J-7 

CHAIRMAN OF THE JOINT 

CHIEFS OF STAFF 

INSTRUCTION 

DISTRIBUTION: A, B, C, S 

CJCSI3405.01 

1 September 2011 

CHAIRMAN'S TOTAL FORCE FITNESS FRAMEWORK 

References: See Enclosure E. 

1. Puroose. This instruction identifies a framework for adopting and 

implementing total force fitness (TFF). The TFF framework is a methodology for 

understanding, assessing, and maintaining Service members' well-being and 

sustaining their ability to carry out missions. This instruction identifies terms, 

definitions, descriptions, and responsibilities. 

2. Cancellation. None. 

3. Applicability. This instruction applies to the Military Services, the Office of 

the Chairman of the Joint Chiefs of Staff, the combatant commands, Defense 

agencies and DOD field activities, other organizations in DOD where Service 

members are assigned, and Service members. The terms "Service member" 

and "Armed Forces" refer to the Active and Reserve Components of the U.S. 

Army, Navy, Air Force, Marine Corps, and U.S. Coast Guard, while that Service 

is serving with DOD under the provisions of federal statute. 

4. Policy 

a. Establishes the TFF framework as a key readiness component. 

b. The instruction establishes TFF as a key component to the DOD's Force 

Health Protection Program and the Chairman's Health of Force (HoF) priorities 

in accordance with CJCS Guidance for 2011. 

c. The TFF framework is designed to enhance and support the Secretary of 

Defense force health policies and Service Title 10 responsibilities. 

d. This instruction supports, augments, and informs the responsibilities 

defined in references f-m in Enclosure E. . , 
5. Definitions. See Glossary. 

6. Responsibilities. See Enclosure C. 

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1 September 2011 

7. Releasability. This instruction is approved for public release; distribution is 

unlimited. DOD components (to include combatant commands), other federal 

agencies, and the public may obtain copies through the Internet from the CJCS 

Directives Home Page--http://www.dtic.mil/cjcs_directives. 

8. Effective Date. Effective upon receipt. 

Enclosures: 

~~41A~ M. G. Mullen 

Admiral, U.S. Navy 

A -- Total Force Fitness Framework 

B -- Total Force Fitness Integration 

C Responsibilities 

D Metrics 

E References 

GL -- Glossary 

2 
DISTRIBUTION 

Distribution A, B, and C plus the following: 

CJCSI3405.01 

1 September 2011 

Copies 

Secretary of Defense ...................................................................................... 2 

i 
(INTENTIONALLY BLANK) 

ii 

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TABLE OF CONIENTS 

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Page 

ENCLOSURE A -- TOTAL FORCE FITNESS (TFF) FRAMEWORK 

Introduction ........................................................................................... A-l 

TFF Framework ...................................................................................... A-l 

TFF Domains .......................................................................................... A-l 

TFF Tenets ............................................................................................. A-3 

TFF Strategies ........................................................................................ A-3 

TFF Metrics ............................................................................................ A-3 

Summa.ry- ............................................................................................... A-3 

Appendix A -- Physical Fitness ............................................................ A-A-l 

Appendix B -- Environmental Fitness ................................................. A-B-1 

Appendix C -- Medical and Dental Fitness ......................................... A-C-l 

Appendix D -- Nutritional Fitness ...................................................... A-D-l 

Appendix E -- Spiritual Fitness ........................................................... A-E-l 

Appendix F -- Psychological Fitness ................................................... A -F-l 

Appendix G -- Behavioral Fitness ....................................................... A-G-l 

Appendix H -- Social Fitness .............................................................. A-H-l 

ENCLOSURE B -- TOTAL FORCE FITNESS INIEGRATION 

Strategic Guidance ................................................................................. B-l 

Joint Doctrine ........................................................................................ B-l 

Joint Capability Area .............................................................................. B-1 

DOD Programs .................................................................................... t •• B-l 

Service Programs .................................................................................... B-2 

ENCLOSURE C -- RESPONSIBILITIES 

General Guidance ................................................................................... C-l 

The Joint Staff ........................................................................................ C-l 

Combatant Commands and DOD Agencies ............................................. C-3 

Millta.ry- Services ..................................................................................... C-3 

ENCLOSURE D -- METRICS 

Introduction .......................................... ................................................ D- 1 

Physical Fitness ..................................................................................... D-l 

Environmental Fitness ........................................................................... D-3 

Medical and Dental Fitness .................................................................... D-3 

Nutritional Fitness ................................................................................. D-3 

Spiritual Fitness .................................................................................... D-4 

Psychological Fitness ............................................................................. D-5 

Behavioral Fitness ................................................................................. D-6 

Social Fitness ........................................................................................ D-7 

Conclusion ............................................................................................ D-7 

iii 
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ENCWSURE E -- REFERENCES .................................................................. E-l 

GWSSARY OF ACRONYMS AND ABBREVIATIONS ................................... GIrl 

FIGURES 

1. TFF Domains .......................................................................................... A-l 

2. Physical Fitness Metrics ........................................................................ D-2 

3. Spiritual Fitness Metrics ........................................................................ D-4 

4. Psychological Fitness Metrics ................................................................. D-5 

iv 
ENCLOSURE A 

TOTAL FORCE FITNESS FRAMEWORK 

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1. Introduction. The most valuable resource in our military is our people. 

