A Balanced Assessment of the pros and cons of Bootcamp Fitness Training

We're on YOUR time, now ladies!

Graeme Marsh gives us a balanced perspective about Military Style Bootcamps. He offers a unique perspective as a former soldier with extensive experience and qualifications in the health and fitness industry.

Every few years the fitness industry gets hit with a new idea that starts the innovation cycle off all over again in an effort to increase the end user of people getting out there and training. Over more recent years we have had vibration training, pilates (and all sorts of frankly ridiculous bastardisations of old JPs ideas), functional training, gymsticks, BOSU’s, kettlebell training, in fact too many to list. Some of these are good, some less so, and some just plain old rubbish with little other than gimmick value (20 minutes on this vibrating platform as good as 3 x 1 hour sessions in the gym? well maybe if your workout consists of reading Heat magazine on the recumbent bike it is, but otherwise I don’t think so).

So, today I was interested to read a piece from the Daily Mail (http://bit.ly/aLWaUc) - and I don’t often say that. Tinged with the usual media health hyperbole it was extolling all the dangers of ‘bootcamp’ training along with the usual story of someone who had been pushed to injury etc and the obligatory doctor who declared the inherent dangers, happily tarring every single bootcamp with the same brush. As someone with nearly five years hard training behind me in the military as a proud Royal Engineer, (of which a lot of the time was spent in training munching on Ibuprofen like they were smarties) this is a topic of genuine interest. As usual the piece was full of anecdote and light on real evidence, so once again I am about to don my gear grinding geek hat and investigate this further.

First up then, lets define what actual bootcamps are. The term is an american one and typically was used to refer to basic military training or a place run in a strongly pseudo military fashion. I am guessing the term springs from the amount of time you spend in military training shining your boots. Central to this bootcamp format was a ‘character building’ element, where recruits are put into demanding and difficult situations that require them to push themselves hard as part of a group, in turn learning the value of working for others and achieving results together. Recruits tend to pass through a journey (of which fitness forms only part) where they are physically and psychologically stressed. Physical training is often used as a punishment (called a ‘beasting’ in the military). In the military this develops the characteristics of discipline and dedication to duty that typify the armed forces. The modern fitness bootcamp though seems to have morphed a bit from the original definition and now is more of a catch-all term for generally outdoor, group-based fitness training (which admittedly wouldn’t make such an appealing title) with each variation bearing different degrees of resemblance to actual military training.

So, with that little history and semantics lesson out the way let’s look at the military recruit style of training a little closer and see if it really is a good idea to model fitness training for the general public on military methodology. While you won’t find much online if you search under bootcamps, there is a lot of research looking at injuries in military recruits. However, comparisons of military recruits with control groups and/or groups that have started other methods of training are lacking so we need to remember that injury is a problem in other forms of exercise, including running, weight training, and recreational sport.

A study in 1993 found that female-gender and a low level of aerobic fitness were strong predictors of injury risk in american recruits, interestingly finding that the men who were in the less fit half of the cohort were 29% more likely to suffer a time-loss injury compared to 0.0% in the upper half. Yes, that is zero injuries in the fitter group! So, this tells us that the less fit you are, the more you might be at risk of injury. O.k, not exactly a revelation, but interesting nonetheless. This is reinforced by a further study that found that entrants to Royal Marine training who smoked (and who were presumably also less fit as a consequence) were also predisposed to injury.

However, the more worrying trend in all the research is the greater degree of injury sustained by females in military training. A worrying study in the UK found that when they leveled the playing field for allowing females entry to the military (by matching the required fitness standards to that of men), discharges due to injury actually went up in women (despite less actual female recruits). This is consistent throughout the research, with a British Medical Journal review finding female military recruits to be ten times more likely to suffer a lower extremity injury. It was further echoed in an Australian study that found a shocking rate of 164 women per 1000 who were being medically discharged through injury, leading the researchers to conclude that mixed gender fitness training needed to be seriously reconsidered (even more interesting was that this study was done on interventions designed to reduce discharge rates, yet they increased in women). Another study on the U.S Marines found an absurd injury rate of just under 40% over 12 weeks, with over 80% to the lower extremity and 78% being diagnosed as overuse injuries. You can probably start to see a theme coming through here. Injury rates in military training are high and the overall training volume is clearly an issue, but the real problem is the massive disparity in women who are getting injured over men.

