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Alemany, JA, Pierce, JR, Bornstein, DB, Grier, TL, Jones, BH, and Glover, SH. Comprehensive physical activity assessment during U.S. Army Basic Combat Training. J Strength Cond Res XX(X): 000-000, 2021-Physical activity (PA) volume, intensity, and qualitative contextual information regarding activity type and loads carried are limited during U.S. Army Basic Combat Training (BCT). The purpose of this study was to characterize daily (05:00-20:00 hours) PA during BCT using a comprehensive approach. During 2 10-week BCT cycles (n = 40 trainees per cycle), pedometers, accelerometers, and direct observation were used to estimate daily step count, PA volume, and intensity. Physical activity intensity was categorized by metabolic equivalents (METs) such as "sedentary" (1-2 METs), "light" (2-3 METs), "moderate" (3-6 METs), or "vigorous" (≥6 METs). Daily PA data were analyzed longitudinally using linear mixed models, with significance set at p ≤ 0.05. The mean daily step count was 13,459 ± 4,376 steps, and the mean daily accelerometer-assessed PA volume and intensity were as follows: sedentary: 505 ± 98 minutes, light: 190 ± 78 minutes, moderate: 168 ± 51 minutes, and vigorous: 14 ± 14 minutes, with no differences between cycles for all measures (p > 0.50). Cumulative time on feet (∼50%) and sitting (20-25%) accounted for most daily activity types during both cycles. Trainees, on average, carried between 3 and 9 kg, and ≥9 kg, for 60% and 10% of the monitored day, respectively. Basic Combat Training's physical demands are high, where trainees achieved 1.7 to 2.7 times greater daily ambulation and 6 times the recommended weekly moderate-to-vigorous PA compared with civilian counterparts and performed weight-bearing load carriage for nearly half of the day. Basic Combat Training-associated PA may increase injury risk among trainees unaccustomed to arduous PA and exercise. Implementing national PA policies to improve physical fitness and facilitate acclimatization to BCT's high physical demands could reduce public health burdens and military nonreadiness.

IntroductionMilitary studies have investigated acute injuries associated with parachute jumps, but the literature does not address paratroopers’ cumulative microtraumatic (CMT) injury risk, nor does it compare injury risks between paratroopers and the rest of the military population. This study determined whether US active duty Army paratroopers experienced greater injury risks than their non-paratrooper soldier counterparts and whether their injuries cost more to treat suggesting greater injury severity.MethodsThis retrospective study evaluated electronic medical records (2016–2018) for 31 621 paratroopers and a randomly selected comparison group of 170 715 non-paratrooper soldiers. Analyses included univariate and multivariate regression to quantify odds of injuries associated with risk variables and additional descriptive statistics.ResultsParatroopers had a 57% increase in the odds of experiencing one or more injuries (OR=1.57, 95% CI: 1.52 to 1.62) after controlling for sex, race and age, with a greater proportion of acute injuries (OR=1.38, 95% CI: 1.34 to 1.42), relative to comparison group soldiers. Injury types proportionally higher among paratroopers included head trauma and shoulder injuries. Average injury cost among paratroopers was 13% lower than for non-paratroopers ($2470 vs $2830 per injury). Among both populations, acute injury costs were notably higher than for CMT injuries (paratroopers, $1710/$630; non-paratroopers, $1860/$880 per injury).ConclusionsParatroopers were more likely to incur injury, especially an acute injury, than non-paratroopers. However, paratroopers’ average injury costs were less. This may be due to higher return-to-duty motivations, fitness levels, and/or facility-specific cost of care. Future studies should investigate causes of injuries found to be proportionally higher among paratroopers.

IntroductionFalls/near falls are the second leading cause of hospitalisation and outpatient visits among US Army soldiers. While numerous studies have evaluated fall-related or near fall-related injuries among elderly adults, few have evaluated this association among young adults. The objective of this study is to describe the characteristics and risk factors associated with fall-related or near fall-related injuries among male US Army soldiers.MethodsThis is a cross-sectional study of male US Army Airborne Division soldiers (n=5187). Electronic surveys captured demographic, lifestyle, physical training (PT), fitness and injury data during spring/summer of 2016. Multiple logistic regression was used to identify independent risk factors of fall-related or near fall-related injuries, adjusting for potential confounders.ResultsPrimary findings indicated that activities and risk factors associated with fall-related or near fall-related injuries among soldiers included younger age (≤35 years), holding a job that required minimal lifting activities, slower 2-mile run times and not running during personal PT.ConclusionsThe findings from this study suggest that male US Army soldiers and other physically active men may benefit from (1) obtaining and/or maintaining higher aerobic endurance and muscular strength, and (2) training focused on preventing fall-related injuries during PT, road marching and sports/recreational activities. Moreover, prevention strategies and education should further target younger soldiers (≤35 years old), as younger age is not modifiable.

Adverse effects of cigarette smoking on physical performance are well studied. Because of the recent rise in popularity of vaping, it is important to evaluate its effect on fitness both independently and in conjunction with traditional cigarette use.This was a secondary analysis performed in 2018 on data collected from U.S. Army Soldiers during 2016. All metrics were self-reported via an electronic questionnaire. Personal characteristics of current ENDS users, smokers, and dual users were compared with a reference group that reported no history of use. Adjusting for age and physical training habits, an ANCOVA was used to compare Army physical fitness test results. A Fisher's exact test determined specific mean differences between groups.This study population consisted of 2,854 men aged 24.6 years on average. Differences in physical training and fitness were shown between the groups. Never users averaged the most total physical training, followed by ENDS users, smokers, and then dual users. Compared with never users on the fitness tests, ENDS users had an adjusted mean difference of +27 seconds on the 2-mile run, -4.56 push-ups, and -2.01 sit-ups; smokers averaged +8 seconds, -2.15 push-ups, and -1.44 sit-ups; and dual users averaged +32 seconds, -5.17 push-ups, and -3.88 sit-ups. Dual users had significantly (p0.05) lower scores than current smokers and never users on all 3 fitness events.This study suggests that individuals who use e-cigarettes and tobacco cigarettes average a lower level of fitness than individuals who abstain.

Background Self-reported injury data are frequently used in epidemiologic investigations. These data provide useful information about the activities and mechanisms of injuries because injury cause-coding is often not required for outpatient medical visits. Objectives The purpose of this evaluation is to determine the accuracy of self-reported military injuries when compared to injuries in outpatient medical records. Method Injuries reported by survey were compared to diagnoses for injuries (International Classification of Diseases (ICD-9-CM 800–999)) and injury-related musculoskeletal disorders (selected ICD-9-CM 710–739) obtained from medical records. Self-reported injury responses from military personnel were matched to diagnoses by date and body part. A new methodology for including secondary matching body parts was proposed and implemented. Results Infantry Soldiers (n = 5490) completed surveys that requested details about their most recent injury. About one-quarter (24%, n = 1336) reported injuries on the survey and had an injury diagnosis in their medical record in a six month period. Seventy-five percent of the self-reported injuries (n = 996 of 1336) were confirmed by medical records with a date match within 3 months and an identical or nearby body part. Common self-reported injuries were ankle sprains (10%), knee sprains (9%), lower back strains (4%), shoulder strains (3%), and lower back pain (3%). Conclusions A high percentage of self-reported injuries were accurate when compared with medical records, substantiating the use of survey data for the evaluation of injury outcomes. This is the first effort to validate self-reported injuries and musculoskeletal disorders with medical records in a large military population.

