions for fixing the military’s sleep deprivation problems, including raising awareness and enforcing sleep standards.

Read the article.

Lack of sleep leads to lack of readiness, experts say

By DAVID VERGUN
Army News Service

Looking back on the long duty hours required of him as a drill sergeant, sometimes 26 in a stretch, Staff Sgt. Jacob Miller said he realized he has put himself and others in danger more than once.

Miller, who was named the 2015 Drill Sergeant of the Year, spoke at the Army Office of the Surgeon General-sponsored Performance Triad Sleep Summit on Dec. 9.

Staff Sgt. Jacob Miller, the 2015 Drill Sergeant of the Year, discusses how lack of sleep degrades performance. He spoke during the Army Office of the Surgeon General-sponsored Performance Triad Sleep Summit, Dec. 9, 2015. (Photo by David Vergun / Army News Service)
Staff Sgt. Jacob Miller, the 2015 Drill Sergeant of the Year, discusses how lack of sleep degrades performance. He spoke during the Army Office of the Surgeon General-sponsored Performance Triad Sleep Summit, Dec. 9, 2015. (Photo by David Vergun / Army News Service)

Since those long days “on the trail,” Miller said Army guidance has directed more time for sleep for drill sergeants, but enforcement of that is still needed. He added that a shift in culture and leader engagement are also necessary to change old thinking that going without sleep is the mark of a dedicated worker.

Col. Ramona Fiorey, acting director of Quality and Safety, U.S. Army Medical Command at the Pentagon, said senior Army leaders are taking sleep, along with activity and nutrition, seriously now. Those three things are termed the Performance Triad and are considered key factors to increasing performance and resilience and reducing injuries and accidents.

Effects on Performance

Dr. Thomas J. Balkin, a scientist at Walter Reed Army Institute of Research in Silver Spring, Maryland, described findings from his research on sleep deprivation.

Participants were divided into groups, with some getting nine hours of sleep, others seven, five and three over a seven-day period. Participants were then given psychomotor vigilance tests each day to determine their reaction time to visual stimulus, he said.

The results showed marked declines for the five- and three-hour groups each day. After the seven-day trial period, the participants in all groups were allowed eight hours of sleep and tested again each day. Performance for all groups shot back up very quickly, especially on the first day. However, performance didn’t recover to pre-trial levels, except for those who “banked” sleep, or had nine hours of sleep the week before the deprivation.

Balkin noted that other studies from Department of Defense research laboratories have “demonstrated the significant effects of sleep deprivation and fatigue on cognition, attention, reaction time and moral reasoning, all of which are critically important for operational effectiveness.”

Research also suggests, he said, that “more is better” when it comes to sleep and that getting more than eight hours of sleep a night establishes a sleep reserve in case sleep is lost one or more nights in the future.

Sleep Disorders

One in 20 active-duty Soldiers are on sleep medications, according to the Army Office of the Surgeon General, or OTSG, “Health of the Force” report released in December.

Lt. Col. Jacob Collen, a sleep-medicine physician who also specializes in pulmonary issues on Joint Base San Antonio, Texas, told the summit that physicians usually prescribe Ambien, or zolpidem, to Soldiers suffering from insomnia. While it does work in getting Soldiers to fall asleep, zolpidem is a sedative, and it’s also known as a hypnotic.

Collen said that since there are only 24 sleep specialists in the Army, serving more than 1 million troops, an attending physician may not realize that there are non-prescriptive treatments that are effective for sleep issues.

Currently, the most effective treatment is cognitive behavioral therapy for insomnia, or CBTi, he said.

Lt. Col. Ingrid Lim, sleep lead for Performance Triad, OTSG also described BBTi, or brief behavioral therapy for insomnia. BBTi is not only effective in treating sleep problems, but can also be used with patients who have medical and psychiatric conditions, and it can be delivered in a primary care setting.

CBTi treatments last several weeks and BBTi less, she said. Both involve encouraging change to thought patterns and behaviors that are the underlying causes contributing to poor sleep.

While CBTi and BBTi are evidence-based and clinically proven to be effective, there are, unfortunately, “watered-down versions” of those therapies that are out there, Collen said. These pseudo-versions cherry-pick from the manual rather than using the full approach.

