The Rise of the Female Warfighter: Physiology,
Performance, and Future Directions
GABRIELLE E. W. GIERSCH1,2, NISHA CHARKOUDIAN1, and HOLLY L. MCCLUNG3
Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, MA; 2Oak
Ridge Institute for Science and Technology, Oak Ridge, TN; and 3Biophysics and Biomedical Modeling Division, United States
Army Research Institute of Environmental Medicine, Natick, MA
1
ABSTRACT
S
below the Brigade level whose primary mission is to engage
in direct combat (4). This came as many other countries were
moving toward total inclusion policies for women in military
job specialties. Subsequently, the British Ministry of Defense
released findings in 2010 that demonstrated that women perform as well as men in combat roles (5,6). This, among other
findings, served to propel US allies such as the Australian military to begin a 5-yr plan to open combat roles to women, with
frontline roles finally opened in January of 2013 (7). Quick to
follow, Defense Secretary Leon Panetta lifted the military’s
combat exclusion policy in 2013, opening the door to the first
three female candidates and graduates of US Army Ranger
School. In December 2015, then Defense Secretary Ashton
Carter announced “there will be no exceptions” for women,
thus opening all combat MOS to women (8). Interestingly, the
trajectory of inclusion of women in the military has a similar
time course and other parallels with inclusion of women in sport
and athletic events, the specifics of which are outside the scope
of the present review but have been reviewed elsewhere (9,10).
The apprehension of US policy makers regarding full
gender-inclusion across the military ran deeper than the “historical male combat identity,” although that likely contributed.
In biomedical terms, there were concerns that women were at
an unsurmountable disadvantage as compared with their average male counterparts in terms of body size and composition,
lean mass, muscle strength, aerobic capacity, skeletal properties,
and military task performance. Importantly, comprehensive scientific evidence did not exist to conclude whether women could
effectively and safely perform as well as men in combat roles.
A cascade of research followed the 2015 “No Exception” policy
ervice in the US military has been open to women for
more than 70 yr, since the passing of the Armed Services Act in 1948, which allowed women to serve as
permanent members of the US military in noncombat roles,
not just during times of war as had previously been the case.
Full integration in the military was not complete at this time,
as roles open to women continued to be limited to only a subset
of military occupational specialties (MOS) for the more than
50 yr that followed (Fig. 1). Beyond service roles, it was not until the mid-1970s that women were allowed to attend the military service academies (the US Military Academy at West
Point, Naval Academy, US Coast Guard Academy, and Air
Force Academy) where they would receive military training
and graduate as military officers (1). Notably, admission for
women into Public Senior Military Colleges, The Citadel,
and the Virginia Military Institute required intervention from
the US Supreme Court in1995 and 1996, respectively (2,3).
In spite of this apparent forward momentum, in 1994 the US
Department of Defense formally excluded women from units
Address for correspondence: Holly L. McClung, M.S., R.D.N. C.S.S.D., Biophysics and Biomedical Modeling Division, US Army Research Institute of
Environmental Medicine (USARIEM), 10 General Greene Avenue, Natick,
MA 01760; E-mail: holly.l.mcclung.civ@mail.mil.
Submitted for publication August 2021.
Accepted for publication November 2021.