After nearly 10 years of conflict, members of the Armed Forces are confronted 

with considerable, sustained, and diverse stressors that significantly impact 

the readiness of the force. To be fully prepared to continually execute our 

central mission -- to fight and win the country's wars -- the approach to how 

we understand, assess, and maintain the fitness of the force needs to be 

adjusted. This instruction introduces a TFF framework. Leaders throughout 

the force need to understand, establish, and support TFF within their 

organizations. 

2. TFF Framework. The TFF framework is a methodology for understanding. 

assessing, and maintaining the fitness of the Armed Forces. The TFF 

framework consists of eight distinct domains whose interrelated functionality is 

informed by five overarching tenets. In its application. the TFF framework and 

its tenets are designed to keep Service members resilient and flourishing in the 

current environment of sustained deployment and combat operations. 

3. TFF Domains. The TFF domains are derived from various sources, 

including current practices on medical fitness, such as the Army's 

Comprehensive Soldier Fitness (CSF) Program, the Navy's Total Family Fitness 

and the Combat Operational Stress Program, the Total Airman Comprehensive 

Fitness Program, and the integrative health care approaches being piloted in 

the Air Force and the National Guard. Central to the responsibility for 

achieving total fitness is our ability to define processes and influence a 

diSCiplined culture that integrates the TFF domains. The individual TFF 

domains are: 

a. Physical Fitness. Physical fitness refers to the ability to physically 

accomplish all aspects of the mission while remaining healthy and uninjured. 

See Appendix A. 

b. Environmental Fitness. Environmental fitness refers to the ability to 

perform mission-specific duties in any environment. See Appendix B. 

c. Medical and Dental Fitness. Medical and dental fitness refers to the 

ability to meet established standards for medical readiness. See Appendix C. 

d. Nutritional Fitness. Nutritional fitness refers to the ability to recognize 

and select the requisite nutrition to sustain and optimize physical and 

cognitive performance and health. See Appendix D. 

A-I Enclosure A 
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1 September 2011 

e. Spiritual Fitness. Spiritual fitness refers to the ability to adhere to 

beliefs, principles, or values needed to persevere and prevail in accomplishing 

missions. See Appendix E. 

f. Psychological Fitness. Psychological fitness refers to the ability to 

effectively cope with the unique mental stressors and challenges needed to 

ensure mission readiness. See Appendix F. 

g. Behavioral Fitness. Behavioral fitness refers to the relationship between 

one's behaviors and health. See Appendix G. 

h. Social Fitness. Social fitness refers to the ability to engage in healthy 

social networks that promote overall well-being and optimal performance. See 

AppendixH. 

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Social support 

Task cohesion 

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Figure 1. TFF Domains 

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a. Total fitness extends beyond the Service member; total fitness should 

strengthen resilience in families, communities, and organizations. 

A-2 EnciosureA 
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b. A SeIVice member's family's health plays a key role in sustained success 

and must be incorporated into any definition of total fitness. 

c. Total fitness metrics must measure positive and negative outcomes, and 

must show movement toward total fitness. 

d. Total fitness is linked to the fitness of the society from which the SeIVice 

members are drawn and to which they will return. 

e. Leadership is essential in achieving total fitness. 

2. TFF Strategies. Effective TFF strategies are inclusive, innovative, and 

preventive; these strategies should be focused on strengthening resilience in 

our SeIVice members. families, communities, and organizations. TFF strategies 

should enable SeIVice members to achieve and sustain optimal performance. 

When an imbalance arises among the TFF domains, developing prompt and 

dynamic responses are essential for maintaining total force readiness. TFF 

strategies should also address eliminating the stigma and other factors that 

prevent SeIVice members (and their families) from seeking help early and focus 

on achieving increased performance. These strategies should eqUip our people 

with the tools and skills required to continually assess and adjust. or calibrate, 

their environment, allowing them to maintain the necessary balance of 

intellectual skill, physical endurance. and emotional stamina needed to carty 

out missions. 

3. TFF Metrics. Leaders must identify the metrics that will set the right 

conditions to promote fitness. Metrics must be feasible. effectively measuring 

the desired outcome and accurately assessing whether the TFF program is 

meeting its goals. They must also demonstrate progress toward achievable and 

realistic outcomes, addressing positive as well as negative outcomes that 

clearly indicate the overall readiness of the Armed Forces. Metrics must tell us 

whether we are improving the fitness of the force in each TFF domain. 

Enclosure D lists some metrics currently being used and recommends others 

for conSideration. 

4. Summary. TFF is an integrated process to optimize the well-being and 

readiness of the individuals and families of the total force. Success in 

establishing TFF will enable individuals to sustain optimal well-being and 

demonstrate the resilience needed to carty out assigned missions. 

A-3 Enclosure A 
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A-4 

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Enclosure A 
APPENDIX A TO ENCLOSURE A 

PHYSICAL FITNESS 

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1. Physical fitness includes a set of characteristics that people have or can 

achieve relating to their ability to perform physical activity. Our Service 

members must demonstrate the ability to physically accomplish all aspects of 

the mission while remaining healthy and meet the criteria for deployment, 

retention, and continued military service. 

2. Many components of physical fitness are shared across the Services. The 

common thread among them is that Service members and their families benefit 

from a holistic approach to physical fitness. A well-rounded physical fitness 

program should include varied cardio training: balanced strength training that 

includes core strengthening exercises, flexibility, speed, and agility training; 

appropriate amounts of sleep and recovery; and effective mind-body programs, 

such as yoga, martial arts, and meditation. 

3. Physical fitness is a fundamental element of one's physical and mental 

health, mission performance, and readiness. By integrating physical fitness 

into the other seven domains of TFF, Service members and their families can 

prepare themselves for the intenSity of today's operational demands. 