IntroductionMultiple studies report increasing cases of surgically treated pectoralis major (PM) muscle and tendon ruptures in military populations. Studies associate this with a growing popularity of weight-training and bench press exercises. Mild-to-moderate non-surgical PM traumas and overuse injuries have not been included in these studies despite evidence that these types of outpatient injuries account for the majority of the military’s injury medical burden.MethodsTo assess rates of all PM injuries (ruptures, tears, strains, overuse), regardless of form of treatment, a PM injury surveillance definition was derived from International Classification of Disease (ICD) diagnostic codes used in routine US Army injury surveillance. A detailed clinical examination of 2016 Active Duty Army medical records was used to identify ICD codes commonly associated with PM injuries. Cost data were calculated and the definition applied to medical data from 2016 through 2018to assess trends.ResultsThe estimated incidence of PM cases among soldiers was over 95% greater than if only considering severe surgical cases. Over 96% of army annual PM injury costs (direct medical and indirect from lost labour) were for outpatient services. PM injury incidence rates were not statistically different from 2016 to 2018.ConclusionsThe PM injury surveillance definition provides a consistent means to monitor trends over time and evaluate the effectiveness of prevention efforts. PM injuries have a larger military impact than previously recognised and prioritised prevention strategies are needed to reduce them. Future interventions could focus on the bench press given its observed association with PM injuries.

Grier, T, Brooks, RD, Solomon, Z, and Jones, BH. Injury risk factors associated with weight training. J Strength Cond Res XX(X): 000-000, 2020-The purpose of this evaluation was to identify injury risk factors associated with weight training (WT). Subjects were 4,785 men and 542 women in a U.S. Army Division. Personal characteristics, unit training, personal training, fitness, and 12-month injury history were obtained by an electronic survey. Risk factors for WT injuries were explored using backward stepping multivariable logistic regression. Risk ratios, odds ratios (ORs), and 95% confidence intervals (95% CIs) were calculated for each risk factor. Over a one-year period, 4.5% of men and 0.6% of women experienced a WT injury. Weight-training injury incidence was 0.31 and 0.05 per 1,000 hours of WT for men and women, respectively. Overall, men were 7.4 times more likely to experience a WT injury compared with women. For men who participated in WT, independent risk factors for a WT injury included older age (OR [23-27/≤ 22 years] = 1.99, 95% CI 1.22-3.27; OR [>28/≤ 22 years] = 2.48, 95% CI 1.52-4.03) and higher amounts of personal WT per week (OR [60-165/≥ 166 minutes] = 0.58, 95% CI 0.39-0.88; and OR [15-59/≥ 166 minutes] = 0.40, 95% CI 0.24-0.66). A linear trend was revealed indicating an increasing risk of a WT injury with greater amounts of time spent WT per week (p < 0.01). Performing moderate amounts of WT may reduce the risk of experiencing a WT injury. However, because muscle strength is an important component of fitness for Soldiers, specialized WT programs that improve strength while minimizing injury risks are needed.

Background Prior studies have identified cigarette smoking and low fitness as independent risk factors for injury; however, no studies have evaluated the combined effect of cigarette smoking and fitness on injury risk. Objective To evaluate the combined effect of cigarette smoking and fitness on injury risk in men and women. Design This is a secondary analysis of data collected from US Army recruits (n = 2000) during basic combat training within the United States in 2007. Physical training and fitness, cigarette smoking, and prior injury data were obtained from questionnaires, whereas demographic and injury data were obtained from medical and basic combat training unit records. Chi-squared tests were used to assess differences in injury risk by fitness level and cigarette smoking. Relative risk values were calculated with 95% confidence intervals. Results The primary findings showed that smokers experienced 20%–30% higher risk of injury than nonsmokers. In addition, higher aerobic and muscular fitness was generally not protective against injury between least fit and more fit smokers. However, higher fitness was protective against injury between least and more fit nonsmokers, with least fit nonsmokers being 30%–50% more likely to experience an injury than fit nonsmokers. Conclusion This study revealed that higher aerobic and muscular fitness was not protective against injury among smokers; however, it was protective against injury among nonsmokers. Further implementation of smoking cessation programs may be beneficial for military and civilian personnel who are required to be physically fit in order to carry out their job responsibilities. Implications Male and female smokers experienced significantly higher risk of injury than nonsmokers. Although higher fitness is protective against injury in nonsmokers, the protective effect of fitness is lost among smokers. In an attempt to reduce injury risk among military and emergency personnel, smoking cessation programs should be further implemented among both more fit and less fit smokers.

There is limited literature concerning the types of injuries that military working dogs (MWDs) face while in a deployed theater of operations and associated risk factors. To summarize injuries and identify injury risk factors in MWDs during their first deployments to Iraq, demographic and medical data were collected for 794 MWDs from the U.S. Army, Air Force, Navy, and Marine Corps that deployed to Iraq between March 20, 2003 and December 31, 2007. Sixty-two percent (n = 490) had a medical encounter during deployment. Injuries were categorized as traumatic or musculoskeletal. MWD demographics, characteristics, and injury types were summarized. Injury risk factors were assessed using multivariable logistic regression. A majority of the population were German Shepherds (56 %), intact males (49 %), and dogs certified in both patrol and explosives detection (73 %). During their first deployment to Iraq, 20 % (n = 156) experienced an injury. Risk factors included breed, age, and occupational certification. Belgian Malinois and Labrador Retriever dogs had greater odds of injury compared to German Shepherds (p = 0.04 and p = 0.02) and the oldest MWDs had about a 50 % higher risk of injury compared to the youngest (p = 0.01), especially for musculoskeletal injuries. MWDs with Specialized Search certification were at increased injury risk (p = 0.02). Training, equipment, and supplies for veterinary service personnel, MWD handlers, and MWDs should be tailored with consideration of the injury risks of the MWD population. Further study is needed to investigate chronic injuries in military working dogs to better understand causation and prevention.

Objectives Army body composition standards are based upon validated criteria; however, certain field-expedient methodologies (e.g., weight-for-height, body mass index [BMI]) may disqualify individuals from service who may otherwise excel on physical performance and military-relevant tasks. The purpose was to assess soldier physical performance and military-specific task/fitness performance stratified by BMI. Design Cross-sectional observational study. Methods Male (n = 275) and female (n = 46) soldiers performed a wide-array of physical fitness tests and military-specific tasks, including the Army physical fitness test (APFT). Within-sex performance data were analyzed by BMI tertile stratification or by Army Body Composition Program (ABCP) weight-for-height (calculated BMI) screening standards using ANOVA/Tukey post-hoc or independent t-tests, respectively. Results BMI stratification (higher vs. lower BMI) was associated with significant improvements in muscular strength and power, but also with decrements in speed/agility in male and female soldiers. Within the military specific tasks, a higher BMI was associated with an increased APFT 2-Mile Run time; however, performance on a 1600-m Loaded March or a Warrior Task and Battle Drill obstacle course was not related to BMI in either sex. Male and Female soldiers who did not meet ABCP screening standards demonstrated a slower 2-Mile Run time; however, not meeting the ABCP BMI standard only affected a minimal number (∼6%) of soldiers’ ability to pass the APFT. Conclusions Military body composition standards require a careful balance between physical performance, health, and military readiness. Allowances should be considered where tradeoffs exist between body composition classifications and performance on physical tasks with high military relevance.

Objectives To determine the age- and sex-specific differences of physical fitness performances and Body Mass Index (BMI) in basic training and the operational Army. Design Cross-sectional Study. Methods This secondary analysis utilizes retrospective surveys of U.S. Army Soldiers in Basic Combat Training (BCT) and operational units to compare physical performances between men and women as measured by the Army Physical Readiness Test (APFT). An ANOVA was used to compare mean differences in APFT results and BMI within sex-specific populations. A post hoc Tukey test identified specific mean differences. Adjusting for age, an ANCOVA was used to compare sex and occupation (infantry and non-infantry) differences in APFT results. Results Surveyed populations consisted of 2216 BCT Soldiers (1573 men and 643 women) and 5515 Operational Soldiers (4987 men and 528 women). Male and female operational Soldiers had greater muscular performance (79%–125% higher APFT push-ups, 66%–85% higher APFT sit-ups) and cardiorespiratory performance (22%–24% faster APFT 2-mile run times) than BCT Soldiers. Male BCT and operational Soldiers outperform their female counterparts on tests of muscular and cardiorespiratory endurance. Sex differences in physical performances attenuated among female Soldiers in operational units compared to BCT. Among male operational Soldiers, infantry Soldiers exhibited greater cardiorespiratory and muscular performance than non-infantry Soldiers. Higher BMI was associated with higher age groups, except for female BCT Soldiers. Conclusions Gaps in cardiorespiratory and muscular performances between men and women should be addressed through targeted physical training programs that aim to minimize physiological differences.