0195-9131/21/5404-0683/0
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DOI: 10.1249/MSS.0000000000002840
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GIERSCH, G. E. W., N. CHARKOUDIAN, and H. L. MCCLUNG. The Rise of the Female Warfighter: Physiology, Performance, and Future
Directions. Med. Sci. Sports Exerc., Vol. 54, No. 4, pp. 683-691, 2022. Since 1948, the United States military has been open to both men and
women as permanent party service members. However, in the majority of the time since, there have been a subset of military occupational
specialties (MOS), or job descriptions, open only to men. In particular, jobs requiring more intense physical and/or environmental strain were
considered to be beyond the physiological capabilities of women. In the present analysis, we review the literature regarding neuromuscular, physical performance, and environmental physiology in women, to highlight that women have no inherent limitation in their capacity to participate in
relevant roles and jobs within the military, within accepted guidelines to promote risk mitigation across sexes. First, we discuss performance and
injury risk: both neuromuscular function and physical capabilities. Second, physiological responses to environmental stress. Third, we discuss risk
as it relates to reproductive health and nutritional considerations. We conclude with a summary of current physiological, performance, and injury
risk data in men and women that support our overarching purpose, as well as suggestions for future directions. Key Words: WOMEN,
EXERCISE, MILITARY, THERMOREGULATION, NEUROMUSCULAR
FIGURE 1—Timeline and historical perspectives for female inclusion in the US military.
Second, we discuss physiological responses to environmental
stress. Third, we discuss risk as it relates to reproductive health
and nutritional considerations. We aim to highlight, where appropriate, areas for future research to ensure that US military
policies are scientifically sound for both male and female service personnel.
PART I: PHYSICAL PERFORMANCE AND
INJURY RISK
One controversial topic that appeared/s to exclude women
from “full inclusion” in military roles was the perception of
a women’s capability to physically perform at the level of their
APPLIED SCIENCES
focused specifically on the health and performance of the female warfighter (a term used by the US military that includes
Soldiers, Sailors, Airmen, and Marines). This was a helpful addition to the body of work regarding women’s health as relevant
to the military, which has been slowly increasing in volume
over the past two decades.
In the present analysis, we review the literature regarding
exercise physiology and performance in women. We conclude
that women have no inherent limitation in their capacity to participate in physically demanding tasks relevant to roles and
jobs within the military, by focusing on three main areas (summarized in Fig. 2). First, we discuss performance and injury
risk: both neuromuscular function and physical capabilities.
FIGURE 2—Schematic diagram of specific areas for consideration discussed in this review.
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RISE OF THE FEMALE WARFIGHTER
training duration and intensity came the susceptibility to injury.
Stress fractures rose to the top as the most costly and common
injuries to occur in military training (26). Women are more
than twice as likely to suffer a stress fracture compared with
men (27). Sex differences in bone properties likely contribute
to the discrepancy in fracture risk (28). However, recent evidence has demonstrated that women are able to increase their
bone strength, enhance their microarchitectural bone properties, and mount a greater skeletal response than men during
military training (29).
Physical performance in women, contrary to previous beliefs, is not suboptimal to men in the context of military work.
Although maximal efforts are not equivalent between the
sexes, the relative workloads required for military training
are attainable by both sexes (22,25). Specifically, women
can overcome any discrepancies in relative workload or performance with physical training (30,31). Overall, women are
often required to perform at a higher percentage of their maximal physical ability to perform job-related tasks than male
counterparts (32). In the military, a majority of the jobrelated tasks are absolute across MOS, similar to physically
demanding jobs in the civilian sector (e.g., wildland firefighters, law enforcement officers, and steelworkers). Specific
job-related tasks, for example, individuals in combat MOS
(11B (Infantry), 11C (Indirect Fire Infantry), 12B (Combat
Engineer), 13F (Fire Support), 19D (Cavalry Scout), and 19K
(Armor Crewmember)), are required to complete a casualty
drag task (drag a dummy of 123 kg a distance of 15 m in up
to 60 s) independent of sex or body size (14,16). Civilian firefighters similarly require a casualty drag (75-kg dummy) as a
job-related task. Such absolute performance requirements are
common across physically demanding occupations with full
sex integration. Women’s physical performance can be impacted
by fitness status, physical characteristics such as body size, and
hormonal variation. Although hormonal variation does impact
women physiologically, there is, to date, no clear evidence of
a consistent impact on physical performance because of either
menstrual cycle or oral contraceptive use (33,34).
