Nadia Urban

Musculoskeletal injuries among overweight army trainees: incidence and health care utilization.

BACKGROUND Musculoskeletal injuries are a major cause of morbidity in military training. They are more common among overweight/obese individuals, and the prevalence of overweight/obesity in the military has increased. During strong economic periods, the military can be challenged to recruit enough qualified personnel, and physical standards are sometimes relaxed. AIMS This study was conducted to compare the incidence of and outpatient utilization for training-related overuse injuries among men who were over body fat (OBF) standards compared with those who were weight qualified (WQ). METHODS All study subjects were men ≥18 years old, who were classified as OBF or WQ and were followed for 90 days. During this period, everyone entering through the study sites was required to take a physical fitness test (5 min step test). Only individuals passing the fitness test were included in these analyses. RESULTS There were 812 OBF and 6511 WQ study participants. OBF were 47% more likely to experience a musculoskeletal injury and had 49% higher health care utilization. Other significant factors included age >19 and a history of smoking. CONCLUSIONS Among this population who had passed a fitness test, those who were OBF had a substantially higher risk of injury and higher utilization for these injuries. Because the recruiting environment is much better, military entrance standards have been tightened, but should the economy improve substantially the military may again be challenged to recruit adequate numbers of personnel, and the lessons learned in this project may prove valuable.

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.

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

Fitness, obesity and risk of asthma among Army trainees

5,141 less expensive per year than EBF female recruits. WQ males were

Self-Reported Physical Activity and Preaccession Fitness Testing in U.S. Army Applicants

2,785 less expensive per year of military service than EBF male recruits. Among WQ recruits, fit females were

Fitness, obesity and risk of heat illness among army trainees

3,638 and fit males were

Accession Medical Standards Analysis and Research Activity

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.

Accession Medical Standards Analysis & Research Activity (AMSARA) 2011 Annual Report

BACKGROUND Epidemiological data suggest an association between overweight/obesity and asthma. However, less is known about the relationship between physical fitness and asthma. AIMS To enumerate new-onset asthma diagnoses in Army recruits during the first 2 years of service and determine associations with fitness and excess body fat (EBF) at military entrance. METHODS New asthma diagnoses over 2 years in Army recruits at six entrance stations were obtained from military health and personnel records. Poisson regression models were used to determine associations of asthma diagnosis with pre-accession fitness testing, EBF and other potential factors. RESULTS In 9979 weight-qualified and 1117 EBF entrants with no prior history of asthma, 256 new cases of asthma were diagnosed within 2 years of military entry. Low level of fitness, defined by a step test and EBF, was significantly associated with new asthma diagnosis [adjusted incidence rate ratio (IRR), 1.47; 95% confidence interval (CI) 1.11-1.96 and adjusted IRR, 1.53; 95% CI 1.06-2.20, respectively]. CONCLUSIONS Individuals with low fitness levels, EBF or both are at higher risk of asthma diagnosis in the first 2 years of military service.