Introduction

Over the years I have spoken to friends, family, colleagues, boot camp members, and members of the general public and asked for their thoughts on boot camps.  There are two common themes.  The first is that boot camps involved being ‘shouted at’, and that this shouting would be obnoxious rather than to be heard.  The second is that members would be punished for some perceived misdemeanour.

The vast majority of people who attend outdoor fitness, fitness boot camps or military fitness sessions really enjoy themselves and get so much out of it, such as: improved fitness; weight loss; new friends; renewed vigour; and team working skills and so on.  However, boot camp training also has its critics.  Some have never been to a boot camp before and others lack an appreciation and understanding of what military physical training is about (such as its ethos, syllabus, skills and qualifications framework).

Independent research demonstrates the efficacy and effectiveness of boot camp training with suitably qualified instructors, yet critics never refer to this.  There is much research on injuries sustained in the military environment but there is none looking at civilian versions of military physical training and injuries.  Critics instead refer to anecdotes of the injuries they have had to deal with.

Common Misconceptions

Whilst conducting research for this blog, I wondered what to discuss regarding the common misconceptions in the world of boot camps.  A search through the online version of the Daily Mail provided me with exactly what I was looking for.  In a piece by Lucy Fry (2010) in the Daily Mail there were a number of concerns raised by both Dr Ralph Rogers (consultant in sports medicine at the London Orthopaedic Clinic) and Paul Raw (an osteopath) that require redress in defence of boot camp training.

Issue 1: Dr Rogers worries that these kinds of boot camps result in injury, not weight loss and fitness.  Exercise needs to be done gradually, with proper supervision otherwise there is a risk of injury. “I would never recommend an overweight patient to do one of these military boot camps. When you overload the body, the result is injury – anything from shin splints to back problems – and, in this kind of environment, people make things worse by trying to soldier on.”

Redress: Evidence provided in this book demonstrates that this statement is incorrect.  Boot camps facilitate weight loss and improve fitness.  Competent instructors utilise adaptation and progression techniques to cater for overweight patients.  Although, to be fair only a small number of fitness professionals have had specialist training or qualifications to specifically deal with this patient group.

Issue 2: Dr Rogers worries that neither the psychological aspect of why someone is overweight nor the nutritional aspect is addressed by a boot camp.

Redress: It is typically personal trainers and other fitness professionals who have gained specific nutritional qualifications who can competently provide nutritional advice.  Most leisure centres (public sector) and health clubs (private sector) do not routinely provide their members with individual nutritional advice or psychological counselling.

Issue 3: Dr Rogers stated that even fit people can hurt themselves by being overzealous.

Redress: This could be said for any form of training or physical activity!

Issue 4: Paul Raw states he “has seen a lot of ex-soldiers with bad backs because the idea of military-style training is to push yourself beyond your limit. This means the likelihood of eventual injury is high. It’s a British thing I think, to assume that exercise must equal pain.”

Redress: In the military context Paul Raw is correct, however, this not the military.  Competent instructors aim to encourage members but also provide advice on issues such as overtraining syndrome.  Exercise must equal pain is from a bygone era.

Issue 5: Paul Raw states as an osteopath “he looks to the quality of the exercise. Just being tired from it isn’t always productive.”  As a personal trainer, he has have worked with clients from all walks of life. “Everybody is individual, with different strengths and weaknesses, and making someone do lots of press-ups when they can’t even do a single one properly is a recipe for a bad back.”

Redress: Just like the British Army incorporates stretching sessions into their training programmes, boot camps also conduct sessions which focus purely on form and correct technique.  However, no matter how often you tell them some members just will not do the exercise in the manner intended (to my frequent chagrin).

Issue 6: Paul Raw states if the ratio of instructor to participant is about 1:20, clearly the instructor does not have enough eyes to ensure everybody is doing everything right.

Redress: I totally agree on this point. During some sessions, due to instructors not attending, I have had to instruct large groups and it can be difficult to handle.  However, military fitness instructors are trained to instruct larger numbers of exercisers than our civilian counterparts.

Issue 7: Paul Raw states that sit-ups are one of the main culprits when it comes to developing back problems through exercise. “From what I have witnessed, all those who pay their monthly membership fee (not including the joining fee) are encouraged to do lots of sit-ups.  Yet such exercises are appropriate only for those with no lower back or postural issues – a small percentage of the population – and even then there are preferable exercises less likely to encourage a rounding of the shoulders or put pressure on the spine.”

Redress: There exists an argument between sports scientist’s and the fitness industry in general as to whether the spine should be flexed to work the abdominals such as with sit-ups and crunches.  These concerns are predicated on the basis that the spine has a finite number of flexion cycles and that too many flexion movements will lead to degeneration of the spine.  Some fitness experts have even confidently argued that ‘flexion is the enemy of the spine’.