Hormonal variation across the menstrual cycle (endogenous)
or with contraceptive use (exogenous) can impact women physiologically, including temperature regulation and body fluid
regulation, which will be discussed later in this review. However, factors impacting injury risk such as running economy
(35), ligament laxity (36), and bone health (37) have been
shown to be impacted by hormonal variation. Ligament injury
prevalence seems to be impacted by hormonal variation across
the menstrual cycle with estrogen increasing ligament laxity
(38), and increased injury risk observed around ovulation in
eumenorrheic soccer players (39). Conversely, the incidence
of anterior cruciate ligament injuries has been observed to be
increased on days 1 and 2 of the menstrual cycle (40) when estrogen concentrations are low—suggesting that more research
is necessary to determine practical impacts of hormone concentration or ligament injury risk. In addition, neuromuscular
control may be impaired by increased estrogen concentration,
potentially increasing risk for all injury types (41).
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male counterparts. It has been well documented that women
are, on average, physically weaker than men, specifically in
upper body strength (11,12). Women on average have half
the upper body strength and two-thirds of the lower body
strength of that of men (13). However, the question was not
“are women stronger than male counterparts?” it was instead
“could women successfully perform occupational tasks as well
as men (required in combat roles)?” This more specific question inspired a battery of research studies aimed to determine
the (sex-neutral) physical employment standards for combatspecific operational roles (14–16). Identifying physically demanding tasks that were specific and relevant to combat roles
set the stage for full gender integration. Although inherent anthropometric differences exist across sex (e.g., on average,
women are smaller in stature and body size and, generally,
have less lean body mass and higher body fat compared with
men), women now had specific and quantifiable performance
measures to train toward.
Women have a higher body fat percent than males (17).
Even when controlling for body mass index, women (on average) have approximately a 10% higher body fat as compared
with men (18). Anatomically, women generally distribute their
adipose tissue differently from men, less centrally, and more
subcutaneously (19). It is unclear if these sex-based differences in body composition and distribution are related to physical performance. However, there is some scientific evidence
that suggest that enforcing body size standards may penalize
the strongest females (unpublished findings by McClung, HL,
August 2021). Women who were over the Body Composition
Standards as set in Army Regulation 600-9 (AR 600-9) (20)
were stronger and had a greater proportion of fat-free mass than
those women who met the body fat standard. The authorized
method for estimating body fat in AR 600-9 is the circumferencebased tape method. Three sites are used for women (neck,
waist, and hip) to calculate percent body fat. Acceptable total
body fat in the Regulation is directly related to Soldier age,
ranging from 30% to 36% for women and 20% to 26% for
men (20). A more comprehensive understanding of the body
composition of women in the military could help the military
refine the maximum body fat mass standards, or (perhaps of
greater interest) a minimum lean body mass requirement across
age. Either or both of these would provide more specific insight
into strength requirements and performance metrics.
Over the years, evidence has supported the idea that strength
across sexes overlaps, such that the strongest women are as
strong, or stronger, than the least strong men (21). Evidence
has shown that following Army Basic Combat Training (BCT;
9-wk training), female recruits had a greater positive increase in
muscle mass and strength than male recruits (22,23). Sexspecific differences may be explained by lower initial strength
levels in women, or their physiological response to the intensity
of military training. Longer duration training studies with women
built upon the hypothesis that any deficits in strength could be
minimized through physical training, showing significant improvements across strength, power, endurance (aerobic and muscular), and body composition (24,25). Along with increased
Continuing research is necessary to fully elucidate these effects, from a practical and military perspective. To maintain
ecological validity, future research should ensure that appropriate controls are met, but not at the expense of continuing research in women. For example, women should not be excluded
from a study if it is not feasible to control for menstrual cycle
(although cycle should be controlled where possible) (42,43).
In military women, this is particularly true because menstrual
cycle and oral contraceptive phase are so often dysfunctional
or unknown during operational training or deployment.