The goals of this project were to quantify medical problems among a population of Military Working Dogs (MWDs) and analyze factors associated with common medical conditions. Medical conditions recorded in veterinary Master Problem List (MPL) entries for 774 young, non-deployed, active MWDs were categorized and combined with demographic information to analyze risk factors. Most dogs were male (74%), German Shepherd (39%) or Belgian Malinois (31%) breeds, certified in Explosive Detection (60%), and had a dark coat color (83%). Ages ranged from one to six years, with an average of 2.6 years (± 0.5 years). Eighty-three percent of dogs had a non-surgical medical problem in their record. The most common non-surgical medical problems were dermatologic (25% of MPL entries), alimentary (21%), dental (15%), soft-tissue injury (10%), and musculoskeletal conditions (4%). Factors associated with each medical condition were breed (Odds Ratios 1.96-8.24), sex and spay/neuter status (ORs 1.78-5.77), occupational duty certification (ORs 2.65-3.62), military command location (ORs 2.32-7.44), and military branch (OR 5.16). As MWDs are a valuable asset for the Department of Defense, training and work conditions for the identified at-risk groups of MWDs should be further assessed to maximize their operational capabilities and assess the potential to serve as sentinel indicators for human diseases. Improved understanding of the most common medical problems affecting MWDs, and the identification of factors associated with these conditions, can help drive changes in their preventive care.

In physically demanding occupations or athletic populations, sleep has been shown to be an important factor for both performance and recovery. However, evidence is limited on sleep duration and its association with musculoskeletal injury risk in physically active populations. Therefore, the purpose of this analysis was to evaluate the relationship between sleep duration and musculoskeletal injury incidence in a population of physically active men and women.Data were collected via electronic survey and analyzed for 7,576 soldiers from the United States Army Special Operations Command.This population was mostly men (95%) ≤ 35 years old (70%). The incidence of musculoskeletal injury was 53% over the twelve months before survey administration. After adjusting for other covariates, soldiers who slept ≤ 4 hours were 2.35 (95% CI: 1.89-2.93, p0.01) times more likely to experience a musculoskeletal injury compared with those who slept eight ≥ 8 hours. When stratified by age (≤ 35 years,35 years), older men were found to have significantly higher risk of a musculoskeletal injury than their younger counterparts across all sleep duration groups.These findings suggest that sleep duration may be inversely related to risk of musculoskeletal injury. It is possible that interventions targeted at sleep may have a positive impact on prevention of musculoskeletal injuries within physically active populations.

Background Musculoskeletal injuries (MSKIs) are common in military trainees and present a considerable threat to occupational fitness, deployability, and overall military readiness. Despite the negative effects of MSKIs on military readiness, comprehensive evaluations of the key known and possible risk factors for MSKIs are lacking. The U.S. Army Research Institute of Environmental Medicine (ARIEM) is initiating a large-scale research effort, the ARIEM Reduction in Musculoskeletal Injury (ARMI) Study, to better understand the interrelationships among a wide range of potential MSKI risk factors in U.S. Army trainees in order to identify those risk factors that most contribute to MSKI and may be best targeted for effective mitigation strategies. Methods This prospective study aims to enroll approximately 4000 (2000 male and 2000 female) U.S. Army trainees undergoing Basic Combat Training (BCT). Comprehensive in-person assessments will be completed at both the beginning and end of BCT. Participants will be asked to complete surveys of personal background information, medical history, physical activity, sleep behaviors, and personality traits. Physical measurements will be performed to assess anthropometrics, tibial microarchitecture and whole body bone mineral density, muscle cross-sectional area, body composition, and muscle function. Blood sampling will be also be conducted to assess musculoskeletal, genetic, and nutritional biomarkers of risk. In addition, participants will complete weekly surveys during BCT that examine MSKI events, lost training time, and discrete risk factors for injury. Participants’ medical records will be tracked for the 2 years following graduation from training to identify MSKI events and related information. Research hypotheses focus on the development of a multivariate prediction model for MSKI. Discussion Results from this study are expected to inform current understanding of known and potential risk factors for MSKIs that can be incorporated into solutions that optimize Soldier health and enhance military readiness.

Injuries are a leading health and readiness concern for the US Army. For effective prevention planning, details concerning circumstances associated with injuries are needed. Over 5,000 Soldiers were surveyed to collect demographic and injury details (type, body part, mechanism, activity, limited duty days); 874 reported an injury within 6 months of survey administration. The greatest proportion of limited duty time was associated with knee (19.2%), ankle (14.8%), and lower back injuries (12.9%). Overexertion was the leading injury mechanism (43.9%), followed by falls, jumps, trips, and slips (35.2%), which accounted for the highest average limited duty days per injury (42±43 days). Running was the leading activity associated overexertion injuries (39.3%) and falls (30.5%). Running also accounted for the greatest total limited duty days (5,844 days, 29.8%). For Army infantry units, results suggested a focus of prevention activities on running-related injuries resulting in overexertion or falls. Healthcare providers can facilitate injury prevention with contributions to initiatives providing details on injury mechanisms and activities associated with injuries.

This investigation aimed to identify risk factors for lower extremity sprain/strain injuries in physically active men. Lower extremity (LE) sprain/strain injuries are a significant source of morbidity among physically active populations. Data on and risk factors for injuries, including personal characteristics, and physical training and fitness were obtained from male Soldiers in an operational US Army division (N=6,865) by survey. Injury risks, risk ratios (RR), odds ratios (OR), and 95% confidence intervals (95% CI) were calculated. Multivariate analysis utilized logistic regression. Self-reported injury incidence for the prior 12 months was 43% (n=2,939), with 30% (n=878) of injuries attributed to LE sprains/strains. Lower extremity sprain/strain injuries were most commonly caused by falls, jumps, trips, or slips (49.4%), occurred while running (30.6%), and often resulted in limited duty profiles (64%). Higher risk of LE sprain/strain injury was independently associated with higher body mass index (ORoverweight/normal=1.2, 95% CI: 1.0-1.5), (ORobese/normal=1.4, 95% CI: 1.1-1.9), lower aerobic endurance (from 2-mile run time) (ORQuartile 2 (Q2)/Quartile 4 (Q4)=1.4, 95% CI: 1.0-1.8), (ORQuartile 1 (Q1)/Q4=1.6, 95% CI: 1.3-2.1), and lower core strength (sit-up repetitions) (ORQ1/Q4=1.4, 95% CI: 1.1-1.8). Lower risk of LE sprain/strain injury was associated with performing unit resistance training 3 or more times per week (OR3 times/none=0.5, 95% CI: 0.3-0.8). LE sprain/strain injuries contribute a significant portion of injuries among US Army Soldiers. Emphasis on aerobic fitness, core strength, and resistance training may help reduce the risk of LE sprain/strain injury among physically active men.

Many epidemiological studies rely on valid physical fitness data. The purpose of this investigation was to assess the validity of self-reported Army Physical Fitness Test (APFT) data and determine whether men and women recall APFT performance differently. U.S. Army soldiers (N = 1,047) completed a survey, including questions on height, weight, and most recent APFT performance. Height, weight, and APFT performance were also obtained from unit records. The mean ± SDs for unit and self-reported push-up repetitions were 63.5 ± 13.1 and 66.3 ± 14.0 for men and 37.7 ± 12.8 and 40.2 ± 12.8 for women, respectively. The mean ± SD for unit- and self-reported sit-up repetitions were 66.3 ± 11.4 and 68.1 ± 12.1 for men and 64.2 ± 13.6 and 66.5 ± 12.9 for women, respectively. The mean ± SD unit- and self-reported 2-mile run times were 15.2 ± 1.8 and 14.9 ± 1.6 minutes for men, and 18.0 ± 2.9 and 17.4 ± 1.9 minutes for women, respectively. Unit- and self-reported body mass indices (BMIs) (calculated by height and weight) were 26.4 ± 3.4 and 26.3 ± 3.6 for men and 24.6 ± 2.8 and 24.2 ± 3.3 for women. Correlations between unit- and self-reported scores for push-ups, sit-ups, 2-mile run, height, weight, and BMI were 0.82, 0.78, 0.85, 0.87, 0.97, and 0.88 for men and 0.86, 0.84, 0.87, 0.78, 0.98, and 0.78 for women, respectively. On average, men and women slightly overreported performance on the APFT and overestimated height, resulting in underestimated BMI. There was no difference in recall ability between men and women (p > 0.05). The very good to excellent correlations (r = 0.78-0.98) between unit- and self-reported scores indicate that self-reported data are valid for capturing physical fitness performance in this population.

