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.

Physical Activity Communication: A Scoping Review of the Literature.

Engaging in regular physical activity can help prevent chronic disease and enhance quality of life. Unfortunately, less than 20% of American adults meet the recommended physical activity guidelines, perhaps indicating ineffective communication efforts around physical activity. In preparation for the release of the second edition of the Physical Activity Guidelines for Americans, and using the physical activity guidelines as a cornerstone of our approach, we conducted a scoping review of physical activity communication research to understand the scholarly efforts related to communicating about physical activity. Using a social-ecological perspective, we identified studies using the keywords physical activity* OR exercise* AND health communication* in three public health and communication databases and retained studies conducted in the United States and published in English from 1995 through 2015. Sixty-seven articles included a mention of physical activity guidelines, a health communication focus, and media channels used in promoting physical activity. Half of the studies were published in health/science communication journals. One third of the studies mentioned physical activity guidelines. Only 19% of the studies featured mental health benefits of physical activity while more than 64% emphasized physical health benefits. Nearly all the studies (96%) mentioned the use of persuasion to encourage engagement in physical activity. More effort is needed to study the influence of communicating physical activity guidelines to the public. Best practices for future physical activity communication are discussed for both researchers and practitioners.

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.

New Perspective on Factors Related to Coalition Success: Novel Findings From an Investigation of Physical Activity Coalitions Across the United States.

CONTEXT: Physical activity (PA) coalitions are a fundamental component of efforts to increase population levels of PA in the United States. Coalitions are often composed of organizational members including government agencies, for-profit corporations, and nonprofit organizations. Very little is known about PA coalitions, their organizational members, and the factors related to their success. OBJECTIVE: First, this study aimed to describe the characteristics of PA coalitions across the United States. Second, the study aimed to describe the characteristics of organizational members of PA coalitions. Third, the study aimed to investigate the association between organizational membership and coalition success. DESIGN: A cross-sectional design was employed to study individuals from a diverse sample of PA coalitions across the United States. A total of 120 individuals (86% response rate) completed the Member Involvement in Physical Activity Coalitions (MIPAC) survey. The MIPAC included 3 sections: (1) demographic items assessing descriptive characteristics of PA coalitions and their organizational members; (2) 3 subscales for assessing key organizational membership factors (Strategic Alignment, Organizational Alignment, and Providing Input); and (3) 2 subscales for assessing perceived coalition success. MAIN OUTCOME MEASURES: Descriptive statistics characterize PA coalitions and their organizational members. Univariate analyses were employed to investigate associations between key organizational membership factors and perceived coalition success. RESULTS: Statistically significant associations were observed between the key organizational membership factors (Strategic Alignment, Organizational Alignment, and Providing Input) and measures of perceived coalition success. Many PA coalitions lacked organizational members from the settings in which the coalitions strive to make change. CONCLUSIONS: Physical activity coalitions and health-based coalitions overall may be more likely to succeed when they can identify ways in which their coalition provides opportunities for strategic alignment, organizational alignment, and providing input to existing and perspective organizational members. In addition, PA coalitions may benefit from engaging more organizational members from the built environment and education sectors.

Factors related to partner involvement in development of the US national physical activity plan.

CONTEXT: Physical activity coalitions are increasingly forming to meet the demands associated with policy, systems, and environmental change necessary to realize increases in population levels of physical activity. Little is known about what makes physical activity coalitions successful; however, evidence from community-based coalitions in other public health domains suggests that factors related to each organization that joins a coalition may explain coalition success or failure. OBJECTIVE: The objective of this study was to employ qualitative methods to understand the factors related to organizations' decisions to join and remain committed to the coalition that developed and launched the US National Physical Activity Plan (NPAP). DESIGN/SETTING: Qualitative semistructured phone interviews were conducted with key informants from the NPAP coalition's partner organizations. Interviews were transcribed verbatim and coded separately by members of the research team. PARTICIPANTS: Fourteen individuals representing 13 NPAP partner organizations participated in the study. MAIN OUTCOME MEASURES: Analysis focused on key factors explaining why and how partner organizations decided to join and remain committed to the NPAP coalition. RESULTS: Five primary factors emerged: (1) strategic alignment, (2) organizational alignment, (3) provide input, (4) seminal event, and (5) cost/benefit ratio. CONCLUSIONS: Building and maintaining a physical activity coalition with highly committed partners may hinge upon the ability to fully understand how each current or prospective partner perceives it could benefit from strategic alignment with the coalition, aligning with other organizations involved with the coalition, having input with the coalition's activities, participating in important events and products of the coalition, and realizing more overall advantages than disadvantages for participating in the coalition.