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PART II: PHYSIOLOGICAL CONSIDERATIONS
AND ENVIRONMENTAL STRESS
Warfighters are commonly exposed to extreme environments during training and deployment; these can often have
a significant negative impact on their ability to perform optimally. Environmental stressors in conjunction with operational stress are known to have a profound impact on health
and readiness and may impact male and female warfighters
differently. A comprehensive understanding of sex differences
in response to environmental stressors is vital to ensure appropriate recommendations and informed decisions are made to
enhance safety and performance of all warfighters.
Thermoregulation during heat stress. It is well established that female reproductive hormones have important influences on nonreproductive systems, including the systems
involved in the regulation of body temperature. In humans,
the primary heat dissipation mechanisms during exercise in
the heat are cutaneous vasodilation and sweating (44,45). In
general, estradiol promotes heat dissipation via augmented
sweating and cutaneous vasodilation, whereas progesterone
tends to increase body temperature and promote heat conservation (9,44,46).
Kolka and Stephenson (47,48) were among the first to perform a series of studies to evaluate reflex thermoregulatory
control of sweating and skin blood flow during exercise in
the heat over different phases of the menstrual cycle. They
noted that in the midluteal phase, when estradiol and progesterone are elevated, body temperature at rest and during exercise is
shifted to higher levels because of shifts in central control of
thermoregulatory responses. These shifts in thermoregulatory
control during exercise are also seen with the exogenous hormones of oral contraceptives (49). Interestingly, steady-state
levels of skin blood flow were increased above early follicular
phase levels during the midluteal phase, likely an effect of estradiol to promote vasodilation (50). This prolonged vasodilator
effect may offset some of the increased body temperature influences of the elevated progesterone in this phase. Observations
such as these have led to the broader question of whether
women are at a disadvantage for heat dissipation (or increased
risk of heat illness) when these hormones are elevated in the circulation. The short answer to this question seems to be “no”
(45). Indeed, there is little evidence for a specific “disadvantage” in women during exercise in the heat. When controlling
for factors such as heat production and environmental stressors
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Official Journal of the American College of Sports Medicine
(heat and humidity), women only sweat significantly less than
men at the highest levels of exercise workload combined with
high heat and humidity (a so-called “uncompensable” environmental heat stress) (51). Because such conditions—in actual
practice—are likely to be associated with rest and hydration
breaks (to avoid heat illness in both men and women), it is unlikely that they would represent a “real-life” increased risk of
heat illness in women. Importantly, women seem to make
good behavioral/strategic decisions during prolonged exercise, which are not affected by hormonal status (52) and may
decrease their risk of heat illness relative to men of similar fitness levels (45). Regarding heat acclimation/acclimatization,
there seems to be some limited evidence to suggest women
may not adapt as quickly as men to systematic heat stress; specifically, men have shown adaptations to short-term heat acclimation, where women do not (53,54), but the mechanism governing
this difference is unclear and thus warrants future research.
Thermoregulation during cold stress. Overall, there
is less available evidence regarding sex differences in cold
thermoregulation compared with thermoregulation in the heat.
As with thermoregulatory responses to exercise/heat exposure,
the thermoregulatory responses to cold are also shifted depending on phase of the menstrual cycle. Thus, reflex (whole
body) shivering and cutaneous vasoconstriction responses
are shifted to defend higher internal body temperatures when
progesterone and estrogen are elevated compared with when
they are low (55,56). Local vasoconstrictor mechanisms in
the acral skin of the hands are significantly different between
the sexes (57) and likely contribute to the higher incidence
of Raynauds phenomenon in women compared with men
(58). Interestingly, where estradiol seems to promote vasodilation under most circumstances, in the situation of Raynauds,
there seems to be an effect of estradiol to augment alpha-2c–
mediated vasoconstriction. Manual dexterity in the cold is a
major issue for the military and other occupations in which
work in the cold is a requirement. Because women have
smaller hands and therefore larger surface area to mass ratio
(which promotes faster heat loss for a given cold environment),
it is likely that women would have a more rapid decrease in dexterity (59), although this has not been specifically evaluated.