Background: The Functional Movement Screen (FMS) is a series of 7 tests used to assess the injury risk in active populations. Purpose: To determine the association of the FMS with the injury risk, assess predictive values, and identify optimal cut points using 3 injury types. Study Design: Cohort study; Level of evidence, 2. Methods: Physically active male soldiers aged 18 to 57 years (N = 2476) completed the FMS. Demographic and fitness data were collected by survey. Medical record data for overuse injuries, traumatic injuries, and any injury 6 months after the FMS assessment were obtained. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated along with the receiver operating characteristic (ROC) to determine the area under the curve (AUC) and identify optimal cut points for the risk assessment. Risks, risk ratios (RRs), odds ratios (ORs), and 95% CIs were calculated to assess injury risks. Results: Soldiers who scored ≤14 were at a greater risk for injuries compared with those who scored >14 using the composite score for overuse injuries (RR, 1.84; 95% CI, 1.63-2.09), traumatic injuries (RR, 1.26; 95% CI, 1.03-1.54), and any injury (RR, 1.60; 95% CI, 1.45-1.77). When controlling for other known injury risk factors, multivariate logistic regression analysis identified poor FMS performance (OR [score ≤14/19-21], 2.00; 95% CI, 1.42-2.81) as an independent risk factor for injuries. A cut point of ≤14 registered low measures of predictive value for all 3 injury types (sensitivity, 28%-37%; PPV, 19%-52%; AUC, 54%-61%). Shifting the injury risk cut point of ≤14 to the optimal cut points indicated by the ROC did not appreciably improve sensitivity or the PPV. Conclusion: Although poor FMS performance was associated with a higher risk of injuries, it displayed low sensitivity, PPV, and AUC. On the basis of these findings, the use of the FMS to screen for the injury risk is not recommended in this population because of the low predictive value and misclassification of the injury risk.

Objectives The objectives of the study are to quantify the proportion of cumulative microtraumatic overuse injuries in a physically active population, evaluate their impact in terms of lost work time, and link them to precipitating activities to inform prevention initiatives. Study design The study design is retrospective cohort study. Methods For a population of U.S. Army Soldiers, diagnoses from medical records (International Classification of Diseases [ICD]-9 800–999 and selected ICD-9 710–739) were matched with self-reported injury information. Common diagnoses, limited duty days, and activities and mechanisms associated with the injuries were summarized. Results Most self-reported injuries (65%) were classified by providers with diagnoses that described cumulative microtraumatic tissue damage, and these injuries led to a higher incidence of limited duty (85%) than acute traumatic injury diagnoses. Reported mechanisms and activities often indicated repetitive physical training-related onset. Conclusions Because many diagnoses for cumulative microtraumatic musculoskeletal tissue damage are categorized as diseases to the musculoskeletal system in the International Classification of Diseases, they are often not included in definitions of injury. However, reported injury activities and mechanisms in this population provide evidence that cumulative microtraumatic injuries often arise from identifiable and preventable events. This finding confirms that these diagnoses should be classified as injuries in epidemiologic evaluations and surveillance to accurately represent injury burden.

We sought to assess the rehabilitation process, training, performance, and injury rates among those participating and not participating in the Tactical Human Optimization, Rapid Rehabilitation, and Reconditioning (THOR3) program and determine injury risk factors.A survey inquiring about personal characteristics, injuries, physical performance, and THOR3 participation during the previous 12 months was administered to Army Special Operations Forces (SOF) Soldiers. Based on responses to physical training, Soldiers were categorized into three groups: a traditional physical training (TPT) group, a cross-training (CT) group, and a THOR3 group. To identify potential injury risk factors, risk ratios and 95% confidence intervals (95% CIs) were calculated. Backward- stepping multivariable logistic regression models were used to assess key factors associated with injury risk.The survey was completed by 328 male Soldiers. Most of the Soldiers (62%) who scheduled an appointment with the physical therapist were seen within 1 day. Self-reported injury rates for the TPT, CT, and THOR3 groups were 70%, 52%, and 48%, respectively. When controlling for personal characteristics, unit training, and fitness, the TPT group had a marginally higher risk of being injured than the THOR3 group (odds ratio [OR], 2.72; 95% CI, 0.86-8.59; p = .09). Soldiers who did not perform any unit resistance training (ORnone/90-160 min, 3.62; 95% CI, 1.05-12.53; p = .04) or the greatest amount of resistance training (OR160 min/90-160 min, 3.44; 95% CI, 1.64-7.20; p.01) were more likely to experience an injury than the moderate-resistance training group.THOR3 appears to offer human performance optimization/injury prevention advantages over other SOF human performance programs.

Musculoskeletal injuries (MSIs) result in the most medical encounters, lost duty days, and permanent disability. Women are at greater risk of injury than men and physical training is the leading cause of injury. The purpose of this study was to investigate the demographic, body composition, fitness, and physical training risk factors for injuries in female Soldiers serving in garrison Army units over the past 12 months. Self-report survey was collected from 625 women. The ankle was the most frequently injured body region, 13%. Running was the activity most often associated with injury, 34%. In univariate analysis lower rank, older age, history of deployment, no unit runs, weekly frequency of personal resistance training, and history of injury were all associated with injury. In multivariate analysis rank, history of injury, weekly frequency of unit runs, and weekly frequency of personal resistance training were the best combination of predictors of injury. Running once or twice a week with the unit protected against MSIs, whereas participating in personal resistance training sessions once or twice a week increased the risk of MSIs. With more emphasis on running and resistance training, the U.S. Army could reduce injuries and save billions of dollars in training and health care costs.

Introduction The purpose of this investigation was to examine changes over time in the physical fitness of the United States (US) Army infantry. A systematic review was conducted to identify and analyze articles and databases that reported on physical characteristics (height, weight, and body mass index) and/or Army Physical Fitness Test (APFT) scores of male infantrymen or men in infantry units. Materials and methods The National Library of Medicine's PubMed and the Defense Technical Information Center were searched using specific keywords. Reference lists of obtained articles, specific author searches, contact with authors, and secondary analysis of available databases enhanced the search. Studies and databases were selected if they involved infantry soldiers or soldiers in infantry units and provided a quantitative assessment of at least one physical characteristic or APFT measure. Average values for each measure were obtained, plotted by the year of data collection, and fitted to linear regression models. Results Thirty-one articles and five available databases met the review criteria encompassing years 1976-2015. Regression analysis suggested a small temporal increase in height for infantry soldiers (2%) and soldiers in infantry units (1%). Body weight and body mass index increased over the period (9-15%) in both groups. APFT performance of infantry soldiers was generally higher than that of infantry units. There was little change in APFT performance over the period for infantry soldiers. For soldiers in infantry units, push-up performance changed little over time, whereas sit-up performance increased (8%) and two-mile run performance decreased (8%). Conclusion Over the surveyed period, body weight and body mass index increased in US Army infantry soldiers and soldier in infantry units. Infantry soldier performance on the APFT appears to have been maintained over the period. For soldiers in infantry units, there has been a small improvement in sit-up performance, but lower two-mile run performance.