“We want Soldiers to get the rigorous, evidence-based version,” he said. “It would be better to have no treatment at all than to get the wrong one.”

The solution, Collen said, is to provide more physicians — not just the 24 sleep specialists — training in CBTi and BBTi. Mobile training teams could be used to educate health care providers, including integrated behavioral health consultants.

Lim said that another common sleep disorder Soldiers suffer from is obstructive sleep apnea, which occurs when breathing stops and then starts in cycles. She said the treatment for that is a Continuous Positive Airway Pressure, or CPAP device, which pumps oxygen into the nasal passage to restore normal breathing.

Inadequate Sleep

Lim said inadequate sleep, meaning less than seven or eight hours, is a huge concern.

The Health of the Force report notes that one-third of Soldiers get five hours or less of sleep per night, and 62 percent of Soldiers get less than seven. The report lists possible effects of inadequate sleep:

– Increased musculoskeletal injuries

– Risk of behavioral health disorders

– Greater susceptibility to illnesses

– Likelihood of developing symptoms of anxiety, depression and post-traumatic stress

And finally, the report notes that “individuals who routinely get five to six hours of sleep perform much like a person with a blood alcohol content of 0.08.”

Lim said there are many steps Soldiers can take themselves to get better rest. The three prongs of the Performance Triad – sleep, activity and nutrition – interact with each other. Limiting junk food and not drinking caffeinated beverages before going to sleep are two examples of how to positively impact sleep, she said.

If Soldiers are not eating right or exercising, sleep quality suffers, so they might want to change what they’re doing, she said.

“Sleep needs to be a Soldier’s resource like ammo,” Lim said. “Are you going to go across the line without adequate fuel for your vehicle, ammo and food? Why are we going to cross the [line of departure] without sleep?”

Army seeks feedback on new Performance Triad app

By DAVID VERGUN
Army News Service

Important information and helpful links on sleep, activity and nutrition — the three components of Performance Triad — are now available as an app that can be downloaded to any smartphone.

While version 1.0 of the app is useful in its current form, future versions will contain interactive features, said Lt. Col. Myong S. Woo, health informatics officer and technical lead for Performance Triad. The Army Office of the Surgeon General would like to receive feedback from Soldiers, Army civilians and family members about exactly what they would like the app to feature, she said, as app developers are meeting next month to discuss future versions.

Important information and helpful links on sleep, activity and nutrition -- the three components of Performance Triad -- are now available as an app that can be downloaded to any smartphone. (Photo by David Vergun)
Important information and helpful links on sleep, activity and nutrition — the three components of Performance Triad — are now available as an app that can be downloaded to any smartphone. (Photo by David Vergun)

Commanders have already expressed interest in an interactive dashboard feature that would allow them to provide guidance to their troops or answer any questions or concerns they might have, she said, adding that Soldiers would have complete control of their confidentiality.

Perhaps Soldiers would like a daily inspirational message or tips on managing work, while getting the proper amount of sleep, or a nutritional tip of the day. Other possibilities, she said, include entering steps taken per day and hours of sleep or food eaten to track sleep wellness or calories.

Feedback like this will help guide future app development, Woo said, noting that “it’s now very much a work in progress.”

Users can visit their app store for this free app for iPhone, Android or Windows. Search for “Performance Triad” and download the app to the smartphone.

Once the app is downloaded, avatars of a Soldier, Army civilian, family member and retiree will be displayed. Users should click on their avatar, which will open up content most applicable to them, she said.

Content in the app is organized by the three sleep, activity and nutrition categories. Within each category are such things as frequently asked questions and links to helpful sites like Army wellness centers, the Human Performance Resource Center and Operation Supplement Safety.

After reviewing the content, users should click on “review” to provide feedback, she said, adding that she hopes squad leaders and other leaders can promote the app to their Soldiers and their own family members.

The app supports the Army’s Ready and Resilient Campaign by giving Soldiers and family members the tools they need to maintain peak performance, Woo said, adding that August is Performance Triad month, and it’s also the one-year anniversary when the first Performance Triad pilot course started.

The Army Public Health Command, U.S. Army Training and Doctrine Command, U.S. Army Combined Arms Support Command and U.S. Army Sustainment Center of Excellence also participated in the apps development and will participate in future revisions, Woo said.