A-A-2 Appendix A 

Enclosure A 
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Appendix A 

Enclosure A 
APPENDIX B TO ENCLOSURE A 

ENVIRONMENTAL FITNESS 

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1. Environmental fitness includes the ability to perform mission-specific duties 

in any environment and withstand the multiple stressors of deployment and 

war. The physical environment in which our Anned Forces must operate has 

histOrically played a huge role in military operations. Environmental factors on 

the battlefield have been deSCribed as the "first enemy you meet," and one of 

the most formidable. However, many theater-specific environmental stressors 

can be identified, assessed, and mitigated before deployment. 

2. Environmental fitness is composed of physiological readiness and personal 

protection that prepare Service members to perform their missions, while 

enduring various environmental stressors. These stressors include physical 

(temperature, altitude, nOise, air quality, and radiation); biological (food, water, 

and vector-borne disease); and chemical (food, water, and occupational and 

environmental contaminants). 

3. Varied environmental conditions may require specific physiological and 

behavioral adaptations as well as personal protective equipment and training to 

achieve or sustain optimal environmental fitness. Understanding the 

environmental component of TFF will eqUip leaders with the training and skills 

needed to optimize human performance and military effectiveness. 

A-B-l AppendixB 

Enclosure A 
(INTENTIONALLY BlANK) 

A-B-2 

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AppendixB 

Enclosure A 
APPENDIX C TO ENCLOSURE A 

MEDICAL AND DENTAL FITNESS 

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1 September 2011 

1. Medical and dental fitness is a condition of mental and physical well-being 

as determined by medical standards and prerequisites for individual mission 

accomplishment and worldwide deployability. Medically fit Service members 

can perform their job without risk to themselves or others. and possess the 

phySiological. anatomical. and psychological capacities to adapt to their 

specific occupational environment. 

2. Medical and dental fitness components are Service and individual specific. 

but generally encompass the following: 

a. Screening for overall wellness. diseases. physical and duty limiting 

conditions. and behavioral and disease risk factors. 

b. Immunizations to assist in mitigating or eliminating future risk to Service 

members and optimizing success during training and on the battlefield. 

c. Prevention and pretreatment against disease and injury by implementing 

strategies that cannot be accomplished through wellness or immunization. 

d. Medical conditions related to dental. vision. and auditory health is 

critical to individual readiness and is often a potential marker for underlying 

physical illness. 

3. The components of medical fitness converge to establish that an individual 

Service member is free of contagious diseases and medical conditions or 

physical defects that would require excessive lost duty time or affect 

performance of duties. The Service member is capable of satisfactorily 

completing required training or effectively performing mission-specific duties in 

a deployed environment. 

A-C-l AppendixC 

Enclosure A 
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Appendix C 

Enclosure A 
APPENDIX D TO ENCLOSURE A 

NUTRITIONAL FITNESS 

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1 September 2011 

1. Nutritional fitness includes the provision and consumption of food in 

quantities, quality, and proportions sufficient to preserve mission performance 

and to protect against disease or injury. 

2. Members of the Armed Forces need to be educated on how to make wise 

nutritional choices; eat for balance, variety, and moderation; and be exposed to 

new foods in a positive way. Many factors, such as social interaction and 

enjoyment, religion and culture, family traditions, social status and cost 

factors, dieting, and a quick-fix mentality, impact individual food choices. 

3. The goal of nutritional fitness is to achieve optimal health and performance. 

Our leaders, Service members, and their families must be taught how to 

promote, implement, achieve. and maintain healthy eating behaviors and to 

create an environment that makes healthy food and beverage options an easy 

and appealing choice. 

A-D-l AppendixD 

Enclosure A 
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A-D-2 

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AppendixD 

Enclosure A 
APPENDIX E TO ENCLOSURE A 

SPIRITUAL FITNESS 

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1. Spiritual fitness includes an individual's or group's ability to maintain 

beliefs, principles, and values needed to provide support in times of stress. 

Spiritual fitness includes the development of personal qualities needed to 

sustain a person in times of stress, hardship. and tragedy. These personal 

qualities may come from religious, philosophical, or human values and form 

the basis for character, disposition, decision making, and integrity. Human 

spirit development provides people with an understanding of who they are in 

terms of core values and identity. This awareness contributes to consistent 

behavior in accordance with one's values and identity and living with integrity. 

2. Spiritual fitness has several traditional rather than scientific components. 

Those components include spiritual beliefs, values and practices; core beliefs: 

purpose and meaning; self-awareness, reflection and introspection; 

transcendence; relationships beyond self; and spiritual experiences. These 

components overlap, interpenetrate, and have somewhat different meanings in 

different traditions. 

3. A strong spirit promotes resiliency and enhances one's ability to mitigate 

adverse responses to stress. Promoting spiritual fitness is a vital component of 

a TFF program and fully complements the other seven fitness domains. 

A-E-l AppendixE 

Enclosure A 
(INIENTIONALLY BLANK) 

A-E-2 

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Appendix E 

Enclosure A 
APPENDIX F TO ENCLOSURE A 

PSYCHOLOGICAL FITNESS 

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1. Psychological fitness includes the integration and optimization of mental, 

emotional, and behavioral abilities and capacities to optimize performance and 

strengthen resilience. It describes a Service member's ability to effectively cope 

with the unique mental stresses and challenges of Military Service. 