To investigate the effects of age, aerobic fitness, and body mass index (BMI) on injury risk in operational Army soldiers.Retrospective cohort study.Male soldiers from an operational Army brigade were administered electronic surveys regarding personal characteristics, physical fitness, and injuries occurring over the last 12 months. Injury risks were stratified by age, 2-mile run time, and BMI. Analyses included descriptive incidence, a Mantel-Haenszel χForty-seventy percent of 1099 respondents reported at least one injury. A linear trend showed that as age, 2-mile run time, and BMI increased, so did injury risk (p0.01). When controlling for BMI, the most significant independent injury risk factors were older age (odd ratio (OR) 30years-35years/≤24years=1.25, 95%CI: 1.08-2.32), (OR≥36years/≤24years=2.05, 95%CI: 1.36-3.10), and slow run times (OR≥15.9min/≤13.9min=1.91, 95%CI: 1.28-2.85). An ANOVA showed that both run times and BMI increased with age.The stratified analysis and the multivariable logistic regression suggested that older age and poor aerobic fitness are stronger predictors of injury than BMI.

Objectives Road marching is an important physical training activity that prepares soldiers for a common occupational task. Continued exploration of risk factors for road marching-related injuries is needed. This analysis has assessed the association between modifiable characteristics of physical training and injury risk. Methods Injuries in the previous 6 months were captured by survey from 831 U.S. Army infantry soldiers. Road marching-related injuries were reported as those attributed to road marching on foot for specified distances while carrying equipment. Frequencies, means, and relative risk ratios (RR) for road marching-related injury with 95% confidence intervals (CI) were calculated. Adjusted odds ratios (OR) and 95% CI were calculated for leading risk factors using multivariable logistic regression. Design Retrospective cohort study. Results Half (50%) of reported injuries were attributed to road marching or running. When miles of exposure were considered, injury risk during road marching was higher than during running (RRroad marching/running = 1.8, 95% CI: 1.38–2.37). A higher product of road marching distance and weight worn (pound-miles per month) resulted in greater injury risk (RR≥1473 pound-miles/ 25% of one’s body weight (OR>25%/1-20% = 2.09, 95% CI: 1.08–4.05), having high occupational lifting demands (OR50-100+lbs/25-50lbs = 3.43, 95% CI: 1.50–7.85), road marching ≥5 times per month (OR≥5 times/4 times = 2.11, 95% CI: 1.14–3.91), and running Conclusions Ideally, attempts should be made to decrease the percentage of body weight carried to reduce road marching-related injuries. Since this is not always operationally feasible, reducing the cumulative overloading from both physical training and occupational tasks may help prevent injury.

Grier, TL, Canham-Chervak, M, Bushman, TT, Anderson, MK, North, WJ, and Jones, BH. Evaluating injury risk and gender performance on health- and skill-related fitness assessments. J Strength Cond Res 31(4): 971-980, 2017-The purpose of this analysis was to investigate the association of injury risk and gender performance on health- and skill-related fitness assessments. A survey was used to collect personal characteristics and Army Physical Fitness Test scores (2-mile run, push-ups, and sit-ups). Within the same day, 9 physical fitness assessments were performed. Percent body fat was estimated using height, weight, age, and sex. All fitness assessment data were categorized into tertiles of high, moderate and low performance. To investigate potential injury risk predicted by fitness assessment performance, injury risk ratios, odds ratios (ORs), and 95% confidence intervals (CIs) were calculated using medical record data. A total of 3,264 soldiers completed surveys and physical fitness assessments. Tertiles of fitness performance with men and women combined showed that on an average, 14% of women and 70% of men were in the moderate- and high-performance groups. Among men, higher injury risk was independently associated with low performance on a 2-mile run (ORslow/fast = 1.51, 95% CI 1.18-1.94) and low performance on a weighted 300-yard shuttle run (ORslow/fast = 1.36, 95% CI 1.06-1.74). For women, a higher risk of injury was associated with low performance on the 2-mile run (ORslow/fast = 2.38, 95% CI 1.04-5.74). Therefore, out of the 13 fitness assessments, the 2-mile run and weighted 300-yard shuttle run can also (in addition to measuring performance) be utilized to identify soldiers or athletes who are at a higher risk of experiencing an injury.

Objectives The Functional Movement Screen (FMS™) has been used as a screening tool to determine musculoskeletal injury risk using composite scores based on movement quality and/or pain. However, no direct comparisons between movement quality and pain have been quantified. Design Retrospective injury data analysis. Methods Male Soldiers (n = 2154, 25.0 ± 1.3 years; 26.2 ± .7 kg/m 2 ) completed the FMS (scored from 0 points (pain) to 3 points (no pain and perfect movement quality)) with injury data over the following six months. The FMS is seven movements. Injury data were collected six months after FMS completion. Sensitivity, specificity, receiver operator characteristics and positive and negative predictive values were calculated for pain occurrence and low (≤14 points) composite score. Risk, risk ratios (RR) and 95% confidence intervals were calculated for injury risk. Results Pain was associated with slightly higher injury risk (RR = 1.62) than a composite score of ≤14 points (RR = 1.58). When comparing injury risk between those who scored a 1, 2 or 3 on each individual movement, no differences were found (except deep squat). However, Soldiers who experienced pain on any movement had a greater injury risk than those who scored 3 points for that movement (p Conclusions Pain occurrence may be a stronger indicator of injury risk than a low composite score and provides a simpler method of evaluating injury risk compared to the full FMS.

Grier, TL, Canham-Chervak, M, Anderson, MK, Bushman, TT, and Jones, BH. Effects of physical training and fitness on running injuries in physically active young men. J Strength Cond Res 31(1): 207-216, 2017-The purpose of this investigation was to determine the effects of physical training (PT) and fitness on risks for running-related injuries (RRIs) in physically active young men. Personal characteristics, PT, Army Physical Fitness Test scores, and injury data were obtained by survey. Army Physical Fitness Test variables (push-ups, sit-ups, and 2-mile run) were converted into quartiles (Q), where Q1 = lowest performance and Q4 = highest performance. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated using multivariate logistic regression. Over 4,000 (n = 4,236) soldiers were surveyed. Running injury incidence was 14%. A greater risk of an RRI was associated with older age (OR31+/

Purpose: The purpose of this study was to look at the effect of additional individual physical training (PT) in addition to mandatory unit PT as well as other risk factors on physical fitness. Design: A cross-sectional design. Setting: This study was conducted on a US military installation. Participants: Participants were 6290 male and 558 female active duty US Army soldiers in 3 light infantry brigades. Measures: Participants completed self-administered questionnaires asking about individual characteristics, PT, and physical fitness. Cut points were established for soldiers scoring within the top 33% for each of the 3 Army Physical Fitness Test events (2-mile run, sit-ups, and push-ups) and top 50% in each of the tests combined for overall performance. Analysis: Odds ratios and 95% confidence intervals from multivariate analyses were calculated. Results: Variables impacting physical fitness performance of men and women included increased body mass index, leading unit PT sessions, and individual distance running mileage. Other variables impacting physical performance for men included increased age, smoking, and individual resistance training. Conclusion: Soldiers performing additional individual PT demonstrated a positive influence on fitness compared to unit PT participation alone. Increased age and being overweight/obese negatively influenced physical fitness. To enhance fitness performance through unit PT, running by ability groups and resistance training should be encouraged by leadership.

Two years after the closing of the Army Physical Fitness Research Institute, an active duty Army physical therapist was once again assigned to serve the Army Sergeants Major Academy (SMA) students. Purpose: To evaluate the effects of an on-site physical therapist on injuries and physical fitness of Sergeants Major Course (SMC) students and assess risk factors for injury among the SMC students. Methods: Injury risk factors, physical fitness, and injury data were collected by survey from a SMC class with a physical therapist, Class 64, in September 2013 and May 2014. SMC Class 63 did not have a dedicated, on-site physical therapist (PT), so was used for comparison. For both classes, rosters and electronic APFT results were obtained from the SMA and medical records were obtained from the Defense Medical Surveillance System (DMSS). Semi-structured interviews with the SMC physical therapist provided initial program background and intent, and follow-up details of the program implementation, strengths, weaknesses, and next steps. Results: A total of 406 students in Class 64 took both surveys (77 percent). Most students who took both surveys were male (89 ), over age 40 (62 ), Army (93 ) and active duty (90 ). APFT run times and BMI did not change during SMC attendance, while APFT sit-up and push-up performance increased by 2 to 3 repetitions. The proportion of students treated for injury during the SMC for Class 64 was slightly higher than Class 63 (70 vs. 64 , p=0.07). The incidence of lower extremity injury medical encounters was statistically significantly higher in Class 64 (57 vs. 50 , p=0.02). Nearly half of all SMC students in Class 64 had seen the SMC physical therapist and 46 percent of those who had seen the physical therapist stated they would not have sought physical therapist care if she had not been co-located at the school. Conclusions: Based on this evaluation of the short-term effects on injury and fitness, we... (cont.)

