Assessing Community-Based Public Health Plans: An Example From US Army Injury Prevention.

CONTEXT: The US Army requires community health coalitions to develop action plans for their top public health priorities. OBJECTIVE: To date, the US Army has not implemented a standardized review process for community action plans. DESIGN: This project used the Plan Quality Index (PQI), an evidence-based, standardized tool, to evaluate injury prevention action plans created by injury prevention teams (IPTs). SETTING: 17 Army installations. PARTICIPANTS: 17 IPT leads; 5 Health Promotion Program Officers. INTERVENTION: Implementation of the PQI to evaluate the strength of injury prevention action plans and make recommendations for quality improvement to drive reductions in injuries at 17 Army installations. MAIN OUTCOME MEASURE: PQI total scores for high- (≥50 points on the PQI) and low-ranking plans (<50 points on the PQI) were assessed for differences using t tests of the mean PQI score. Chi-square tests were employed to identify differences in meeting criteria between high- and low-scoring plans. RESULTS: PQI total scores ranged from 9 to 78 points out of 80. The weakest planning elements among all plans were lack of use of SMART objectives (18%), lack of identification of responsible parties (18%), absent evaluation plan (24%), and lack of timelines (35%). The mean score for the high-ranking plans (64.6 ± 9.5) was significantly higher than the mean score for the low-ranking plans (26.2 ± 12.7) ( P < .001). Mean scores for clarity, effectiveness, and quality were all significantly higher for the high-ranking plans than for the low-ranking plans ( P = .014, P = .002, and P < .001, respectively). CONCLUSIONS: The PQI tool provides a framework for objective, standardized, and evidence-based feedback and recommendations for improving community health plans. The project identified examples of high-quality action plans and provided actionable recommendations for plan improvement to facilitate sustainability of initiatives addressing injuries, which have long posed a threat to military health and readiness.

Demographic, psychosocial, and physical fitness predictors of successful graduation from U.S. Army Ranger School.

U.S. Army Ranger School is an arduous 64-day leadership training course designed to simulate the stressors of combat. Although physical fitness has been shown to be an important predictor of successful graduation for Ranger School, psychosocial characteristics like self-efficacy and grit have not been examined. The purpose of this study is to identify personal, psychosocial, and fitness characteristics associated with successful completion of Ranger School. This study was a prospective cohort examining the association of baseline characteristics of Ranger School candidates with a primary outcome of graduation success. Multiple logistic regression was performed to determine the contribution of demographics, psychosocial, fitness and training characteristics to graduation success. Out of 958 eligible Ranger Candidates, this study obtained graduation status for 670 students, 270 (40%) of which graduated. Soldiers who graduated were younger, more likely to come from units with a higher proportion of previous Ranger School graduates, had higher self-efficacy and faster 2-mile run times. The results from this study suggest that Ranger students should arrive in optimal physical conditioning. Furthermore, training programs that optimize student self-efficacy and units with a high proportion of successful Ranger graduates may confer advantage for this challenging leadership course.

Injuries and Factors Associated with Injuries Among U.S. Army Band Musicians.

The Department of Defense is the largest employer of full-time musicians. In the U.S. military, many musicians experience unique occupational exposures such as extended periods of standing, sitting, and marching for rehearsals and performances, static and non-neutral postures, and a variety of repetitive motions while playing instruments. These exposures are in addition to physical training and fitness standards required of U.S. Army soldiers. METHODS: An electronic survey was administered to active-duty U.S. Army Band musicians. The survey collected demographics, personal characteristics, Army Physical Fitness Test performance, occupational demands, health behaviors, and injuries from October 2017 to December 2018. Survey responses were combined with medical and physical fitness performance records. Descriptive statistics were reported and factors associated with injuries were investigated. RESULTS: There were 465 Army Band members in this population, with approximately half (49%) completing the survey. Most survey respondents (81%) reported an injury in the past year, which they predominantly attributed to overuse (54%). Leading reported activities resulting in injury included running for physical training (21%), repetitive movements while playing an instrument (11%), and standing while playing (11%). A majority of survey respondents (60%) also had a medical encounter for an injury. Factors significantly associated with injury among men were lower aerobic fitness and higher body fat percentage; additional unadjusted factors associated with injury among all Army Band soldiers included female sex, older age, and longer periods of marching and standing while playing. CONCLUSIONS: Injury prevention initiatives for Army Band musicians should focus on the reduction of overuse and repetitive motion injuries. Suggested prevention strategies include balanced physical training, ergonomic adjustments, rehearsal breaks, and leadership support for injury prevention efforts.