2. Given the current demands placed on our forces. a Service member's 

resilience -- ability to withstand, recover, grow, and adapt under challenging 

circumstances -- is vital to readiness and mission accomplishment. Without 

resilience, Service members and their families are at risk of burnout, 

psychological stress, and physical danger due to impaired functional abilities. 

3. Bolstering psychological fitness in Service members can help ensure 

mission readiness and decrease the potential risk that they may face stressrelated injury or illness down the road. 

A-F-l Appendix F 

Enclosure A 
(INTENTIONALLY BLANK) 

A-F-2 

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AppendixF 

Enclosure A 
APPENDIX G TO ENCLOSURE A 

BERA VIORAL FITNESS 

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1. Behavioral fitness includes the ability to adopt behaviors that support 

individual readiness and health. Behavioral health refers to the integration 

and optimization between one's behaviors and positive or negative health 

outcomes. A high degree of behavioral fitness highlights the importance of 

individual responsibility and leader awareness to help shape healthy behaviors. 

2. Behavioral fitness is not simply about avoiding negative behavior; it is also 

about supporting and affinning positive behavior. The success of reinforcing 

positive behavior lies in positive examples and continuous feedback by leaders 

and is crucial to preventing risky behavior that adversely affects the health of 

Service members and families. 

3. The majority of our Armed Forces and their families have endured hardship 

and separation. Many are exposed to Significant ongoing stress by living under 

an unrelieved threat of danger. Most adjust well. but some have a harder time. 

requiring leaders who are observant. caring. and involved. 

A-G-l AppendixG 

Enclosure A 
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AppendixG 

Enclosure A 
APPENDIX H TO ENCWSURE A 

SOCIAL FITNESS 

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1. Social fitness includes the ability to engage in healthy social networks that 

promote overall well-being and optimal unit performance. Social fitness 

intertwines the individual. unit. family. and community. All four components 

are necessary for enhancing and sustaining social fitness within the context of 

TFF. 

2. Individual social fitness is the most basic element that must be achieved for 

greater conditions of social fitness within a unit. family. and military 

community. It is best achieved through development of purpose. clarity of 

personal values. understanding and awareness of mission. and preparation for 

the challenges Service members and their families will face. 

3. Unit fitness is characterized as the healthy connections within the social 

network of the unit structure for overall well-being and optimal unit 

performance. When unit members earn the trust of their leader. they can be 

more autonomous and lead independent missions as required. Leaders know 

that they can trust their subordinates to accomplish the assigned tasks. 

Likewise. subordinates must believe that leaders care and consider their 

well-being when making decisions. 

A-H-l AppendixH 

Enclosure A 
(INTENTIONALLY BLANK) 

A-H-2 

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AppendixH 

Enclosure A 
ENCWSUREB 

TOTAL FORCE FITNESS IN1EGRATION 

1. Strategic Guidance 

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1 September 2011 

a. "Improve Health-of-Force" is one of three priorities in the CJCS Guidance 

for 2011, which includes caring for our people and their families, and restoring 

readiness. 

b. DOD Force Health Protection Policy. 

(1) Service members are physically and mentally fit to carry out their 

missions. 

(2) Commanders and supervisors promote, improve, sustain, and restore 

the physical and mental well-being of members of the Armed Forces. 

(3) DOD components implement programs and processes that promote 

and sustain a healthy and fit force; prevent injury and illness; protect the force 

from health hazards; and deliver the best possible medical and rehabilitative 

care to the sick and injured anywhere in the world. 

2. Joint Doctrine. The TFF framework is captured in Chapter 6 (Joint Force 

Development) in Joint Publication 1, Doctrinejor the Anned Forces ojthe United 

States, illustrating its importance in the purposeful preparation of individual 

members of the Armed Forces, and the units that contain them, to produce a 

force capable of executing DOD missions. 

3. Joint Capability Area (JCA). JCAs serve as a common language that 

support DOD planning. The Force Support JCA provides the ability to 

establish, develop, maintain, and manage a mission-ready Total Force. Health 

Readiness. Force Health Protection, and Human Performance Enhancement 

are components of the Force Health JCA. 

4. DOD Programs. The DOD approach to well-being lists TFF as one of four 

key pillars, along with the Service's well-being programs, DOD well-being of the 

force, and external well-being programs outside DOD. The TFF framework will 

support a unified, coherent construct for measuring well-being to strengthen 

individual and mission readiness and family support. 

5. Service Programs. The TFF framework is intended to support and augment 

the individual Service fitness efforts. TFF Is prevention focused and centered 

on the Service member, family, and environment collectively. 

B-1 Enclosure B 
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1 September 2011 

a. The Army's CSF Program contaJns several overlapping areas of emphasis: 

family-Soldier relationships, assessment and training from accession to 

retirement, and leadership engagement as a key component in individual 

growth. 

b. The Air Force has undertaken a quest to improve human performance. 

They moved from a traditional model founded on force protection to a holistic 

approach to managing Airmen using a performance-based force projection 

model that concentrates on human performance. 

c. The USMC Combat Operational Stress Control (COSC) Program 

objectives promote maintaining a ready, resilient force and providing for longterm health and well-being. The primary goals of the COSC program are to 

maintaJn a ready fighting force and to protect and restore the health of Marines 

and their family members. 

d. The Navy's Operational Stress Control Program seeks to help create an 

environment where Sailors, commanders, and their families are able to thrive 

during stressful operations. The program aims to teach Sailors that asking for 

help and guidance for stress is not a sign of weakness, but a sign of strength. 

It accomplishes the mission by educating Sailors, families, and command 

leaders to take care of themselves by remaining fit and healthy. 