BMI and Physical Activity, Military-Aged U.S. Population 2015-2020.

INTRODUCTION: Obesity and physical inactivity are considered possible U.S. national security threats because of their impact on military recruitment. The objectives of this study were to estimate the prevalence of (1) BMI eligibility for military entrance, (2) adequate physical activity participation among the BMI-eligible population, and (3) combined BMI eligibility and adequate physical activity. METHODS: This cross-sectional study of nonpregnant, military-aged civilians (aged 17-42 years) used objectively measured weight and height data and self-reported aerobic physical activity data from the 2015-2020 National Health and Nutrition Examination Survey. BMI eligibility was defined as 19.0-27.5 kg/m2, per Department of Defense regulation. Adequate physical activity for entering initial military training was defined as ≥300 minutes/week of equivalent moderate-intensity aerobic physical activity from all domains, approximating U.S. Army guidance. Participants meeting both definitions were further classified as eligible and active. Analyses were conducted in 2021-2022. RESULTS: Of military-aged participants (unweighted n=5,964), 47.3% were eligible by BMI. Among BMI-eligible participants, 72.5% reported adequate physical activity. Taken together, 34.3% were both eligible and active. The prevalence of eligible and active status was higher among males, persons who were younger and non-Hispanic White, college graduates, and those with higher family income than among their counterparts. CONCLUSIONS: Among the military-aged U.S. population, slightly under half were eligible to enter the military on the basis of their BMI, and only 1 in 3 met BMI eligibility and were adequately physically active. Equitable promotion of healthy weight achievement and physical activity participation may improve military preparedness.

A state-by-state and regional analysis of the direct medical costs of treating musculoskeletal injuries among US Army trainees.

INTRODUCTION: Low physical activity (PA) and physical fitness (PF) are well-known factors for chronic diseases generally and cardiovascular diseases specifically. The economic burden from these chronic diseases is also well documented, as is their disproportionate prevalence among states in the Southern region of the U.S. Low PA and PF have also become recognized factors impacting military readiness and national security. Specifically, low PA and PF are highly correlated with musculoskeletal injures (MSKIs), now considered the greatest medical impediment to military readiness. Prior research shows low PF and MSKI incidence are greater among Army recruits from Southern states, however no previous research has investigated the economic impact of MSKIs at the state- and regional-level. The aim of this study was to determine the economic impact of MSKIs among U.S. Army initial military trainees on a state- and regional-basis. METHODS: Rosters for recruits entering U.S. Army Initial Military Training (IMT) for fiscal year 2017 were obtained (n = 103,487). Roster data included the unique personal identifier, demographics with postal zip code, training start/end dates, and height and weight and were subsequently linked to medical encounters and cost data from the Military Health System Data Repository. Trainees with one or more MSKIs were considered injury cases (n = 33,509) and were stratified by gender. The percent of trainee MSKI cases was calculated as number of injury cases divided by total number of trainees. For each injury case, the direct medical cost for MSKIs was calculated. The percent of trainees and direct medical costs for MSKIs were aggregated to home-state and regional-levels for the four U.S. Census tract regions. A test for equality of proportions was performed at state- and regional-levels to investigate differences in percent of trainees with MSKIs by state/region. A one-way ANOVA was used to investigate possible differences in medical cost/trainee by region. RESULTS: 34% (n = 33,509) of all trainees sustained at least one MSKI. State-specific MSKI percentages showed ten states having the greatest percentage of trainees with at least one MSKI, eight of which were from the South region (AL, FL, GA, LA, MS, NC, SC, TN). The South was the only region to have a statistically significantly higher percentage of trainees with MSKIs at 34% (p < 0.001), as compared to all other regions. The total direct medical cost of treating MSKIs among all trainees was $14,891,563. The South was the costliest region ($7,168,997), accounted for nearly 50 % of the total national cost, and had the highest mean MSKI cost/trainee. DISCUSSION: This study was the first in demonstrating the disproportionate economic burden Southern states pose to the U.S. Department of Defense resulting from its significantly higher MSKI cost. PA and PF are known to ameliorate chronic disease and MSKI burden among general and military populations. Therefore, increasing PA and PF among all young Americans, and specifically those living in Southern states, is imperative for improving public health and reducing the economic and practical burden of MSKIs on military readiness and national security.