Our spines are in flexion the majority of the day while working at desks, eating and driving, and lower back disc bulges poking out the back (moved in that direction with spinal flexion) are far more frequent than those poking out the front (moved in that direction with spinal extension).

Based on research by Contreras and Schoenfeld (2011) that has shown a cause-effect relationship between spinal flexion of pig spines and disc damage, there are experts that believe extra spinal flexion within the fitness world should be avoided at all costs.  However, criticisms based on this research include:

  • In vitro (not studied in the body), research has implicated that repeated lumbar flexion is the primary mechanism of disc problems (herniations and prolapses). However, in vitro studies, the muscles, supporting structures and natural responses to spinal flexion movement (including fluid flow, hormones, reflexes etc) have been taken out of the equation; therefore studying in vitro does not accurately show what would actually happen in the body (in vivo).  Although I did find one in vivo study using anaesthetised cats (Navar et al., 2006);
  • Studies included thousands of repetitions without any rest between, which does not accurately represent what would occur in an exercise programme, such as 3 sets of 10 crunches;
  • Degenerative disc disease is a multi-factorial process involving genetic, mechanical, biological and environmental factors and therefore it is inaccurate to point the finger at purely mechanical causes;
  • Studies do not necessarily replicate what happens during an abdominal crunch, which involves flexing the trunk to 30 degrees, making the thoracic spine the region of greatest motion, not the lumbar spine; this reduces the power of the argument;
  • Abdominal flexion was found to enhance spinal unloading, presumably through a greater movement of fluid in and out of the discs;
  • Spinal motion has been shown to facilitate nutrient delivery to intevertebral discs;
  • Spinal movements have repeatedly been shown to offer therapeutic benefits provided the exercise does not exceed the adaptive capacity of the tissue; and
  • Most, if not all, of this type of research uses a small number of participants (frequently cats and pigs) in an intervention group; control groups are not frequently used.  To be fair, I did find one study utilising cats in the intervention group and healthy humans in the control group! (Solomonow et al., 2012).

Everyone will handle exercises differently, with some tolerating more flexion in their spines than others.  The best thing you can do is listen to your body and if you start developing a twinge in your lower back when you perform spinal flexion exercises, do not do them!  A competent instructor will offer an alternative exercise.

Finally, if exercises such as sit-ups are so unsafe why have the relevant bodies not advised fitness professionals to discontinue their use?  The evidence is equivocal and lifestyle and work factors within the research are not normally taken into account.

Issue 8: Paul Raw states “Stretches can be similarly problematic. Placing your hands in the small of the back and squeezing your elbows together is one way of stretching out your chest, but getting your partner to hold your elbows from behind and force them together, as I witnessed recently, is damaging.  The one being stretched will only arch their back to relieve the pain in the shoulder. We start with a natural arch in the back, but if it is increased, the segments in between spinal discs are further squeezed, creating compression. Over time, this can cause problems, the kind which only the orthopaedic industry will profit from.”

Redress: evidence please!  There is currently no evidence that suggests if your partner holds your arms it is damaging!  There is a presumption here that 1) a person will automatically feel pain when completing this particular stretch and 2) the automatic response, if pain is felt, is to arch the back.

Issue 9: and goes on to say “And then there is the endless jogging, upon which the military boot camp is founded: ‘Running is integral to improving fitness,’ says the well-spoken chap in the video voiceovers on the website. But this is only partially true.  Certainly running is good for cardiovascular fitness, but so is swimming. If you are carrying extra weight, fast walking is better than jogging, the impact of which can cause lower back pain and exacerbate existing injuries.”

Redress: First, boot camps are not founded upon endless jogging.  Secondly, the red (beginner) ability group level is intended to provide members with low intensity exercise and utilising adaptation and progression techniques competent instructors should be providing said members with the option of either walking or jogging.

Issue 10: also states “the majority of the leaders [fitness instructors] don’t know if their clients have problems because they provide no screening at the outset.  This is typical of most boot camps.  All you need to do before participating in a class is to register online, fill in a health form and liability waiver.”  When we questioned the manager about this he said: “The health form has a list of injury questions.”  In fact, while the form does contain health questions, they are standard ones regarding things like allergies, heart issues, blood pressure and asthma.  “The onus is on the participant to tell us about any injuries themselves,” the manager added. “But we do check at the beginning of the class whether there are any first-timers and they can ask questions if they need.”

Redress: Firstly, how many boot camps has Paul Raw attended in order to make such a sweeping statement?  Paul Raw suggests that instructors do not know if their members have problems because there is no screening at the outset.  It is the policy of the training provider he is criticising that all instructors ask their members if they have any injuries, illnesses or conditions that may affect their ability to conduct the exercise that is about to take place.  The Health form is an adaptation of the PAR-Q form (Chapter 4) developed by the Canadians.  What does Paul Raw expect; training providers cannot compel exercisers to disclose medical details.