B-2 Enclosure B 
ENCWSUREC 

RESPONSIBILmES 

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1 September 2011 

1. General Guidance. TFF is an emerging framework, evolving toward defining 

a balance between readiness and well-being that are mutually supportive. A 

total force that has achieved total fitness is healthy, ready, and resilient, 

capable of meeting challenges and surviving threats. Leaders at all levels, 

scientists, health care providers, and Service members must synchronize and 

harmonize efforts to: 

a. Develop tangible and results-oriented measures of TFF. 

b. Give Service members the guidance and support they need. 

c. Give leaders the tools to know when to intervene. 

d. Assess and report TFF metrics that are results-oriented and clearly 

demonstrate progress toward achievable and realistic goals and standards. 

e. Explore the anecdotal evidence regarding TFF and develop SCientific 

protocols to put these observations to objective tests. 

f. Keep your mind open to creative new concepts and possibilities. 

g. Create an environment that supports behaviors needed to achieve TFF. 

2. The Joint Staff 

a. Directorate for Manpower and Personnel (J-l) and Joint Staff Chaplain. 

(1) Synchronize the Joint StaffTFF effort with Service component and 

Office of the Secretary of Defense, Personnel and Readiness (OSD (P&R)) wellbeing, quality of life, and family readiness efforts. The TFF framework will 

complement the OSD approach to well-being. 

(2) As required, assess, integrate, and report TFF measures/metrics 

related to quality of life, family readiness, and well-being measures currently in 

place. 

(3) Develop and, where required, revise joint plans, policy, and guidance 

on manpower and personnel support matters to reflect HoF priorities and the 

TFF framework. 

C-l Enclosure C 
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1 September 2011 

(4) Assist as needed with developing metrics and measures for assessing 

behavioral, social. psychological. and spiritual fitness. As required, facilitate 

integration of the TFF framework between the combatant commands and 

Service chaplains. 

b. Directorate for Operations (J-3). 

(1) Serve as Office of Coordinating Responsibility (OCR) for developing 

and reporting TFF measures/metrics related to quality of life, family readiness, 

and well-being measures currently in place. 

(2) Serve as OCR for developing procedures for reporting TFF 

measures/metrics into the Chairman's Readiness System. 

c. Directorate for Logistics (J-4), in particular the Joint Staff Surgeon and 

Health Services Support Division. 

(1) Serve as the Joint StaffTFF Cross Functional Team lead. acting as 

the Office of Primary Responsibility (OPR) for the TFF synchronization efforts 

across the Joint Staff. 

(a) Annually develop and report TFF progress (one-to two-page 

snapshot) that illustrates and clearly highlights where we are doing well and 

where we need to focus TFF and HoF efforts. 

(b) For the initial report, use existing medical, personnel, training, 

and readiness data and apply it to the TFF framework. Where there is no 

existing data, illustrate where the gaps are and recommend solutions. 

(c) As required, and in collaboration with the Military Services, assess 

and report TFF measures/metrics related to health service support. 

(d) Integrate and synchronize the TFF framework with joint health 

service support efforts. 

(e) Provide SME input into the Chairman's Readiness System on the 

impact of health service support -related readiness issues. 

(2) Provide J-8 with SME support for monitoring and assessing medical 

reporting and data evaluation. 

d. Directorate for Joint Force Development (J-7). 

(1) Integrate the TFF framework and desired results into doctrine and 

force development. 

C-2 Enclosure C 
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1 September 2011 

e. Directorate for Force Structure, Resources, and Assessment Directorate 

(J-8). 

(1) PrOvide the TFF OPR with staff SME as needed to synchronize the 

J oint Staff TFF effort with ongoing or developing requirements and acquisition 

programs that may be related to the TFF framework. 

(2) Ensure JCA development, refinement, management, and 

implementation demonstrate HoF priorities. 

f. The Senior Enlisted Advisor to the Chairman (SEAC) 

(1) SeIVe as the Chairman's TFF primary senior enlisted advocate to the 

total force. Advise the Chairman and the Joint Staff on all enlisted matters as 

they relate to the overall fitness of the force. 

(2) Synchronize and influence the TFF effort across DOD and the total 

force. 

(3) In conjunction with the JS J-4, provide annual written TFF status 

reports and quarterly TFF briefings in support of the Chairman's HoF priorities. 

g. Assistant to the Chairman for ReseIVe Matters. Provide guidance and 

expertise required for integrating the TFF framework within the ReseIVe 

Components. 

3. Combatant Commands and DOD Agencies. Ensure adherence to TFF 

standards, policies, and programs for the sustainment and protection of all 

forces assigned or attached to their command. 

4. Military SeIVices 

a. Use the TFF framework to enhance and/or refine current fitness 

programs. Continually evaluate the TFF program and recommend changes or 

improvements as required. 

b. Review and, when required, modify readiness reporting standards to 

account for health and fitness issues impacting the SeIVices' ability to provide 

organized, trained, and equipped forces. 

c. Continue to promote healthy lifestyles, optimize safety and healthy 

working conditions, facilitate access to health care, and conduct periodic 

health assessments. 

C-3 Enclosure C 
CJCSI3405.01 

1 September 2011 

d. MOnitor the total fitness of personnel; identify and mitigate the threats, 

stressors, and other risks to their health and safety; and ensure the availability 

of countermeasures and preventive methods. 

e. Continue to ensure that deploying personnel are holistically fit for 

worldwide duty in accordance with the TFF standards. 

f. Provide appropriate medical support, training, equipment, and supplies 

to implement these policies. 