The impact of combined health factors on cardiovascular disease mortality.

BACKGROUND: The combined effect of modifiable health factors on the risk of cardiovascular disease (CVD) mortality has not been well established. The objective of this study was to determine the association between 5 modifiable health factors in combination on the risk of CVD mortality in a sample of adult men. METHODS: A cohort of 38,110 men (aged 20-84 years and of middle and upper socioeconomic strata) was followed over time until their date of death or December 31, 2003. A health profile score (unweighted and weighted) was developed based on cardiorespiratory fitness (CRF; moderate or high vs low), self-reported physical activity (active vs inactive), smoking status (not current vs current), alcohol consumption (1-14 drinks per week vs 0 or >14 drinks per week), and body mass index (BMI; 18.5-24.9 vs >or=25.0 kg/m(2)). RESULTS: During 16.1 +/- 8.4 years of follow-up and 613,571 man-years of exposure, there were 949 deaths from CVD. High CRF, normal BMI, being physically active, and not currently smoking were individually associated with reduced risk of CVD mortality after adjusting for confounders. When considered in combination, a minimum of 2 of 5 positive health factors reduced the risk of CVD mortality (hazard ratio = 0.67, 95% CI 0.49-0.91). The weighted score indicated that a combination of high CRF, not currently smoking, and normal BMI is of most clinical importance to CVD mortality (hazard ratio = 0.31, 95% CI 0.24-0.39). CONCLUSIONS: Exposure to increasing numbers of beneficial health factors in adulthood reduced the risk of CVD mortality in men, and multibehavioral prevention efforts in adulthood should be encouraged.

Application of the Rosetta Stone to understand how much MVPA preschoolers accumulate: A systematic review.

OBJECTIVES: This study illustrates the utility of the Rosetta Stone equations for comparing estimates of preschool-age children's moderate-to-vigorous physical activity (MVPA) across studies utilizing different cutpoints. DESIGN: Systematic review. METHODS: A search of online databases was conducted to identify studies that reported daily minutes of MVPA in preschoolers using the cutpoints from which Rosetta Stone equations have been developed. Mean MVPA minday-1 from each study and the transformed estimate using the Rosetta Stone equations were compared across 7 sets of cutpoints. The weighted mean was used to calculate absolute differences between the MVPA estimates of studies using the same cutpoints (e.g all studies that have used Pate cutpoint), and from all of the remaining studies using different cutpoints (e.g., all remaining studies that have not used Pate cutpoint), before and after the Rosetta Stone transformation. RESULTS: A total of 33 manuscripts met the eligibility criteria and reported MVPA for 12,178 preschoolers (50% girls). The mean MVPA for the total sample ranged from 21.1 (Puyau cutpoint) to 288.6 (Freedson cutpoints) minday-1. The difference between studies using the same cutpoint and estimates from remaining studies using different cutpoints was 82.4 and 80.0minday-1 for boys and girls, respectively. These differences were reduced to approximately 14minday-1 for boys and girls, after Rosetta Stone transformations. CONCLUSIONS: The Rosetta Stone equations substantially reduced the differences across studies that utilize different cutpoints and improved the ability to interpret findings across studies. Future equations should be developed for sedentary and total physical activity, as well as, comparisons across different devices and placements.