Injury Risk Factors Associated With Weight Training.

ABSTRACT: Grier, T, Brooks, RD, Solomon, Z, and Jones, BH. Injury risk factors associated with weight training. J Strength Cond Res 36(2): e24-e30, 2022-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.

Comprehensive Physical Activity Assessment During U.S. Army Basic Combat Training.

ABSTRACT: 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 36(12): 3505-3512, 2022-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.

The Combined Effect of Cigarette Smoking and Fitness on Injury Risk in Men and Women.

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.

A prospective field study of U.S. Army trainees to identify the physiological bases and key factors influencing musculoskeletal injuries: a study protocol.

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.

Which US States Pose the Greatest Threats to Military Readiness and Public Health? Public Health Policy Implications for a Cross-sectional Investigation of Cardiorespiratory Fitness, Body Mass Index, and Injuries Among US Army Recruits.

OBJECTIVE: Many states in the southern region of the United States are recognized for higher rates of obesity, physical inactivity, and chronic disease. These states are therefore recognized for their disproportionate public health burden. The purpose of this study was to investigate state-level distributions of cardiorespiratory fitness, body mass index (BMI), and injuries among US Army recruits in order to determine whether or not certain states may also pose disproportionate threats to military readiness and national security. METHODS: Sex-specific state-level values for injuries and fitness among 165 584 Army recruits were determined. Next, the relationship between median cardiorespiratory fitness and injury incidence at the state level was examined using Spearman correlations. Finally, multivariable Poisson regression models stratified by sex examined state-level associations between fitness and injury incidence, while controlling for BMI, and other covariates. MAIN OUTCOME MEASURES: Cardiorespiratory fitness and training-related injury incidence. RESULTS: A cluster of 10 states from the south and southeastern regions (Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, and Texas) produced male or female recruits who were significantly less fit and/or more likely to become injured than recruits from other US states. Compared with the "most fit states," the incidence of injuries increased by 22% (95% CI, 17-28; P < .001) and 28% (95% CI, 19-36; P < .001) in male and female recruits from the "least fit states," respectively. CONCLUSIONS: The impact of policies, systems, and environments on physical activity behavior, and subsequently fitness and health, has been clearly established. Advocacy efforts aimed at active living policies, systems, and environmental changes to improve population health often fail. However, advocating for active living policies to improve national security may prove more promising, particularly with legislators. Results from this study demonstrate how certain states, previously identified for their disproportionate public health burden, are also disproportionately burdensome for military readiness and national security.

Fitness tests and occupational tasks of military interest: a systematic review of correlations.

: 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.

Statistical process control charts for monitoring military injuries.

BACKGROUND: An essential aspect of an injury prevention process is surveillance, which quantifies and documents injury rates in populations of interest and enables monitoring of injury frequencies, rates and trends. To drive progress towards injury reduction goals, additional tools are needed. Statistical process control charts, a methodology that has not been previously applied to Army injury monitoring, capitalise on existing medical surveillance data to provide information to leadership about injury trends necessary for prevention planning and evaluation. METHODS: Statistical process control Shewhart u-charts were created for 49 US Army installations using quarterly injury medical encounter rates, 2007-2015, for active duty soldiers obtained from the Defense Medical Surveillance System. Injuries were defined according to established military injury surveillance recommendations. Charts display control limits three standard deviations (SDs) above and below an installation-specific historical average rate determined using 28 data points, 2007-2013. Charts are available in Army strategic management dashboards. RESULTS: From 2007 to 2015, Army injury rates ranged from 1254 to 1494 unique injuries per 1000 person-years. Installation injury rates ranged from 610 to 2312 injuries per 1000 person-years. Control charts identified four installations with injury rates exceeding the upper control limits at least once during 2014-2015, rates at three installations exceeded the lower control limit at least once and 42 installations had rates that fluctuated around the historical mean. CONCLUSIONS: Control charts can be used to drive progress towards injury reduction goals by indicating statistically significant increases and decreases in injury rates. Future applications to military subpopulations, other health outcome metrics and chart enhancements are suggested.

Effects of Physical Training and Fitness on Running Injuries in Physically Active Young Men.