C-4 Enclosure C 
ENCWSURED 

METRICS 

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1 September 2011 

1. Introduction. TFF memcs should measure positive and negative outcomes. 

Measures should show movement toward total fitness rather than just a 

reduction in the many problems exposed by todays ongoing operations. The 

following memcs are illustrative and intended to help leaders begin to think 

about how to effectively assess total fitness. Additionally, several DOD-level 

working groups are in the process of evaluating and recommending memcs 

that align with the TFF framework. Leaders should consider the 

recommendations of these and similar working groups when thinking about 

how to effectively assess TFF. 

2. Physical Fitness 

a. Current available memcs include fitness tests, injury statistics, and 

profile data. Most fitness tests prtmarily evaluate muscular strength and 

cardiovascular endurance. Physical training prtmarily consists of distance 

running, push-ups, pull-ups, and sit-ups. Physical fitness tests should 

complement the physical tasks required by the mission so that Service 

members are training effectively for mission accomplishment. 

b. Memcs should include physical fitness tests that reflect mission tasks 

and measures mobility in addition to muscle strength and cardiovascular 

endurance. The memcs listed below are examples within the components of 

fitness and require little equipment or specialized locations. 

D-l Enclosure D 
Component 

Mobility 

Strength 

Power 

Speed 

Balance 

Agility 

Aerobic capacity 

Anaerobic capacity 

Body composition 

CJCSI3405.01 

1 September 2011 

Field Assessment Examples 

Functional Movement Screen 

The Functional Movement Screen is a seven-part test 

that assesses mobility and flexibility. 

P IU, Pull-Ups, Squat Test, Grip Strength 

Push-ups, pull-ups, and squat tests assess muscular 

endurance of the upper and lower extremity. 

Vertical leap, Horizontal leap, Seated Med Ball Throw 

Vertical and horizontal leap assess muscular power in 

height of jump and length of jump. Seated med ball 

throw assesses upper extremity power. 

30-meter sprint 

Lower Extremity Y-Balance & Upper Extremity YBalance 

The Lower Extremity Y -Balance test assesses the 

ability to maintain single limb balance with a dynamic 

movement. The Upper Extremity Y -Balance assesses 

trunk mobility. 

Illinois Agility Test, T -Test of Agility 

Agility tests assess the ability to change the body's 

direction efficiently while accelerating and decelerating 

through a series of cones. 

1.5-mile run 

Running Anaerobic Sprint Test 

The Running Anaerobic Sprint Test assesses quick, 

explosive activity endurance and provides 

measurements in peak, average, and minimum power 

along with fatigue index. 

Skinfold Measurement 

Skinfold thickness measures using calipers is an 

effective way to assess and monitor changes in body fat 

composition. 

Figure 2. Physical Fitness Metrics 

3. Environmental Fitness 

D-2 Enclosure D 
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1 September 2011 

a. The environment in which war is fought is central to fitness for combat. 

Tools to assess the environmental stresses that occur during wars include 

biomedical and mission-related metrics. Biomedical methods include 

nutrition, acclimation, and hydration. Mission-related methods include the 

clothing and equipment our Service members wear and use. Acclimation and 

tolerance are also key indicators when members of the Armed Forces are 

deployed to an adverse environment. 

b. One possible metric that could significantly contribute to evaluating 

environmental fitness is having Service members assess their individual limits. 

However, leaders must be aware of the potential that Service members may 

downplay symptoms that, left unchecked, put themselves and others at greater 

risk. 

4. Medical and Dental Fitness. The existing metrics for medical fitness include 

deoxyribonucleic acid; dental, anthrax and other immunizations; hearing and 

vision readiness; ongoing PHA; and other metrics tracked by service-specific 

information management systems. Others include: 

a. The Alcohol Use Disorders Identification Test (AUDIT C) for alcohol 

screening, rates of alcohol-related incidents (e.g., DUI/DWI, assaults, sexual 

assaults), and rates of tobacco use (captured in periodic health assessments 

(PHA) and the Armed Forces Health Longitudinal Technology Application) 

indicate the contributions of some behaviors to medical fitness. A body mass 

index (BMI) would also provide a metric for medical fitness at the individual 

and aggregate levels. 

b. Women's health could be measured through routine PAP and 

mammogram screenings, clinical breast and pelvic exams, contraceptive 

counseling, unplanned/unintended pregnancy counseling, sexually 

transmitted infection counseling, and compliance with post-partum pregnancy 

physical training guidance. 

c. Adequate sleep has been shown to provide improved cognitive 

performance and judgment, improved resilience, and more rapid recovery from 

injury and illness. Sleep could be measured through self-reporting, or through 

the addition of a sleep instrument such as the Pittsburgh Sleep Quality Index 

or the Epworth Scale to the PHA, Post-Deployment Health Assessment (PDHA), 

and the Post-Deployment Health Reassessment (PDHRA). 

5. Nutritional Fitness 

a. Research has already demonstrated dietary requirements for nutritional 

fitness. The challenge in this domain is changing behavior and culture. The 

optimal metrics are those that quantify the availability and consumption of 

D-3 Enclosure D 
CJCSI 3405.01 

1 September 2011 

healthy options (some of which already exist and are discussed below) and 

those that measure the commander's effectiveness in changing individual 

behavior. 

b. Some tools already exist for monitoring the components of nutritional 

fitness at the unit level. such as the Choose Healthy Options for Wellness 

(CHOW) and Develop Improved Nutrition Environment (DINE) surveys used in 

the Navy and Air Force, respectively. At the installation level. the Military 

Nutritional Environment Assessment Tool {m-NEA1j can determine the 

supportiveness of the nutritional environment. One simple metric would be 

whether or not a unit or facility is using these tools. Another metric could be 

the capability of food services to meet the specific energy and nutritional 

requirements of unit activities. 

c. Web sites such as HOOAH4HEALTH (www.hooah4health.com) offer 

animated tools for guidance on healthy eating and a weight management 

tracker. 