Equating accelerometer estimates among youth: The Rosetta Stone 2.

OBJECTIVES: Different accelerometer cutpoints used by different researchers often yields vastly different estimates of moderate-to-vigorous intensity physical activity (MVPA). This is recognized as cutpoint non-equivalence (CNE), which reduces the ability to accurately compare youth MVPA across studies. The objective of this research is to develop a cutpoint conversion system that standardizes minutes of MVPA for six different sets of published cutpoints. DESIGN: Secondary data analysis. METHODS: Data from the International Children's Accelerometer Database (ICAD; Spring 2014) consisting of 43,112 Actigraph accelerometer data files from 21 worldwide studies (children 3-18 years, 61.5% female) were used to develop prediction equations for six sets of published cutpoints. Linear and non-linear modeling, using a leave one out cross-validation technique, was employed to develop equations to convert MVPA from one set of cutpoints into another. Bland Altman plots illustrate the agreement between actual MVPA and predicted MVPA values. RESULTS: Across the total sample, mean MVPA ranged from 29.7MVPAmind(-1) (Puyau) to 126.1MVPAmind(-1) (Freedson 3 METs). Across conversion equations, median absolute percent error was 12.6% (range: 1.3 to 30.1) and the proportion of variance explained ranged from 66.7% to 99.8%. Mean difference for the best performing prediction equation (VC from EV) was -0.110mind(-1) (limits of agreement (LOA), -2.623 to 2.402). The mean difference for the worst performing prediction equation (FR3 from PY) was 34.76mind(-1) (LOA, -60.392 to 129.910). CONCLUSIONS: For six different sets of published cutpoints, the use of this equating system can assist individuals attempting to synthesize the growing body of literature on Actigraph, accelerometry-derived MVPA.

Organizational member involvement in physical activity coalitions across the United States: development and testing of a novel survey instrument for assessing coalition functioning.

INTRODUCTION: Coalitions are often composed of member organizations. Member involvement is thought to be associated with coalition success. No instrument currently exists for evaluating organizational member involvement in physical activity coalitions. This study aimed to develop a survey instrument for evaluating organizational member involvement in physical activity coalitions. The study was carried out in three phases: (a) developing a draft survey, (b) assessing the content validity of the draft survey, and (c) assessing the underlying factor structure, reliability, and validity of the survey. METHOD: A cross-sectional design was employed. In Phase 1, a team of experts in survey development produced a draft survey. In Phase 2, the content validity of the draft survey was evaluated by a panel of individuals with expertise in physical activity coalitions. In Phase 3, the survey was administered to 120 individuals on local-, state-, and national-level physical activity coalitions. Responses were subjected to an exploratory factor analysis in order to determine the survey's underlying factor structure, reliability, and validity. RESULTS: Phases 1 and 2yielded a survey instrument with demonstrated content validity. Phase 3 yielded a three-factor model with three subscales: Strategic Alignment, Organizational Alignment, and Providing Input. Each subscale demonstrated high internal consistency reliability and construct validity. DISCUSSION: The survey instrument developed here demonstrated sound psychometric properties and provides new insight into organizational member involvement in physical activity coalitions. This instrument may be an important tool in developing a more complete picture of coalition functioning in physical activity coalitions specifically and health-based coalitions overall.

Development of a National Physical Activity Plan for the United States.