When taken in the “big picture” context of the ability to maintain body temperature and performance in the cold, these relatively minor differences in physiology do not provide evidence
of a particular disadvantage or decreased capacity in healthy
women compared with men. Potential quantitative differences
between men and women with respect to body temperature
maintenance, physical performance in the cold, and/or adaptations resulting from repeated cold exposure are unclear and warrant additional investigation.
Responses to high altitude and hypoxia. Physiological responses to acute exposure to high altitude (>2500 m)
include hyperventilation, increased heart rate, increased sympathetic nerve activity (sometimes associated with increased
arterial pressure), and diuresis (60). It is relatively common
for lowlanders (people who live at or close to sea level) to experience one or more symptoms of acute mountain sickness
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RISE OF THE FEMALE WARFIGHTER
implications are unclear. When estrogen concentrations are high,
such as in the late follicular phase and midluteal phases, there is a
threshold shift in the synthesis of arginine vasopressin to a lower
osmotic set point, suggesting increased fluid retention at lower
levels of dehydration (75). Although this may impact the fluid retention and fluid balance at low levels of dehydration (76), the effects of hormonal variability at greater levels of dehydration are
unclear. Oral contraceptives containing estrogen may similarly
alter the osmotic threshold for arginine vasopressin stimulation
and thirst, thereby enhancing fluid retention (77). The practical
implications of this threshold shift on fluid regulation and impact on risk for dehydration in women remain unclear.
PART III: ENDOCRINE AND REPRODUCTIVE
HEALTH
Reproductive health. An understanding of the impact of
military training and deployment on women’s reproductive
health is a key component of ensuring optimal wellness and
performance during military operations and in everyday life.
Military women have requirements for physical fitness, and
it is not uncommon for those who are very physically active
to have menstrual cycle dysfunction including secondary amenorrhea (a cessation of regular or irregular menstrual cycles for 3
or 6 months, respectively) (78). Menstrual dysfunction may be
particularly apparent when stress levels are elevated along
with increased physical activity and decreased sleep (79), similar to military deployment. Short-term disruptions in menstrual cycle, such as during military deployment, can likely
be overcome and acute irregularity in cycles may not have
long-term consequences. In contrast, relative energy deficiency syndrome (RED-S; formerly the Female Athlete Triad)
describes the consequences of mismatched energy balance
(i.e., increased energy expenditure without a matched increase
in energy intake) and has been linked to long-term health concerns across reproductive health, bone health and injury risk,
and nutrition. Male or female service members may suffer
from RED-S during episodes of intense training or deployment
scenarios without understanding the health impact and consequences that may ensue (80). However, women may be more
at risk for unintentional disordered eating, which may have
downstream effects on injury risk, reproductive health, and performance (81). RED-S can hinder operational performance but
can be overcome by increasing the education of the force and
ensuring appropriate guidance is provided for energy intake
and balance (82).
Maintaining menstrual health during deployment can pose a
logistical challenge in providing and receiving sanitary products (83). Deployed women often attempt to regulate their
menstrual cycle for convenience using contraception (84). A
recent survey analysis of deployed US military women showed
that 65% used some form of contraception during deployment
and a majority of those used oral contraceptives (84). Current
US military policy does not mandate contraceptive use but does
include education of female service members to the risk–benefit
of use (85).
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(e.g., headache, fatigue, nausea, lethargy), especially with
rapid ascent to high altitude (61). Some evidence suggests that
women may be at an advantage during the first 7–10 d of highaltitude exposure, with decreased severity of acute mountain
sickness symptom development (62). This advantage may be
related to the physiological effect of progesterone to promote
ventilation (63), thus increasing the potential for ventilatory
acclimatization. An earlier study using normobaric hypoxia
(64) evaluated peak power output and oxygen consumption
during progressive ergometry tests and showed lower peak
values in women. The relevance of these specific tests to how
military women are able to train for military-specific tasks is unclear, however, particularly because training was not documented
or controlled in that study (64). There is some evidence of increased diaphragmatic fatigue during hypoxia in women (65),
as noted during a laboratory maneuver called “pressure threshold
loading” where the work of the diaphragm is increased in a controlled manner. Again, it is unclear to what extent this would
translate into a particular disadvantage during military relevant
activity at high altitude and warrants further exploration.