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+/<22 years = 1.62, 95% CI, 1.21-2.18), higher BMI ((Equation is included in full-text article.)), and total distance ran per week during unit PT (OR16.1+/1-5 miles = 1.66, 95% CI, 1.15-2.41). A lower risk of an RRI was associated with total distance run per week during personal PT (OR5.1-10/1-5 miles = 0.70, 95% CI, 0.53-0.91, OR10.1-16 +/1-5 miles = 0.58, 95% CI, 0.35-0.97, OR16.1+/1-5 miles = 0.54, 95% CI, 0.30-0.98), higher aerobic endurance as measured by 2-mile run performance (ORQ4/Q1 = 0.50, 95% CI, 0.35-0.72), and unit resistance training ≥3 times a week (OR≥3 times per week/none = 0.46, 95% CI, 0.29-0.73). Greater personal PT running mileage decreased injuries in this population suggesting that the increased protective effect of higher aerobic fitness outweighed the injurious effect of running more miles during personal PT. Countermeasures to prevent RRIs could entail enhancing aerobic endurance, providing opportunities for personal aerobic training, monitoring for excessive unit PT running mileage and encouraging unit resistance training ≥3 times per week.

Evaluating Injury Risk and Gender Performance on Health- and Skill-Related Fitness Assessments.

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.

Validity of Self-Reported Physical Fitness and Body Mass Index in a Military Population.

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.

Physical Training, Fitness, and Injuries: Lessons Learned From Military Studies.

Injuries are the leading cause of medical encounters across the U.S. military services resulting in more than 2.0 million clinic visits per year. Almost 50% of military service members experience an injury each year and half of those injuries are caused by physical training (PT), exercise, or sports. To prevent a problem as large and complex as injuries in the military requires a systematic approach. Several key questions must be answered to effectively address a problem such as injuries: (1) how big is the problem? (2) what are the causes and risk factors for the problem? (3) do modifiable risk factors for the problem exist? and (4) what works to prevent the problem? The article discusses leading causes of injuries for U.S. Army populations. It then explores key risk factors for exercise and training-related injuries: (1) the amounts of training, (2) types of training activities, (3) participants level of fitness, and (4) personal health risk behaviors. The article concludes with a review of prevention strategies illustrating interventions that have been shown to be effective, and others that are not effective. The data presented suggest that PT and exercise cause injuries and that modifications of training are most likely to prevent the problem.

Pain on Functional Movement Screen Tests and Injury Risk.

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.

Perspectives on Aerobic and Strength Influences on Military Physical Readiness: Report of an International Military Physiology Roundtable.

Physical fitness training of military recruits is an enduring focus of armies. This is important for safe and effective performance of general tasks that anyone may have to perform in a military setting as well as preparation for more specialized training in specific job specialties. Decades of studies on occupationally specific physical requirements have characterized the dual aerobic and strength demands of typical military tasks; however, scientifically founded strategies to prepare recruits with a good mix of these 2 physiologically opposing capabilities have not been well established. High levels of aerobic training can compromise resistance training gains and increase injury rates. Resistance training requires a greater commitment of time and resources as well as a greater understanding of the science to produce true strength gains that may be beneficial to military performance. These are critical issues for modern armies with increased demands for well-prepared soldiers and fewer injury losses. The actual physical requirements tied to metrics of success in military jobs are also under renewed examination as women are increasingly integrated into military jobs previously performed only by men. At the third International Congress on Soldiers' Physical Performance, a roundtable of 10 physiologists with military expertise presented comparative perspectives on aerobic and strength training. These topics included the physiological basis of training benefits, how to train effectively, how to measure training effectiveness, considerations for the integration of women, and the big perspective. Key discussion points centered on (a) the significance of findings from research on integrated training, (b) strategies for effective strength development, and

Injury incidence with T-10 and T-11 parachutes in military airborne operations.