BACKGROUND: Efforts to increase population levels of physical activity are increasingly taking the form of strategic plans at national, state/regional, and local levels. The processes employed for developing such plans have not been described previously. The purpose of this article is to chronicle the processes employed in and lessons learned from developing the US National Physical Activity Plan (NPAP). METHODS: The Coordinating Committee oversaw development of the NPAP. Key steps in the process included creating a private-public coalition based in the private sector, organizing the NPAP around 8 societal sectors, reviewing the evidence base for promotion of physical activity in each sector, conducting a national conference to initiate development of the NPAP's core content, ensuring broad participation in developing and refining the NPAP, and launching the NPAP through a press event that attracted national attention. RESULTS AND CONCLUSION: The 3-year effort to develop the NPAP was guided by a private-public collaborative partnership involving private sector organizations and government agencies. Launched in May 2010, the NPAP included more than 250 evidence-based recommendations for changes to policy and practice at the national, state, and local levels across 8 societal sectors.

Accelerometer-derived physical activity levels of preschoolers: a meta-analysis.

OBJECTIVES: This study synthesized the published estimates of daily moderate-to-vigorous physical activity (MVPAd(-1)) of preschooler-age children (3-5 years). DESIGN: Meta-analysis of previously published studies reporting accelerometer-derived estimates of daily MVPA of preschoolers. METHODS: A comprehensive literature review was conducted to identify studies published by March 2010 that reported daily minutes of accelerometer-derived MVPA in preschool-age children (3-5 years). Random effects point estimates and 95% confidence intervals (95% CIs) were calculated based on study weighted means and standard deviations of raw accelerometer counts per minute (cpm) and reported minutes of MVPA and/or percentage of time spent in MVPAd(-1). RESULTS: 29 articles representing 6309 preschoolers were included. Overall, preschoolers engaged in 42.8 min (95% CI 28.9-56.8) of MVPAd(-1), and 54.4 min (95% CI 29.9-78.9) and 45.4 min (95% CI 25.2-65.6) for boys and girls separately. This translated into approximately 5.5% (95% CI 3.7-7.2%) of time spent in MVPAd(-1), and 7.1% (95% CI 3.9-10.3%) for boys and 6.3% (95% CI 3.9-8.7%) for girls. Studies (76%) using ActiGraph accelerometers reported an average of 714 cpm (95% CI 678-751), with boys and girls having 783 cpm (95% CI 753-813) and 696 cpm (95% CI 665-727), respectively. CONCLUSIONS: Interpretation of accelerometer-derived MVPA is confounded by differences in cutpoints applied within a study. Great care, therefore, should be taken when interpreting the activity levels of preschoolers to inform policy decisions, such as the development of physical activity guidelines. Hence, considerable attention is required to unify accelerometer-derived MVPA so that unbiased comparisons across studies can be made.

Equating accelerometer estimates of moderate-to-vigorous physical activity: in search of the Rosetta Stone.

No universally accepted ActiGraph accelerometer cutpoints for quantifying moderate-to-vigorous physical activity (MVPA) exist. Estimates of MVPA from one set of cutpoints cannot be directly compared to MVPA estimates using different cutpoints, even when the same outcome units are reported (MVPA mind(-1)). The purpose of this study was to illustrate the utility of an equating system that translates reported MVPA estimates from one set of cutpoints into another, to better inform public health policy. Secondary data analysis. ActiGraph data from a large preschool project (N=419, 3-6-yr-olds, CHAMPS) was used to conduct the analyses. Conversions were made among five different published MVPA cutpoints for children: Pate (PT), Sirard (SR), Puyau (PY), Van Cauwengerghe (VC), and Freedson Equation (FR). A 10-fold cross-validation procedure was used to develop prediction equations using MVPA estimated from each of the five sets of cutpoints as the dependent variable, with estimated MVPA from one of the other four sets of cutpoints (e.g., PT MVPA predicted from FR MVPA). The mean levels of MVPA for the total sample ranged from 22.5 (PY) to 269.0 (FR) mind(-1). Across the prediction models (5 total), the median proportion of variance explained (R(2)) was 0.76 (range 0.48-0.97). The median absolute percent error was 17.2% (range 6.3-38.4%). The prediction equations developed here allow for direct comparisons between studies employing different ActiGraph cutpoints in preschool-age children. These prediction equations give public health researchers and policy makers a more concise picture of physical activity levels of preschool-aged children.