There are no comprehensive guidelines on how to achieve TFF for military personnel and their families in Iran so that they can be more vulnerable to physical and mental harm during training, deployment, combat, and re-deployment. This lack of fitness causes damage, which is one of the reasons for the loss of working days among military personnel. Every year, the Armed Forces omit a number of military personnel due to the lack of fitness, despite mandatory tests.
In the present study, during 2020–2021, groups of experts in the fields of psychology, health, occupational medicine, sports physiology, etc cooperate and consulate to integrate the components of TFF in Iran. What became clear in the expert panels was the facts that show the tip of the iceberg, and therefore a comprehensive approach to health and fitness management is needed. In these panels, different domains of TFF were defined and some of the available criteria for evaluating TFF were discussed.
In the experts' panels, occupational fitness was set aside and other domains were included in the questionnaires. TOPSIS method revealed the prioritization of the domains as Spiritual fitness, Physical fitness, Environmental fitness, Medical fitness, Behavioral fitness, Mental fitness, Social fitness, Family fitness, and Nutrition fitness.
In this study, all endurance, mobility, strength, and flexibility components related to physical fitness were confirmed. Physical fitness is required for a military member in comparison to the general population, due to the diverse nature of military missions and the heavy military equipment carried by military personnel. How to develop and maximizing the physical fitness of military personnel is possible by training aerobic and anaerobic training consisting of four parts endurance, mobility, strength and flexibility (6,7).
In the present study, all components related to psychological fitness, including mental abilities, problem-solving, optimism, self-confidence, awareness, coping, decision making were approved. Psychological fitness is defined as the integration and optimization of mental, emotional, and behavioral abilities to optimize performance and enhance the resilience of military personnel that can be provided using basic training. These training principles include raising awareness and skills through training, practice and repetition, feedback mechanisms, performance motivations, and adequate challenge to maximize skills (8).
In the present study, hallucinogenic substances abuse in behavioral fitness was not confirmed. The behavioral fitness was generally approved and its components were confirmed. Behavioral fitness plays an important role in long-term health outcomes and current performance. Although substance use and abuse, including tobacco use and drug and alcohol use, have a long history in military life (10), however, substance use is not a major problem for the military in Iran. By the way, in addition to high financial costs, behavioral problems affect military readiness, for example, deprivation of nicotine reduces their awareness and cognitive function (11,12). Weight and sleep are also behavioral psychological factors that affect military readiness. Overweight among military personnel is a growing concern and affects their performance and potential health consequences (13). Sleep problems affect the general population, and in military personnel, sleep disorders are a common complaint during and after dispatch. Poor quality sleep can greatly reduce work efficiency and increase accidents (14).
In the present study, the components of physical examination, vaccination, hearing and vision assessment, lack of contagiousness, mental illness, and sleep are confirmed and important in medical fitness. However, components such as dental health have not been confirmed, so for military personnel, dental health is not very important in medical fitness, and according to tradition, dental health may be more influential in aviation jobs. The main advantage of having medical readiness for military personnel is the maximum ability to perform the mission (15).
In the present study, all components in the physical stressor were confirmed, the components of water pollution in the chemical stressor and the components of insects dangers in the biological stressor were confirmed in the environmental fitness. Environmental fitness is defined as the ability to perform specific mission tasks in any environment and resistance to multiple stressors resulting from deployment and combat. Many specific environmental stressors can be identified, evaluated, and reduced before dispatch. These stressors are usually classified by their physical, chemical, or biological parameters and include heat, cold, altitude, ionizing radiation, noise, hazardous chemicals, ultrafine particles, and biological agents in food, water, or other substances (15).
Food nutrients, proper food, at the right time, with the sufficient amounts and according to physical activity and environmental conditions were confirmed and other components such as having nutritional knowledge, eating behavior, food preparation effect (cooking and storage), excessive daily energy intake, improper use of dietary supplements were not approved. The importance of nutritional fitness for maintaining the health and performance of soldiers was recognized about 150 years ago (16). Proper nutrition of the military person should be considered an essential domain of TFF, because improper nutrition disrupts the readiness of the mission and causes a variety of other health disorders. Proper nutrition prevents disease, improves health, and optimizes emotional, cognitive, and physical abilities. Food provides these benefits by providing nutrients and micronutrients to protect against disease, support damage-related healing processes, and quickly meet emotional, spiritual, and bioenergetic needs. However, how (for example, fast or slow), where, and when (for example, alone or in a group) a person eats a particular meal, independent of the food consumed by the person, can affect the health of the military (17).
All components, including martyrdom, religious beliefs, belief in another world, religiosity, morality, and self-sacrifice were confirmed, and only the distinction between religion and spirituality was not confirmed in spiritual fitness. Martyrdom is specific to the resistance forces and is very important, influential, and valuable, which is one of the strengths of Islamic soldiers. The scientific study of spirituality and health is a very new field. A fivefold increase in research on spirituality and religion from 1990 to 2007 shows an increase in interest in it. Because the field is so new, most research is fundamental rather than applied (18). We do not have proven methods for creating spiritual fitness, preventing moral harm, and improving anxiety in the military environment, but research in these domains is increasing (19). Although religions are spiritual institutions, the importance of distinguishing religion from spirituality has been widely recognized by scholars. However, for some people, including Iranians, all spiritual beliefs and practices fall within the framework of religion. For others, spirituality is largely or completely outside of religion (20). Most of the health benefits of spirituality are not limited to specific components but are due to the combined effect of multiple components in different domains. Benefits that include spiritual and religious factors and have been analyzed 1,200 studies include hope and optimism, less depression, less suicide, less anxiety, less alcohol and drug use, more marital stability, less dangerous behavior, and less death for various reasons (21).
In the present study, the main components of social trust, social participation, social cohesion, social support, and social empowerment in social fitness were confirmed. An extensive study of texts shows that the most common application of the concept of "social fitness" is the concept of social cohesion. Military personnel can be successful in extremely stressful situations, as long as they are dependent on cohesive social groups, as long as the people who are supposed to be with them do not betray them. Stable and cohesive social societies increase individual strengths and protect them from the hostile harms of the world around them (22). For men (usually) in war, a bond of friendship and loyalty develops so strongly and steadily, often much more intensely than the relationship between siblings or children, that the warriors want to sacrifice their lives voluntarily to maintain the survival of bigger unity. Memoirs of Iranian warriors have recorded such facts since the war (22).
The components of life skills, communication, Family intimacy, Anger control, commitment, and loyalty were confirmed as important and influential components in healthy family performance and family fitness. War injuries, both psychological and physical, to a military parent may disrupt family roles, care resources, and supportive tools. These factors emphasize the need to provide family-centered, evidence-based prevention services to military families and their children who have been affected by multiple war separations and the psychological and physical damage associated with parents (23). The concept of TFF will not be complete if each of these domains in question does not exist in the total matrix.
The lack of cooperation from experts to participate in the research project was one of the possible limitations of this study, and frequent visits and repeated invitations from them were on the agenda. Also, the lack of access to some related studies was another possible limitation.