Issue 11: “You’ll learn what you should and shouldn’t do before joining group exercise. If you were buying a house or a car, you would most likely do any necessary research, so why treat your health and fitness any differently?”

Redress: I wholeheartedly agree with this statement.  Consumers should shop around to find the most appropriate training provider who can fulfil their training goals and needs.

Both of these commentators demonstrate some ignorance about military physical training.  Neither has been in the military and they have put forward some subjective views not backed by the scientific evidence that is available.  In addition they do not mention anything about the impact of a sedentary job.  Research demonstrates that having a sedentary job and then completing an hour’s exercise later in the day can still put people at risk of diseases related to physical inactivity (one hour’s exercise activity only goes so far in mitigating the effects of being sedentary for 23 hours (RCGP, 2011)).  There were 280 comments to this online article with a significant proportion robustly refuting the claims made by the two commentators.  However, it is up to the reader to come to their own conclusions.

Sadly, some of the above views are also shared by the wider fitness community with civilian qualified fitness instructors largely unaware of the training, skills, experience and qualifications gained by military qualified fitness instructors.  This lack of understanding only serves to compound the issues facing the boot camp market.

Finally, if Dr Rogers and Mr Law, and of course the reader, would care to view an example of some of the advice that boot camps apparently do not provide then best not look at this article in the Guardian Newspaper (Murphy, 2007):

http://www.guardian.co.uk/lifeandstyle/2007/jan/06/healthandwellbeing.features2

References:

Fry, L. (2010) Why Army-Style Fitness Workouts are All Pain and NO Gain. Available from World Wide Web: <http://www.dailymail.co.uk/health/article-1309646/Why-Army-style-fitness-workouts-pain-gain.html> [Accessed: 08 November, 2012].

Contreras, B. & Shoenfeld, B. (2011) To Crunch or Not to Crunch: An Evidence-Based Examination of Spinal Flexion Exercises, Their Potential Risks, and Their Applicability to Program Design. Strength and Conditioning Journal. 33(4), pp.8-18.

Navar, D., Zhou, B.H., Lu, Y. & Solomonow, M. (2006) High-repetition Cyclic Loading is a Risk Factor for a Lumber Disorder. Muscle and Nerve. 34(5), pp.614-622.

Solomonow, M., Zhou, B.H., Lu, Y. & King, K.B. (2012) Acute Repetitive Lumbar Syndrome: A Multi-component Insight into the Disorder. Journal of Bodywork and Movement Therapies. 16(2), pp.134-147.

RCGP (Royal College of General Practitioners) (2011) Exercise Promotion in Primary Care. InnovAiT. 4(10), pp.569-580.

Murphy, S. (2007) All You Need To Know About Military Fitness. Available from World Wide Web: <http://www.guardian.co.uk/lifeandstyle/2007/jan/06/healthandwellbeing.features2> [Accessed: 08 November, 2012].

Startups (2011) Robin Cope: British Military Fitness: The Ex-officer Tells Us How He Used The Forces to Create a New Kind of Exercise Class. Available from World Wide Web: <http://www.startups.co.uk/robin-cope-british-military-fitness.html> [Accessed: 08 November, 2012].

Adult Learning Inspectorate (2005) Safer Training: Managing Risks to the Welfare of Recruits in the British Armed Services. Available from World Wide Web: <http://news.bbc.co.uk/1/shared/bsp/hi/pdfs/21_03_05_ali.pdf> [Accessed: 13 November, 2012].

Geary, K.G., Irvine, D. & Croft, A.M. (2002) Does Military Service Damage Females? An Analysis of Medical Discharge Data in the British Armed Forces. Occupational Medicine, 52(2), pp.85-90.

Gemmell, I.M.M. (2002) Injuries among Female Army Recruits: A Conflict of Legislation. Journal of the Royal Society of Medicine. 95(1), pp.23-27.

Coleman, N. (2002) How To Shape Up Military Style. Available from World Wide Web: <http://www.dailymail.co.uk/health/article-74072/How-shape-military-style.html> [Accessed: 08 November, 2012].

Lombard, D. (2008) British Military Fitness Puts Ex-homeless Through Their Paces. Available from World Wide Web: <http://www.communitycare.co.uk/Articles/25/09/2008/109482/british-military-fitness-gets-ex-homeless-into-exercise.htm> [Accessed: 08 November, 2012].

Fletcher, G. (2010) British Military Fitness. Available from World Wide Web: <http://www.nhs.uk/Livewell/fitness/Pages/get-fit-military-style.aspx> [Accessed: 08 November, 2012].

GreenSpace (2010) Who We Are. Available from World Wide Web: <http://www.green-space.org.uk/about/whoweare/index.php> [Accessed: 02 December, 2012].

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