Hydration considerations. Military women may have
unique fluid needs, particularly during physical activity, load
carrying, and heat stress, given the potential for differences
in body surface area and sweat rates between men and women
(66). Furthermore, it is important for making recommendations
to not overprescribe fluids to female warfighters to put them at
risk of developing hyponatremia (67). Although hyponatremia
is very rare in both sexes, women experience a slight increase
in hyponatremia incidence compared with men (although most
research has come from work with ultraendurance athletes)
(68). This increase appears to be primarily related to smaller
body size and longer-duration physical activity versus a direct
effect of sex-based physiological differences (69).
Of use to the athlete and warfighter, determination of fluid
losses from sweat for replacement may be the most accurate
method to reduce the risk of performance deficits related to
mild dehydration and preventing body mass losses in excess
of ~2% (70). Dehydration has been shown to negatively impact cognitive performance in women, even at mild levels
(~1% body mass loss) (71), and may also attenuate physical
performance in women in a similar pattern as seen in men
(72); however, further research is needed to elucidate the practical implications of hydration as it relates to cognitive and
physical performance in women. From a logistical perspective, female service members may experience voluntary dehydration due to inconvenience, modesty, and lack of appropriate gear to urinate in field settings, similar to practices used
by fighter pilots during prolonged flight missions (73). Over
longer missions, the effects of dehydration could become cumulative and present as a real risk to both women and men.
Routines resulting in dehydration practiced by women could
be avoided with increased awareness, proper gear, and training, which may involve development of comfortable and efficient tools to assist women in the field.
Similar to thermoregulation, female sex hormones also have
a mechanistic effect on body fluid balance (74), but the practical
The use of long-acting reversible contraceptives (LARC; intrauterine devices, subcutaneous implants) have been proposed
for use in military women to reduce menstruation in deployment scenarios (86), which aide in logistical considerations
and prevent any possible long-term consequences to reproductive health. Importantly, there is a limited understanding of the
physiological and performance implications of LARCs, which
warrants future investigation. Menstrual suppression, the practice of purposefully ceasing menstruation via LARCs or skipping placebo pills in oral contraceptive pill packs, has been of
interest to the military in recent years (83,85,87). However,
the broader health implications of menstrual suppression on
physiology and performance are not fully understood. Specifically, suppression of cycling sex hormones may impact overall
health and reproductive functioning, but the practice has not
been investigated to quantify its longer-term health implications. Pregnancy also has extensive and important influences
on women’s ability to perform military relevant tasks, which are
outside of the scope of this review. Issues related to exercise performance and pregnancy have been reviewed elsewhere (88).
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PART IV: NUTRITION AND SUPPLEMENTATION
FOR PERFORMANCE ENHANCEMENT
As explored earlier, the difference in women’s body size
and composition (less lean body mass and higher body fat)
plays a role in not only physical performance and responses
to environmental extremes, but also energy and nutritional
needs as compared with their male counterparts. It is intuitive
to suggest that men, on average, need more calories to maintain energy balance than women (89). Although few studies
have assessed the differences in energy expenditure (military
training and occupations) and thereby energy intake, across
sex, when energy expenditures were adjusted by body mass
(or lean body mass), men and women did not differ (89). However, differences in metabolism and substrate prioritization
seem to exist between sexes, specifically during military tasks,
where women rely more on fat metabolism than men (90).
