Physiological employment standards IV: integration of women in combat units physiological and medical considerations.

Anthropometric and physiological factors place the average female soldier at a disadvantage relative to male soldiers in most aspects of physical performance. Aerobic and anaerobic fitness levels are lower in women than in men. Thus, women have a lower overall work capacity and must therefore exert themselves more than men to achieve the same output. The lower weight and fat-free mass and the higher body fat of women are associated with lower muscle strength and endurance, placing them at disadvantage compared with men in carrying out military tasks such as lifting and carrying weights or marching with a load. Working at a higher percentage of their maximal capacity to achieve the same performance levels as men, women tire earlier and are at increased risk of overuse injuries. Their smaller size, different bone geometry and lower bone strength also predispose women to a higher incidence of stress fractures. Although training in gender-integrated groups narrows the gaps in fitness, significant differences between the genders after basic training still remain. Nevertheless, integration of women into military combat professions is feasible in many cases. Some 'close combat roles' will still be an exception, mainly because of the extreme physical demands that are required in those units that are beyond the physiological adaptability capacities of an average female. There is no direct evidence that women have a negative impact on combat effectiveness. Once the gender differences are acknowledged and operational doctrines adjusted accordingly, female soldiers in mixed-gender units can meet the physical standards for the assigned missions.