So, where does this information leave us? Well, clearly there is something to the suggestion that military styles of fitness training may not be terribly well suited to the average member of the public. Hmmmm, principle of specificity anyone? This shouldn’t come as any surprise really, military routines tend to be high in volume with scant consideration of individual biomechanics, nutritional status, or injury history (most participants are young and therefore those with pre-existing joint issues are usually excluded by medical screening). Could there however be other challenges that are contributing to the evidenced high rate of lower extremity injuries in female military recruits that are anecdotally reflected in articles such as the Daily Mail piece?

One area worthy of consideration is that of training balance. My own experience is that many of these classes tend to be very knee/quad dominant in exercise selection. Squats, squat jumps, lunges, jumping, squat thrusts, burpees, stair climbing, and running are all commonly used in high volume, focusing load through the knee joint, particularly when done at speed or explosively – both of which increase joint loading. With the literature showing us that factors such as the Q-angle in women are contributory in lower-extremity injury, it is not hard to see why doing hundreds of quadricep dominant exercises over a 45 minute session could quickly lead to knee trouble. Training the posterior chain muscles is more of a challenge in outdoor classes and far more testing on the creativity and skills of the instructor and the limitations/allowances of the environment. However, one feels that better distribution of training load would be advantageous to reducing injury.

Secondly, there is clearly an issue of pre-screening with these classes. Many of them have none, yet simple tests such as assessing flexibility at the ankle and hip, looking at foot structure (excessive high arch or flattened arches both being risk factors), and very basic movement screening could help identify possible injury risk and modifications and progressions easily made to try and prevent injury. This is tricky for bootcamps to practically action, but could be that a simple online video or handout could help by educating participants to assess themselves.

Thirdly is an emphasis on quantity over quality. Often with military style training the ‘getting there’ aspect is valued over all others – an understandable consideration when dealing with life and death scenarios. However, winning or keeping going at all costs – even under severe fatigue in cold conditions and with bad technique – is a short cut to injury and needs to be carefully monitored. Most the attention is given in these classes to the work element and not the quality of that work. Following on from the previous point, identifying limitations in mobility for example can help reduce injury. One study on military recruits noted a significant reduction in lower limb injury simply by introducing regular hamstring stretching.

This is not a push up

Another area of concern is the level of expertise of those running the class. For example in the Mail article, British Military Fitness state their instructors all have a ‘service’ background and some kind of fitness qualification – doesn’t exactly fill you with confidence does it? Only recently I was chatting to a friend in the industry who had to quit her bootcamp as she couldn’t stand how bad the exercise technique was and that even her own knees were hurting, the instructor had no actual qualification outside of a military background and bags of commendable enthusiasm – that’s negligence territory my friends. I am not sure that a background in training young men who are relatively hardy in terms of injury should be the only pre-requisite or key selling point for working with a de-conditioned thirty-something. You can qualify as a fitness instructor in a couple of weeks having never actually taught fitness and then be leading a class of 20 or more men and women in high impact, dynamic, outdoor fitness training. That is an issue.