BACKGROUND: The T-10 parachute has been the U.S. Army standard parachute since 1952 and is now being replaced by the T-11, which has a capacity for heavier loads. This investigation compared injury rates between the two parachute systems during mass tactical parachute training exercises at Fort Bragg, NC. METHODS: Investigators were on the drop zone for all parachute operations. Data on injured jumpers were collected on the drop zone and supplemented with medical records. Operational data were collected from standard reports and weather data were obtained using a Kestrel(®) Model 4500 pocket weather tracker. RESULTS: There were a total of 131,747 jumps resulting in 1101 injured service members for a crude incidence of 8.4 injuries/1000 jumps. Most injuries (88%) with a known injury mechanism were associated with ground impact. In univariate analysis, risk of injury with the T-10 was 9.1/1000 jumps and that with the T-11 was 5.2/1000 jumps [odds ratio (T-10/T-11) = 1.72, 95% confidence interval (95%CI) = 1.45-2.08, P < 0.01]. Other factors that independently increased injury risk included night jumps, combat loads, higher wind speeds, higher temperatures, certain aircraft, and entanglements. After controlling for these factors in a multivariate analysis, injury risk was still higher for the T-10 parachute when compared to the T-11 [odds ratio (T-10/T-11) = 1.56, 95%CI = 1.28-1.89, P < 0.01). For virtually all strata of the independent risk factors, the T-11 had a lower injury rate. CONCLUSION: Compared to the T-10, the T-11 parachute had a lower injury incidence under virtually all the operational conditions examined.

Risk factors for closed-head injuries during military airborne operations.

INTRODUCTION: One of the more serious adverse outcomes of military airborne operations is closed-head injuries. This investigation examined risk factors for closed-head injuries in an Army airborne infantry unit. METHODS: Closed-head injuries were defined as energy exchanges in which the head contacted the ground or an object and the soldier sought medical care for external trauma, headache, loss of consciousness, or altered mental state. Injury data were obtained by investigators in the drop zone and diagnoses were confirmed by a physician. Operational data on potential injury risk factors were obtained from routine reports published by the infantry unit. Weather data were obtained using a pocket weather tracker. RESULTS: There were 96,132 jumps resulting in 310 closed-head injuries for a crude incidence of 3.22/1000 jumps. In 98% of known cases the injury was associated with parachute landings. Multivariate logistic regression revealed that independent risk factors for closed-head injuries included night jumps, combat loads, higher wind speeds, higher temperatures, enlisted rank, and entanglements. CONCLUSIONS: This study identifies the current incidence and extrinsic risk factors for closed-head injuries during military airborne operations. Although it is necessary to conduct airborne training under realistic conditions, trainers and commanders should be aware of these risks and plan airborne operations accordingly.

Consortium for health and military performance and American College of Sports Medicine Summit: utility of functional movement assessment in identifying musculoskeletal injury risk.

Prevention of musculoskeletal injuries (MSKI) is critical in both civilian and military populations to enhance physical performance, optimize health, and minimize health care expenses. Developing a more unified approach through addressing identified movement impairments could result in improved dynamic balance, trunk stability, and functional movement quality while potentially minimizing the risk of incurring such injuries. Although the evidence supporting the utility of injury prediction and return-to-activity readiness screening tools is encouraging, considerable additional research is needed regarding improving sensitivity, specificity, and outcomes, and especially the implementation challenges and barriers in a military setting. If selected current functional movement assessments can be administered in an efficient and cost-effective manner, utilization of the existing tools may be a beneficial first step in decreasing the burden of MSKI, with a subsequent focus on secondary and tertiary prevention via further assessments on those with prior injury history.

A prospective investigation of injury incidence and injury risk factors among Army recruits in military police training.

BACKGROUND: United States Army military police (MP) training is a 19-week course designed to introduce new recruits to basic soldiering skills, Army values and lifestyle, and law enforcement skills and knowledge. The present investigation examined injury rates and injury risk factors in MP training. METHODS: At the start of training, 1,838 male and 553 female MP recruits were administered a questionnaire containing items on date of birth, height, weight, tobacco use, prior physical activity, injury history, and menstrual history. Injuries during training were obtained from electronic medical records and the training units provided data on student graduation and attrition. RESULTS: Successfully graduating from the course were 94.3% of the men and 83.7% of the women. Experiencing at least one injury during training were 34.2% of the men and 66.7% of the women (risk ratio (women/men) = 1.95, 95% confidence interval = 1.79-2.13). Recruits were at higher injury risk if they reported that they were older, had smoked in the past, or had performed less frequent exercise or sports prior to MP training. Men were at higher injury risk if they reported a prior injury and women were at higher risk if they reported missing at least six menstrual cycles in the last year or had previously been pregnant. CONCLUSION: The present investigation was the first to identify injury rates and identify specific factors increasing injury risk during MP training.