6. Spiritual Fitness. Evidence exists that spiritual fitness plays a key role in 

total fitness. Capturing spirituality's contribution to total fitness is essential to 

optimizing the well-being and resiliency of the total force. Some relevant metric 

examples include: 

Desired Outcome Possible Metrics 

Individual and unit fitness - • Mental Health Advisory Team (MHA1j 

• Unit cohesion • Prevalence of unit diSCiplinary 

• Citizenship behaviors problems 

• Appreciating diversity • Qualitative methods, e.g., inspections, 

differences focus groups, surveys 

• HEXACO Personality Inventory -

~eeableness subscale 

Productivity and performance • Health and Work Performance 

Questionnaire 

Effective coping • Coping Style Questionnaire, General 

Self-Efficacy Scale 

Retention • Trends in early separation and reenlistment rates 

Perceived Stress • Perceived Stress Scale 

Resilience • Connor-Davidson Resilience Scale, 

Deployment Risk and Resilience 

D-4 Enclosure D 
Inventory 

• Resilience Quotient test 

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1 September 2011 

Ineffectivecoptng,martifestas • PDHA, PDHRA 

• Substance abuse • Alcohol Use Disorders Identification 

• Anxiety/Depression Test 

• Patient Health Questionnaire 

Compassion fatigue • Professional Quality of Life -

Compassion Satisfaction and Fatigue 

Subscales 

• Dimensions of Self-Concept Form W 

Job Stress Subscale 

Post Traumatic Stress • fYISD Checklist-Military Version 

Figure 3. Spiritual Fitness Metrics 

7. Psychological Fitness 

a. The relevant fitness factors are organized under general headings of 

mental, emotional, and behavioral, but many key components span two or 

more of these headings. In choostng metrics, it is important to differentiate 

between ultimate outcomes and tntermediate outcomes. 

(1) Ultimate outcomes are the impact on performance and function. 

(2) Intermediate outcomes are the changes tn psychological fitness 

domatns (e.g., coptng) that will lead to ultimate outcomes (tndicators of 

improved performance and resilience). 

b. The following metrics address psychological fitness: 

Outcome Category Outcome Variable Sample Metrics 

Performance Individual job Annual performance 

performance appraisals, on-the-job 

tratntng records, rates 

of people completing 

professional and/or 

general military 

education 

Performance Individual task Scores on written and 

performance practical tests, 360 

surveys, customer 

D-5 Enclosure D 
CJCSI3405.01 

1 September 2011 

feedback, and cognitive 

adaptability scale. 

Performance and Exercise and sleep Actigraph, Epworth 

Resilience sleepiness scale 

Performance Team/ organizational Organizations 

job performance inspections (e.g., 

compliance), unit 

surveys (e.p;., climate) 

Performance Team task performance Evaluation of team 

coordination and 

maneuvering in 

Simulated performance 

scenarios 

Performance and Unit cohesion and Cohesion assessments. 

Resilience morale Behavioral needs 

assessments, 

Deployment Risk and 

Resilience Inventory 

Performance Ethical decision making Ethical beliefs and 

behaviors, AF culture 

survey 

Performance and Team/ organizational Civilian lost day rate, 

Resilience safety mishap rates vehicle fatality rate, 

motorcycle fatalities, 

Four-wheel vehicle 

fatalities, class 'A' 

mishap rates, safety 

center data 

Performance and Organizational CFC participation rates, 

Resilience Citizenship behavior Status of Forces survey, 

rates of humanitarian 

medals p;ranted 

Figure 4. Psychological Fitness Metrics 

8. Behavioral Fitness 

a. Metrics should focus on measuring the positive behaviors that the 

military would like to encourage. The outcomes and benefits of behavioral 

fitness include improved performance as well as the reduction of healthcare 

costs and lost duty time due to injury or infection. 

b. The behavioral fitness domain addresses risk mitigation, substance 

abuse, and hygiene. 

D-6 Enclosure D 

I 

I 

I 

i 
CJCSI3405.01 

1 September 2011 

(1) Metrics for risk mitigation could include percentage of seatbelt and 

use over the last month, or percentage of use of hearing and sight protection. 

Other metrics could measure the outcomes of poor behavior, such as 

percentage accidents, musculoskeletal injury, emergency room reports, and 

sick call attendance related to accidents. 

(2) Metrics for substance abuse could include the rates of non-tobacco 

use, rates of non-binge drinking, and other measures of responsible or 

irresponsible use of substances. Data sources for these metrics could include 

risk reduction data, PDHA and PDHRA data, safety data. and command 

sUIVeys. 

(3) Metrics for hygiene could include rates of communicable diseases 

drawn from hospital data and sexual behavior (as a subset of risky behavior) 

measured through rates of sexually transmitted diseases. Additionally, 

existing data supports links between relationships and sexual behavior, and 

outcomes such as depression and suicide (particularly in the case of young 

SeIVice members). 