In contrast many bootcamps are set up and run by skilled personal trainers who have more experience and relevant knowledge of the demographic they are aiming for. The fact is that ex-military personnel are unlikely to be experienced at working with overweight mums or out of shape office workers for example, while a local trainer who wants to offer a lower price alternative for those unable to train one-one-one may be better placed to do that. Of course, there are no guarantees either way and plenty of examples exist to the contrary on both accounts (indeed many ex-military trainers go on to gain this experience and become excellent trainers, while there is no shortage of woefully skilled PT’s). However, this is often the case – truth and reason are rarely as appealing to the media as sensation and naysaying. I can’t agree with the osteopath’s comment in the article that bad backs in ex-soldiers is directly linked to their fitness training and would like to see the evidence for this. Standing for hours on end and stamping feet on the drill square would seem equally as likely to cause these types of problems. I don’t see cause and effect in his comment, many ex-soldiers unfortunately end up homeless for example, is this also likely to be a consequence of undertaking their fitness training? O.k I am being a little facetious there, but lets get some perspective here. Many, many people do these classes without any problems whatsoever and enjoy great benefits as a result.

So, where does that leave the public? Should you start out with bootcamps? Indeed is the modern fitness bootcamp actually synonymous with military style training or has it evolved in some quarters into something more?

From my perspective the benefits of bootcamps are many, they foster camaraderie, inspire people and make them accountable, many of them offer excellent nutrition advice (contrary to the consultant’s point of view that is featured in the article) and they promote that results come through hard work, effort, commitment, and determination. The group format also encourages adherence, and helps provide a support network. Personally, I think that is a fantastic ethic. Too often people want to get the results but without all the aforementioned input, which is why the idea of twenty minutes on a vibrating platform once a week or some gentle mat-based sucking-in of the belly button is so appealing.

So, those are the pro’s but what about the cons? Well, like any group exercise format, instruction will always tend to be generic, you simply cannot get the time and attention you would in a small group or personal training. The ‘bootcamp’ industry is also non-regulated (don’t even get me started on REP’s either) so simply attending a bootcamp and paying your money is no guarantee of the competence of the instructor. Outdoor training camps like this tend to be hard work on the lower body and may contribute to injury in those more predisposed to it, so starting out progressively and developing tolerance of increasing workloads is paramount.

From a personal perspective I have seen several friends run very successful bootcamps and while there are risks associated with the format, the article in the Mail is another triumph for sensation over fact and anecdote over evidence. Clearly the aetiology of injury is complex and rarely ever that simple. For example, the lady featured in the article with the knee pain may well have experienced similar trouble at a BodyPump class or doing Step Aerobics. As ever the voice of reason is a little less sensational and there is a tremendous amount of benefit to be had by joining a regular group to workout. While there are potential risks for some more than others many bootcamps are actually very little like the reality of the duress of military training and with a little diligence and common sense you should be able to enjoy all the benefits and remain injury free.

In the interest of clearing rather than muddying the water, here are a few pointers for any of you thinking of joining your local bootcamp.

1. Find a camp where you work with others of similar ability – if there is a new course or beginners class then even better.

2. If you haven’t trained before or for a long time, or would consider yourself out of shape then you need to work into things progressively. I can’t stress this enough.

3. Get yourself some decent footwear for it, preferably having been assessed for it first, as high arches or supinated feet are both clear risk factors for getting injured. (clue here, don’t go to JJB for your trainers – get yourself to a decent sports shop).

4. Stop if experiencing pain and perform an alternative exercise that is pain free. If your instructor cannot suggest one, time to find another bootcamp

5. Remember, it isn’t the military and it isn’t life or death. Nobody will shoot you if you stop an exercise. Many of these injuries are down to sheer overuse, stop and rest if you have pain.

6. If you have a history of injury, particularly to the lower body (such as shin splints or patellofemoral pain) then a bootcamp may not be the right choice to begin with. One approach is rarely right for everyone after all. Consider approaching a skilled trainer to work on specific strength improvements first. Yes, it will cost a bit more, but what price do you want to put on your health?

7. Don’t try starting out 5 times a week. While the effort is admirable, it may well leave you aching and in pain and lead to you giving up. Start out a couple of times a week and build up – particularly if you are out of shape. Combine your bootcamps with improving your diet and increasing overall activity and results will come.

Now, what are you waiting for – as they said in the army “In position READY! Exercise BEGIN!”

You can catch up with Graeme, and see what he’s up to, on his Facebook page.

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