PURPOSE: This document summarizes current literature regarding injuries associated with foot marching and operational military tasks such as patrolling that require Soldiers to carry heavy loads of equipment and supplies. These are often referred to as load-carriage injuries in scientific literature. Other terms used by the Army to describe activities associated with load-carriage injuries include ruck marches, forced marches, loaded marches, road marches, and patrolling. BACKGROUND: In recent operations Soldiers have frequently carried loads weighing over 100 pounds. These weights exceed guidelines for optimal military performance thresholds for combat operations (20 to 30 body weight) and sustained non-contact operations (45 body weight). Heavy loads carried on the body have been shown to increase the energy cost of locomotion, lead to more rapid fatigue, alter the mechanics of walking, and place stresses on the musculoskeletal system. These factors increase Soldiers risk of developing a variety of injuries related to foot march training and operational military tasks such as patrolling. Military leaders, medical providers, and Soldiers have expressed increasing interest in learning about preventing these foot marching related injuries. RESULTS: This paper provides recommended prevention strategies and guidelines that are best supported by the available evidence. As there still remain notable data gaps regarding exposures and effective means to reduce these injuries, this paper also provides specific recommendations for future study design, data collection, and for routine military documentation of Soldier foot marching exposures (frequencies, amount of weights, durations/distances, and speeds).

Background: Minimalist running shoes (MRS) are lightweight, are extremely flexible, and have little to no cushioning. It has been thought that MRS will enhance running performance and decrease injury risk. Purpose: To compare physical characteristics, fitness performance, and injury risks associated with soldiers wearing MRS and those wearing traditional running shoes (TRS). Study Design: Case series; Level of evidence, 4. Methods: Participants were men in a United States Army brigade (N = 1332). Physical characteristics and Army Physical Fitness Test data were obtained by survey. Fitness performance testing was administered at the brigade, and the types of footwear worn were identified by visual inspection. Shoe types were categorized into 2 groups: TRS (stability, cushioning, and motion control) and MRS. Injuries from the previous 12 months were obtained from the Defense Medical Surveillance System. A t test was used to determine mean differences between personal characteristics, training, and fitness performance metrics by shoe type. Hazard ratios and 95% CIs were calculated to determine injury risk by shoe type, controlling for other risk factors. Results: A majority of soldiers wore cushioning shoes (57%), followed by stability shoes (24%), MRS (17%), and motion control shoes (2%). Soldiers wearing MRS were slightly younger than those wearing TRS ( P < .01); performed more push-ups, sit-ups, and pull-ups ( P < .01); and ran faster during the 2-mile run ( P = .01). When other risk factors were controlled, there was no difference in injury risk for running shoe type between soldiers wearing MRS compared with TRS. Conclusions: Soldiers who chose to wear MRS were younger and had higher physical performance scores compared with soldiers wearing TRS. When these differences are controlled, use of MRS does not appear to be associated with higher or lower injury risk in this population.

Physically demanding occupations (ie, military, firefighter, law enforcement) often use fitness tests for job selection or retention. Despite numerous individual studies, the relationship of these tests to job performance is not always clear. : This review examined the relationship by aggregating previously reported correlations between different fitness tests and common occupational tasks. : Search criteria were applied to PUBMED, EBSCO, EMBASE and military sources; scoring yielded 27 original studies providing 533 Pearson correlation coefficients (r) between fitness tests and 12 common physical job task categories. Fitness tests were grouped into predominant health-related fitness components and body regions: cardiorespiratory endurance (CRe); upper body, lower body and trunk muscular strength and muscular endurance (UBs, LBs, TRs, UBe, LBe, TRe) and flexibility (FLX). Meta-analyses provided pooled r's between each fitness component and task category. : The CRe tests had the strongest pooled correlations with most tasks (eight pooled r values 0.80-0.52). Next were LBs (six pooled r values >0.50) and UBe (four pooled r values >0.50). UBs and LBe correlated strongly to three tasks. TRs, TRe and FLX did not strongly correlate to tasks. : Employers can maximise the relevancy of assessing workforce health by using fitness tests with strong correlations between fitness components and job performance, especially those that are also indicators for injury risk. Potentially useful field-expedient tests include timed-runs (CRe), jump tests (LBs) and push-ups (UBe). Impacts of gender and physiological characteristics (eg, lean body mass) should be considered in future study and when implementing tests.

This study examined demographic and physical risk factors for stress fractures in a large cohort of basic trainees. New recruits participating in US Army BCT from 1997 through 2007 were identified, and birth year, race/ethnicity, physical characteristics, body mass index, and injuries were obtained from electronic databases. Injury cases were recruits medically diagnosed with inpatient or outpatient stress fractures. There were 475 745 men and 107 906 women. Stress fractures incidences were 19.3 and 79.9 cases/1 000 recruits for men and women, respectively. Factors that increased stress fracture risk for both men and women included older age, lower body weight, lower BMI, and race/ethnicity other than black. Compared to Asians, those of white race/ethnicity were at higher stress fractures risk. In addition, men, but not women, who were taller or heavier were at increased stress fracture risk. Stress fracture risk generally increased with age (17-35 year range) at a rate of 2.2 and 3.9 cases/1 000 recruits per year for men and women, respectively. This was the largest sample of military recruits ever examined for stress fractures and found that stress fracture risk was elevated among recruits who were female, older, had lower body weight, had lower BMI, and/or were not of black race/ethnicity.

OBJECTIVE: To examine outpatient injuries before and after deployments of elements of the 10th Mountain Division to Afghanistan (n = 505 men) and the 1st Cavalry Division to Iraq (n = 3242 men). STUDY DESIGN: Observational. METHODS: The military units provided a list of deployed soldiers, and soldiers' outpatient medical encounters were obtained from the Defense Medical Surveillance System. Cumulative injury incidence was examined for two consecutive 90-day periods before the deployments (Periods 1-2) and two consecutive 90-day periods after the deployments (Periods 3-4). RESULTS: Both groups showed post-deployment increases in the overall incidence of injury (Afghanistan group = 14.1%, 14.1%, 16.4, 23.4%; Iraq Group = 15.1%, 12.4%, 35.4%, 43.4%; Periods 1-4, respectively). Soldiers with pre-deployment injuries were 1.4-3.0 times more likely to experience post-deployment injuries. CONCLUSIONS: This study found a post-deployment increase in the incidence of outpatient injury. Also, soldiers with pre-deployment injuries were more likely to experience post-deployment injuries. Language: en

Two years after the closing of the Army Physical Fitness Research Institute, an active duty Army physical therapist was once again assigned to serve Army Command and General Staff College (CGSC) students. Purpose: To evaluate the effects of a physical therapist on injuries and physical fitness of CGSC students and assess risk factors for injury. Methods: Demographics, health behaviors, physical training (PT) activities, and Army Physical Fitness Test (APFT) results were collected by survey from CGSC Class 14-02 at the start and end of the 10-month course. The CGSC Class 13-02, one year prior, did not have an assigned physical therapist and was used for comparison. For both classes, administrative APFT records were obtained from CGSC and injury medical encounter data were obtained from the Military Health System Management Analysis and Reporting Tool (M2). Results: Electronic medical records were available for 293 (99%) students in Class 14-02 and 284 (97%) students in Class 13-02. For Class 14-02, cumulative injury incidence did not differ from injuries one year prior to CGSC (56.1% vs. 56.3%, p=0.93). Class 14-02 injury incidence also did not differ from Class 13-02 (56% vs. 54%, p=0.50). Responses from students who completed initial and follow-up surveys (n=38) showed improvements in APFT run times and push-ups and no changes in body composition. The proportion who conducted sprint training 1-2 times per week decreased slightly during CGSC (78% vs. 53%, p=0.06); no other changes in PT activities were observed. An analysis of injury risk factors found students with an injury in the year prior to CGSC were nearly 4 times more likely to be seen for an injury during CGSC, controlling for age and gender.