9. Social Fitness. Existing metrics that could assist leaders in capturing 

selected aspects of social fitness include: 

(a) A Group Environment Questionnaire as a metric of task cohesion and 

social coheSion. The questionnaire measures individual attraction to the group 

(task). individual attraction to the group (social), and group integration (one for 

task and one for social). 

(b) The Global Assessment Tool used by the Army's CSF program has a 

social component. (Note: the purpose of this program is the self-improvement 

of the individual member and it would have to be modified to provide unit level 

information to leaders). 

(c) The Navy Bureau of Medicine and Surgery (BUMED) developed a "stress 

thermometer" that SeIVice members and their family members can use to 

assess their own stress levels and to initiate conversations on stress and stress 

management. 

(d) Measures of social fitness could also evaluate the effectiveness of the 

leadership. e.g., who do SeIVice members trust in the organization, who do they 

go to for leadership and counsel. 

10. ConclUSion. These metrics are not all encompassing and are not 

universally applied among the SeIVices. However. they can seIVe as examples 

to measure current progress with a clear vision of total fitness. 

D-7 Enclosure D 
(INTENTIONALLY BLANK) 

D-8 

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Enclosure D 
CJCSI 3405.01 

1 September 2011 

ENCWSUREE 

REFERENCES 

a. TItle 10. United States Code. Section 153 

b. Secretary of Defense. "Guidance for Development of the Force" 

c. Chairman of the Joint Chiefs of Staff. "National Military Strategy of the 

United States" 

d. CJCS Annual Guidance for 2011 

e. Joint Publication 1. "Doctrine for the Armed Forces of the United States" 

f. DOD Directive 6200.04. current as of23 Aprt12007. "Force Health 

Protection" 

g. DOD Directive 1010.10. current as of 24 November 2003. "Health Promotion 

and Disease/Injury Prevention" 

h. DOD Instruction 1308.3. 5 November 2002. "DOD Physical Fitness and 

Body Fat Programs Procedures" 

i. DOD Instruction 6025.19.3 January 2006. "Individual Medical Readiness" 

j. DOD Instruction 6490.3, 11 August 2006. "Deployment Health" 

k. DOD Instruction 6490.4,28 August 1997. "Requirements for Mental Health 

Evaluations of Members of the Armed Forces" 

1. DOD Instruction 6490.06,21 Aprt12009. "Counseling Services for DOD 

Military, Guard and Reserve, Certain Affiliated Personnel, and Their Family 

Members" 

m. DOD Instruction 6495.02, 23 June 2006 incorporating through change 1 

dated 13 November 2008. "Sexual Assault Prevention and Response Program 

Procedures" 

n. JSM 5100.01D. 23 January 2009. "Organization and Functions of the Joint 

Staff' 

o. Uniformed Health Services University Conference Report. 30 December 

2009, "Total Fitness for the 21 st Century" 

E-l Enclosure E 
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1 September 2011 

p. Supplement to Military Medicine. August 2010, Vol. 175. No.8, "Total Force 

Fitness for the 21st Century. A New Paradigm" 

q. DOD 5400.11-R, 14 May 2007, "Department of Defense Privacy Program" 

r. Reivich, D. and Shatte, A. (2002). The Resilience Factor, New York: 

Broadway Books 

E-2 Enclosure E 
CHOW 

CSF 

DINE 

DOD 

FHP 

HoF 

J-1 

J-3 

J-4 

J-7 

J-8 

JCA 

JSS 

MHAT 

OCR 

OPR 

PDHA 

PDHRA 

PHA 

SME 

TFF 

USPSTF 

USUHS 

CJCSI 3405.01 

1 September 2011 

GWSSARY 

PARr I -- ACRONYMS AND ABBREVIATIONS 

choose healthy options for wellness 

comprehensive soldier fitness 

develop improved nutrition environment 

Department of Defense 

force health protection 

health of force 

Manpower and Personnel Directorate, Joint Staff 

Operations Directorate, Joint Staff 

Logistics Directorate, Joint Staff 

Force Development Directorate, Joint Staff 

Force Structure, Resources, and Assessment Directorate, 

Joint Staff 

joint capability area 

Joint Staff Surgeon 

medical health advisory team 

office of coordinating responsibility 

office of primary responsibility 

post-deployment health assessment 

post-deployment health reassessment 

periodic health assessment 

subject matter expert 

total force fitness 

U.S. Preventive Services Task Force 

Uniformed Services University of the Health SCiences 

GIrl Glossary 
PARr II -- TERMS AND DEFINITIONS 

Domain -- A sphere of knowledge, influence, or activity. 

ruesI 3405.01 

1 September 2011 

Fitness -- The relationship between one's behaviors and their positive or 

negative health outcomes. 

Force Health Protection -- Measures to promote. improve, or conserve the 

mental and physical well-being of Service members. These measures enable a 

healthy and fit force. prevent injury and illness. and protect the force from 

health hazards (also called FHP). 

Health -- A state of complete physical. mental. social. and spiritual well-being 

and not merely the absence of disease or infirmity. 

Human Performance Optimization -- The process of applying knowledge. 

skills and emerging technologies to improve and preserve the capabilities of 

military members, families and organizations to execute essential tasks. 

Resilience -- The ability to withstand, recover. and grow in the face of 

stressors and changing demands. 

Total Force Fitness -- The state in which the individual, family, and 

organization can sustain optlmal well-being and performance under all 

conditions. 

Wen-being -- The state of being happy. healthy. or prosperous. 

WeUness -- Force health protection program that consolidates and 

incorporates physical and mental fitness. health promotion. and environmental 

and occupational health. 

GL-2 Glossary