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For years, four to five hours of sleep was the norm for Army Surgeon General Lt. Gen. Patricia Horoho, but now she aims for seven hours a night. She and her husband took the television out of the bedroom, and she traded the occasional sleeping pills for tapes of the ocean.
Horoho is the Army’s chief evangelist for her Performance Triad of healthy living — activity, nutrition and sleep. She also lives it. She wants to change the culture of the Army, including soldiers, civilians and dependents, starting with herself.
The Performance Triad espouses what seem to be tips common to any lifestyle magazine. However, magnified across the Army, they’re a simple way to get at a “strategic issue” facing the nation, Horoho said, the readiness of the force, its future health and the associated medical costs.
Horoho set a personal goal of 10,000 steps per day, stands up at her desk and cut dairy and processed foods in favor of fruit, whole grains and a daily green smoothie. In this way, she says she lost 17 pounds and went down a dress size and a half.
“Those are the kinds of things I try to get into my personal battle rhythm,” she said. “I feel great, I’m not on any medication, and, for the first time, I’m not struggling with my weight, and that was a big change for me.
“When we have soldiers with injuries and illnesses, and they’re not able to perform their mission, there’s a readiness cost, and there’s a dollar cost to that,” she added.
Health care makes up 10 percent of the Defense Department’s budget, and its cost is expected to skyrocket from $52 billion to $92 billion by 2030, Horoho said, citing Congressional Budget Office projections.
“To me, that’s unsustainable for military health care,” she said. “We have to put more emphasis on the health aspect if we’re really going to bend the cost curve and improve the health style for the long term.”
Looking at disease rates among retirees, Horoho surmises that most soldiers view fitness as a condition of employment but not a permanent lifestyle. Getting soldiers to adopt healthier habits could prevent future health care costs to the Veterans Affairs Department, not to mention improve and prolong their lives.
“It wasn’t until the 1980s that we saw the impact of caring for our World War II vets, and we haven’t even seen the impact of caring for our Vietnam vets,” Horoho said. “Add now ... millions of service members, who have been serving in our wars, and we don’t know what the long term effects of 12 years of war will be.”
Horoho said she came up with the idea for the Performance Triad in Afghanistan in 2011, when she saw that soldiers were struggling to get enough sleep, maintain a healthy weight and make healthy choices in general. What if the soldiers could be educated to become partners in their own health, she thought.
Army Medical Command on Sept. 9 began to roll out a series of 26-week pilot programs. Preliminary results will be ready in April 2014, and the secretary’s office may decide whether to take the program Army-wide that November.
Horoho is calling on Army medical professionals not only to cure patients of their illnesses but to bring them to optimum health.
She is making squad leaders the linchpin for the Performance Triad’s implementation, calling on them to instruct soldiers and publicly track metrics such as how much sleep their soldiers get.
The short-term payoff, she said, is that improving the health of soldiers improves their job performance and the odds of mission success.
“Once you answer the why, soldier buy-in, I believe, will be very high,” she said. “It’s vital for us that our soldiers are operating at their maximum performance at any mission they’re given.”
For soldiers in combat arms who might lack the control of their schedules to get adequate sleep, Horoho said it’s up to line leaders to ensure they get sleep in advance of a mission. People who have less than five hours of sleep for several days begin to perform as though they are intoxicated, she said.
“If you try to mitigate any other risk on the battlefield, why wouldn’t you try to mitigate this risk?” she said.
Line leaders have many competing demands, but the Performance Triad has the support of senior Army leadership, Horoho said. Tied to other resiliency programs, it, too, is a proactive way to fix problems before they hit, she said.
The Army will measure how widely the Performance Triad training is implemented and whether it leads to improved activity, nutrition and sleep.
The anecdotal feedback has been positive, Horoho said. She said one overweight Army civilian approached her to say she lost 60 pounds, first by tracking the number of steps she takes and then by installing a treadmill desk that lets her walk while she works.
“I have those stories all across my command,” Horoho said. “Those are the stories that are going inspire people.”