The Functional Movement Screen (FMS) is a tool intended to evaluate limitations or asymmetries of movement to detect individuals at risk for exercise- and sports-related injury. The purpose was to determine the association and predictive value of specific FMS tests with injury risk in physically active men. Soldiers aged 18-57 years completed the FMS (n = 2,476). Demographic and fitness data were collected by survey. Medical record data for any, overuse, and traumatic injury 6 months after the assessment were obtained. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value were calculated along with receiver operator characteristics to determine area under the curve (AUC). Risks, risk ratios, odds ratios (ORs), and 95% confidence intervals were calculated to assess injury risks. Multivariate logistic regression identified that pain on 5 of the 7 tests was associated with greater risk for any injury (OR = 1.50-3.51): deep squat, hurdle step, in-line lunge, trunk stability push-up, and rotary stability. However, FMS registered low sensitivity, PPV, and AUC for all 7 tests for the 3 injury types (2-24% sensitivity, 16-74% PPV, and 50-58% AUC). Although the presence of pain was associated with a higher risk of injury on 5 tests, a low sensitivity, PPV, and AUC were displayed. Therefore, caution is advised when implementing the FMS as a screening tool in an Army or similarly active population as it could lead to prevention and treatment resources being directed toward individuals who are not at greater risk for injury.

Objective: To investigate risk factors for time-loss injuries among soldiers attending U.S. Army Ordnance School Advanced Individual Training. Methods: Injuries were obtained from an injury surveillance system. A health questionnaire provided data on age, race, rank, current self-reported injury and illness, and tobacco use. Fitness data was obtained from operations office. Results: Cumulative time-loss injury incidence was 31% for men and 54% for women. For men, higher risk of injury was associated with race, a current self-reported injury, smoking before entering the Army, lower sit-up performance, and slower 2-mile run times. For women, higher risk of injury was associated with race, a current self-reported injury, and slower 2-mile run times. Conclusion: Smoking cessation and fitness training before entry are potential strategies to reduce injuries among soldiers in the Ordnance School.

Past studies indicated that overall Basic Combat Training (BCT) attrition (discharge) was associated with various risk factors. BCT has changed considerably since many of these studies were conducted. This study examined Soldiers medically attrited from BCT. Potential attrition risk factor data on recruits (n = 4,005) were collected from medical records, BCT unit records, and questionnaires. Attrition data from Fort Jackson, South Carolina, showed 203 medical discharges. Cox regression (univariate and multivariate) obtained hazard ratios and 95% confidence intervals for attrition risk factors. Higher attrition risk was associated with female gender. Higher attrition risk for men was associated with cigarette smoking, injury during BCT, and less exercise before BCT. Higher attrition risk for both genders was associated with failure on the initial 2-mile run test and separated or divorced marital status. Attrition risk factors found in this study were similar to those previously identified despite changes in BCT.

Summary Objective This study examined risk factors for self-reported injury incurred before arrival at Ordnance School for advanced individual training (AIT). Study design During AIT in-processing, soldiers ( n = 27,289 men and 3856 women) completed a questionnaire that collected demographic and lifestyle information, and asked if the soldier currently had an injury that would affect their AIT performance. Methods Potential risk factors for self-reported injury were explored using logistic regression. Results For men, self-reported injury was associated with older age [odds ratio (OR) ≥30years/17–19 years = 1.9], race (OR Black/Caucasian = 1.2), basic combat training (BCT) site (OR Fort Benning/Fort Jackson = 1.7; OR Fort Leonard Wood/Fort Jackson = 1.6, OR Fort Knox/Fort Jackson = 1.3), smoking on 20 or more days in the 30 days prior to BCT (OR smoker/non-smoker = 1.2) and current illness (OR ill/not ill = 6.2). For women, increased self-reported injury was associated with older age (OR ≥ 30years/17–19 years = 2.0), BCT site (OR Fort Leonard Wood/Fort Jackson = 1.5) and current illness (OR ill/not ill = 5.8). Conclusions Certain demographic characteristics and lifestyle behaviours may be identified as injury risk factors on arrival at Ordnance AIT.

This study examined the prevalence of tobacco use and factors associated with pre-military service cigarette and smokeless tobacco use. From January 2000 to December 2006, military students arriving for Advanced Individual Training at the U.S. Army Ordnance School completed a questionnaire that asked about their use of tobacco products. The prevalence of smokeless tobacco use from 2000 to 2006 for women generally decreased, as did the number of cigarettes smoked per day by men. For men and women, factors associated with cigarette use included younger age, Caucasian race, and use of smokeless tobacco. Factors associated with smokeless tobacco use among men included younger age, Caucasian race, and cigarette use. For women, cigarette use was the only factor associated with smokeless tobacco use. The identified factors in this study could be used to establish strategies in the future to reduce tobacco use in the military.

Purpose: Popular running magazines and running shoe companies advise using the shape of the weight-bearing plantar surface of the foot as a basis for selecting a proper type of running shoe to reduce injury risk. The imprint is assumed to reflect the height of the medial longitudinal arch (MLA). This study examined the assumption that plantar surface morphology was a surrogate for height of the MLA. Methods: Recruits (n = 3968) entering US Army Basic Combat Training had their plantar foot surfaces assessed visually as low, normal, or high by two raters who viewed imprints of the plantar foot surface. Actual arch height was measured with calipers as distance from the standing surface to the inferior medial border of the navicular tuberosity. Measured MLA heights were compared with plantar surface imprints to evaluate the effectiveness of visual inspection as a means of arch height classification. Results: For the right foot, individuals with low, normal, or high plantar shapes had a mean +/- SD arch height of 33.5 +/- 6.8, 40.4 +/- 7.2, and 43.1 +/- 7.3 mm, respectively (ANOVA, P < 0.01); however, the individuals' measured MLA heights fell into the corresponding plantar shape percentiles (low, normal, high) only 65% of the time. Increased body mass index (BMI) decreased correct assessment of the MLA. Conclusions: Visual assessment of indicating progressively higher plantar shapes corresponded to progressively higher average differences in measured arch heights; nonetheless, there was considerable overlap among the three plantar shapes with 35% of plantar shapes being misclassified compared with measured arch height, especially among individuals with higher BMI.

Introduction Military parachuting has been shown to result in injuries. This investigation systematically reviewed studies examining the influence of the parachute ankle brace (PAB) on injuries during military parachuting and performed a cost-effectiveness analysis. Evidence acquisition Parachute ankle brace studies were obtained from seven databases, personal contacts, and other sources. Investigations were reviewed if they contained original, quantitative information on PAB use and injuries during parachuting. Meta-analysis was performed using a general variance-based meta-analysis method that calculated summary risk ratios (SRR) and 95% CIs. Evidence synthesis Five studies met the review criteria. Compared with PAB users, PAB non-users had a higher risk of ankle injuries (SRR=2.1, 95% CI=1.8–2.5); ankle sprains (SRR=2.1, 95% CI=1.4–3.1); ankle fractures (SRR=1.8, 95% CI=1.1–2.9); and all parachuting injuries combined (SRR=1.2, 95% CI=1.1–1.4). The PAB had little effect on lower body injuries exclusive of the ankle (SRR [no PAB/PAB]=0.9, 95% CI=0.7–1.2). Cost-effectiveness analysis estimated that, for every dollar expended on the PAB, a savings of about $7 to $9 could be achieved in medical and personnel costs. Conclusions The PAB reduces ankle injuries by about half and is a cost effective device that should be worn during military airborne operations to reduce injury risk.

