Self-reported physical activity and preaccession fitness testing in U.S. Army applicants.

The Assessment of Recruit Motivation and Strength (ARMS) study evaluated a physical fitness screening test for Army applicants before basic training. This report examines applicants' self-reported physical activity as a predictor of objective fitness measured by ARMS. In 2006, the ARMS study administered a fitness test and physical activity survey to Army applicants during their medical evaluation, using multiple logistic regression for comparison. Among both men and women, "qualified" and "exceeds-body-fat" subjects who met American College of Sports Medicine adult physical activity guidelines were more likely to pass the fitness test. Overall, subjects who met physical activity recommendations, watched less television, and played on sports teams had a higher odds of passing the ARMS test after adjustment for age, race, and smoking status. This study demonstrates that self-reported physical activity was associated with physical fitness and may be used to identify those at risk of failing a preaccession fitness test.

Effect of pre-accession physical fitness on training injuries among US Army recruits.

OBJECTIVE: To evaluate the association of pre-accession physical fitness, as measured by a five-minute step test, with incidence of overuse injuries and outpatient healthcare utilization among male United States (US) Army recruits. PARTICIPANTS: US Army male trainees who met weight standards and took a pre-accession fitness test. METHODS: In this prospective cohort study, incidence and outpatient healthcare visits for overuse injuries during the first 90 days of military service were compared between recruits who failed the pre-accession step test with those who passed. RESULTS: The hazard rate ratio for injury among recruits who failed the fitness test compared to those who passed the test was 1.31 (95% C.I = 1.20-1.44). Among the subset of recruits with at least one medical encounter for an overuse injury, the utilization rate ratio for subjects who failed the fitness test versus those who passed was 1.15 (95% C.I = 1.09-1.22). Other factors associated with increased risk of injury or healthcare utilization include age, body mass index, and smoking history. CONCLUSIONS: Risk of injury and utilization were associated with fitness test results. These findings may have implications for military accession and training policy as well as for other physically demanding training programs such as police, fire fighters and athletes.

A prospective study of physical fitness, obesity, and the subsequent risk of mental disorders among healthy young adults in army training.

OBJECTIVE: Mental health disorders contribute substantially to medical and occupational morbidity. The role of fitness and physical activity in the prevention of mental health disorders is not well established, but epidemiologic data suggest that physical activity can protect against anxiety and depression. METHOD: The analyses presented in this report, from a prospective cohort study, evaluate the association between fitness (as measured by a 5-minute step test), and being overweight (defined as exceeding weight and body fat allowances) at military entrance, with subsequent onset of mental disorder diagnosis in the first year of service. The association between risk factors and mental disorder diagnosis was analyzed using multivariate Poisson regression with the adjusted incidence rate ratio (aIRR) as the measure of association. RESULTS: Among weight-qualified participants, factors associated with increased incidence of mental disorder included failing the physical fitness test (aIRR: 1.36, p<0.0001), female sex (aIRR: 2.17, p<0.0001), and smoking (aIRR: 1.49, p<0.0001). Among fit participants, being overweight was not significantly associated with mental disorder (aIRR: 1.11, p=0.1540). CONCLUSIONS: This test has potential military utility as an adjunct part of the medical examination process. Additional research is needed among civilians to determine if similar associations exist. If so, intervention studies should be conducted to determine if improving physical fitness reduces subsequent psychiatric disorder risk, particularly among young adults entering into stressful situations.

Cost-effectiveness analysis of the U.S. Army Assessment of Recruit Motivation and Strength (ARMS) program.

The Assessment of Recruit Motivation and Strength (ARMS) Study was conducted at six Military Entrance Processing Sites during 2005-2006. The objectives were to compare morbidity and attrition of Army accessions who exceeded body fat (EBF) accession standards compared to weight for height or body fat qualified (WQ) and to compare among the WQ subset, those who were physically fit as measured by a 5-minute step test compared to unfit. We performed a cost-effectiveness analysis to address both objectives. Analysis was performed by gender with the primary outcomes of musculoskeletal injury and attrition. Results were expressed in terms of cost per year of military service. Sensitivity analysis was performed on probability cost estimates. We found WQ female recruits were $5,141 less expensive per year than EBF female recruits. WQ males were $2,785 less expensive per year of military service than EBF male recruits. Among WQ recruits, fit females were $3,638 and fit males were $10,381 less expensive per year of service than their unfit counterparts. The ARMS step test is a cost-effective method to identify physically fit EBF applicants for accession in weak recruiting environments. It also offers a cost-effective method to reduce poor physical fitness associated morbidity and attrition.

Step test performance and risk of stress fractures among female army trainees.

BACKGROUND: Stress fractures and other musculoskeletal injuries are major sources of morbidity among female military trainees. Several risk factors have been postulated, particularly pre-existing fitness, usually assessed with post-entry run time for ≥ 1.0 mile. PURPOSE: Physical fitness is not formally evaluated prior to Army entry. If a valid and simple test that identified women at increased risk of stress fracture were available and could be applied prior to entry, it would facilitate cost-benefit studies of deferral or interventions. These analyses were undertaken to determine if a 5-minute step test conducted before entry identified women at increased risk. METHODS: A prospective study was conducted of weight-qualified women entering the Army in 2005-2006, with analyses completed in 2011. At the pre-entry examination, information was collected on age, BMI, smoking, race, and activity level. Everyone took the step test. All outpatient medical encounters were captured, and stress fractures and other musculoskeletal injuries identified. Women with stress fractures and those with other musculoskeletal injuries were evaluated separately. RESULTS: 1568 women were included in the study; 109 developed stress fractures and 803 other musculoskeletal injury. Women who failed the step test had a 76% higher stress fracture incidence and a 35% higher incidence of other musculoskeletal injuries. There was effect modification between age and test failure for stress fracture. CONCLUSIONS: A step test that can be administered before military entry identifies women with increased incidence of stress fracture and other musculoskeletal injury. This test could be used pre-entry to defer or target high-risk recruits for tailored fitness training before or after military entrance.