This advantage was first described by Hoyt and colleagues
(90) in a study of male and female cadet candidates undergoing training for the Norwegian Ranger School. After 7 d of extreme food and sleep restriction, female cadets better preserved nonfat mass and derived a greater proportion of energy
needs from fat metabolism than male cadets. Unfortunately,
because of a lack of current research in energy and macronutrient requirements specific to military women, current nutritional requirements are based on average body weights (91).
More detailed research is needed in metabolism and substrate
utilization in women during military training scenarios and occupations to provide more specific nutrient requirements and
recommendations.
Female warfighters require specialized considerations in regard to micronutrient intakes, specifically iron, calcium, and
vitamin D, related to sex-specific reproductive and bone health
requirements. It is estimated that over 20% of female recruits
will suffer from iron deficiency after BCT (92). The cumulative
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effects of poor iron status before BCT inception and the effects
of physical training during BCT have been well documented
(93). Countermeasures such as daily supplementation with
iron over the 9-wk training (BCT) have been found to not only
improve indicators of iron status (blood markers, serum ferritin, and soluble transferrin receptor) but also positively impact
physical performance (e.g., 2-mile run time) post-BCT in
those entering training with poor iron status (94,95). Increased
iron requirements for female warfighters have since been incorporated in the revised Army nutrition policy (91).
Other nutritional targets for military women are calcium and
vitamin D, fueled by the increased incidence of stress fractures
in women as compared with men during BCT. Beyond innate
differences in women’s bone health and structure, low dietary
intake of vitamin D and calcium during BCT, a period of elevated bone turnover, in military females has been documented
in observational studies (96). The combination of the increased
physical activity (e.g., weight-bearing) and low dietary intake of
key nutrients required in bone formation and health leads to a series of intervention studies to explore the efficacy of vitamin D
and calcium supplementation during military training (97,98).
Work by Gaffney-Stomberg et al. (97) demonstrated the benefit of vitamin D and calcium (1000 IU·d−1 and 2000 mg,
respectively) through food bar supplementation provided to
female recruits throughout the BCT. Outcomes included improved blood status markers with supplementation throughout
the 9-wk training. These findings led to an Army policy update
to provide vitamin D and calcium using fortified food bars
(“Performance Readiness” bars) to be administered during
BCT in an effort to prevent stress fractures and improve bone
health in recruits (99).
SUMMARY AND CONCLUSIONS
In this manuscript, we have reviewed evidence for exercise
performance, neuromuscular function, environmental stress,
and fluid volume regulation in women as relevant to the tasks
required by a range of MOS within US military service. It is
clear that women are different from men in many aspects of
physiology (i.e., women are not just smaller men). However,
the salient finding of the present review is that the anatomical
and physiological differences that do exist do not seem to limit
the ability of women to train and achieve physiological and
performance goals that are necessary to excel at all levels
and in all roles in the US military. The preconceptions of the
past that women are broadly too “weak” or “fragile” to perform in extreme environments or with difficult workloads
are being put aside in favor of more specific, quantitative
goals. These goals either can or cannot be met—by people
of both sexes. Representation of women in the US military
has been consistently on the rise since 1970, making it increasingly important to ensure policies and recommendations are
representative and the health and performance of all service
members are accounted for.
The material is presented clearly, honestly, and without fabrication,
falsification, or inappropriate data manipulation. Outcomes do not constitute endorsement by the American College of Sports Medicine or the
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Department of the Army. The authors would like to thank Dr. Ran
Yanovich and Dr. James McClung for their support and critical review
of the manuscript. No funding was received for this work, and the authors declare no conflicts of interest.
The views, opinions, and/or findings contained in this article are
those of the authors and should not be construed as an official US
Department of the Army position, or decision, unless so designated
by other official documentation. This manuscript is approved for public
release; distribution is unlimited. Citations of commercial organizations
and trade names in this report do not constitute an official Department
of the Army endorsement or approval of the products or services of
these organizations.
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RISE OF THE FEMALE WARFIGHTER
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