INTRODUCTION: This investigation examined risk factors for injuries during military parachute training and solicited attitudes and opinions regarding a parachute ankle brace (PAB) that has been shown to protect against ankle injuries. METHODS: Male Army airborne students (N = 1677) completed a questionnaire after they had successfully executed 4 of the 5 jumps necessary for qualification as a military paratrooper. The questionnaire asked about injuries during parachute descents, demographics, lifestyle characteristics, physical characteristics, physical fitness, airborne recycling (i.e., repeating airborne training because of failure to qualify on a previous attempt), PAB wear, problems with aircraft exits, and injuries in the year before airborne school. A final section of the questionnaire solicited open-ended comments about the PAB. RESULTS: Increased risk of a parachute-related injury occurred among students who had longer time in service, were older, taller, heavier, performed fewer push-ups, ran slower, were airborne recycles, did not wear the PAB, had an aircraft exit problem, and/or reported an injury in the year prior to jump school. Among students who wore the brace, most negative comments about the PAB had to do with design, comfort, and difficulties during parachute landing falls. CONCLUSIONS: This study supported some previously identified injury risk factors (older age, greater body weight, and not using a PAB) and identified a number of new risk factors. To address PAB design and comfort issues, a strap is being added over the dorsum of the foot to better hold the PAB in place. Language: en

As combat arms occupations become available to women, adequate muscular strength and aerobic endurance will be essential for the completion of physically demanding job-related tasks. Therefore, in addition to US Army Physical Readiness Training, Soldiers will often engage in their own personal physical fitness training programs.To evaluate fitness and injury outcomes for women participating in personal cross-training programs compared to women performing one mode of training or having no personal fitness program.Demographics, physical training activities, physical fitness, and injuries were obtained from surveys administered to female Soldiers in an infantry division. Women were categorized into the following 4 groups based on their personal physical fitness program: cross-training (CT), running only (R), weight training only (WT), and no personal fitness program (NPF). An ANOVA was used to compare physical training, health behaviors, and physical fitness across groups. A χ² test was used to compare injury rates between fitness programs. Risk (%), risk ratios (RR) and 95% confidence intervals (95% CI) were used to determine injury risk.A total of 620 women completed the survey and indicated whether or not they had a personal fitness program (cross-training, n=260; running only, n=93; weight training only, n=86; no personal fitness program, n=181). Average age and body mass index was 26.2±5.8 years and 24.5±3.3 kg/m² respectively with no differences between the 4 fitness groups. The cross-training group had higher physical performance on the muscular endurance (push-ups and sit-ups) portion of the Army physical fitness test (APFT) when compared to the 3 other groups (CT 42 push-ups vs (R 38, WT 35, NPF 36)); (CT 68 sit-ups vs (R 63, WT 62, NPF 62)). For the aerobic endurance (2-mile run) portion of the APFT, the cross-training group had higher performance when compared to those with no personal fitness program (CT 17.4 minutes vs NPF 18.5 minutes). Overall, 53% of female Soldiers sustained an injury over a 12-month period. All injury rates and lower extremity injury rates among women with a cross-training personal fitness program were not different from the other personal fitness programs. Those performing cross-training were 2.6 and 2.1 times more likely to experience a running related injury when compared to those in the weight training and no personal fitness group, respectively. On the other hand, women performing cross-training were 65% less likely to experience a lifting/moving heavy objects related injury when compared to the weight training only group.Women who participated in a cross-training program for personal physical fitness training had higher muscular endurance compared to the other fitness groups and higher aerobic endurance when compared to the no personal fitness group. There were no differences for all injuries and lower body injuries between cross-training and other fitness programs. Cross-training may be the best option for improving physical fitness when compared to just one mode of fitness training.

To investigate changes in physical training (PT), fitness, and injury during deployment and identify differences between men and women.Data were collected on male and female US Army Soldiers through self-reported surveys completed before and after deployment to Afghanistan. Changes in physical training activities, physical fitness, injury incidence, BMI, and smoking status were analyzed. Descriptive statistics were used to compare before deployment and deployment results and differences between men and women.Surveys were completed by 727 men and 43 women. The percentage of Soldiers engaging in unit PT running of 5 miles or more per week decreased by almost half for men and women. The percentage of Soldiers doing personal PT running of 5 miles or more per week and engaged in resistance training 3 or more days per week more than doubled for men and women during deployment. Cardiorespiratory endurance for women improved by 50 seconds (P=.06) and for men declined by 29 seconds (P.01), while muscular endurance increased by 0.6 repetitions (P.01) during deployment. Injury rates for men decreased, on average, 36.2 to 19.0 injuries per 1,000 Soldiers per month (P=.01). Injury rates for women decreased on average from 42.6 to 14.0 injuries per 1,000 Soldiers per month (P=.02). During deployment, BMI did not change for men or women and smoking increased 19% for men (P.01), but did not increase for women.Comparisons of physical training activities and health behavior among men and women before and during deployment suggests that increased resistance training could be recommended for women and smoking cessation for men. Given the potentially important role of personal PT in maintaining physical fitness in the deployment environment, future work should support provision of the necessary environment and equipment for Soldiers to perform personal PT effectively and safely on their own. Further, the physical training gaps between men and women should be addressed, with suggestions regarding where improvements can be made, especially for women interested in seeking combat positions with high physical demands.

Purpose: To help evaluate the Army Physical Fitness Test (APFT) and ensure a future test is associated with Soldiers performance of common physical job requirements, the USAPHC applied a Systematic Review (SR) methodology to identify and synthesize published correlations between military task performance and physical fitness tests. Methods: A preliminary step to our SR was to identify key military-relevant tasks and physical fitness components of interest. Starting with the Army's Warrior Tasks and Battle Drills (WTBDs), twelve task categories were identified, including some tasks performed by both military and civilian occupations (e.g., firefighters, police, and athletes). Physical fitness tests were sorted into four physical fitness groups: cardiorespiratory endurance (e.g., aerobic fitness), muscle strength, muscle endurance, and flexibility. Tests of muscular strength and muscular endurance were further subcategorized into Upper and Lower Body, Core, or Whole Body regions. Physical tests included the APFT events (2-mile run, sit ups, push-ups) as well as other equipment and non-equipment physical fitness tests (e.g., jump tests, squats, sprints, pull-ups, grip tests, arm lifts, curls, and various extension machine tests). To synthesize the data, a series of meta-analyses provided pooled correlation coefficients for the twelve tasks and eleven physical fitness test groups. Results: Flexibility tests were the least frequently identified, while upper body strength tests were most frequently identified in studies that met our inclusion criteria. Correlations with aerobic tests were fairly well studied, with a few notable gaps (e.g., the Loaded March task). Pooled r coefficients for specific physical tests (e.g., run tests, push-ups, sit-ups, grip tests, and vertical and broad jump tests) were also calculated. Of the physical fitness component groups evaluated, aerobic capacity is most strongly correlated across the greatest number of military tasks.

Purpose: To evaluate the effect of a new physical training program on injury risks and to identify risk factors for injury in a Brigade of an Infantry Division. The program included the addition of physical therapy and athletic training staff. Methods: Demographics, physical fitness, and PT activities were obtained from surveys administered to Soldiers upon program implementation and 7 months later. Medical records captured injury-related encounters before and after implementation. Results: Both surveys and medical data were available for 1,250 Soldiers; data on matched males(n=1,183) were analyzed. Injury incidence pre and post-implementation did not differ (55 vs.57/1,000 Soldiers/month, p=0.64) and no difference between Army and brigade trends was observed (p=0.72). However, limited duty days increased after the implementation of the program by 32%. Fitness improved, although the changes measured by Army Physical Fitness Test total scores were significant, improvements were minimal (251 vs.255 points, p0.01). The proportion of Soldiers running 10 miles/week with their unit decreased (36% vs.26%, p0.01) and the proportion cross-training with their unit 1 time/week increased (66% vs.75%, p0.01). Conclusion: While injury rates did not change, the number of limited duty days increased by 32%. For physical training, running mileage decreased, while cross-training increased. Improved access to care may have increased injury identification, thereby masking reductions resulting from PT modifications.