Operation Aegis 2002

Operation Aegis:Operation Aegis: Injury Control during Injury Control during

Advanced Individual TrainingAdvanced Individual Training

LTC Annette BergeronLTC Annette BergeronMAJ Vicki ConnollyMAJ Vicki ConnollyCPT Allyson PritchardCPT Allyson PritchardDr. Mary Z. MaysDr. Mary Z. Mays

SSG Mark Kenyon SSG Mark Kenyon SSG Shelia MickelsonSSG Shelia MickelsonIleana King Ileana King Darrel GerikDarrel GerikClaude LeeClaude Lee

OPE

RA T IO N A EG IS

I NJ U R Y C O N T R O L P R O G R A M

COL Valerie J. Berg RiceCOL Valerie J. Berg Rice

BrigadeBrigade• COL Larry E. Campbell COL Larry E. Campbell • COL Kenneth R. CrookCOL Kenneth R. Crook• LTC Rosaline Cardinelli LTC Rosaline Cardinelli • LTC Brian AllgoodLTC Brian Allgood• CPT Marc Bustamante CPT Marc Bustamante • CPT Clyde L. HillCPT Clyde L. Hill• CPT Greer M. Evans-CPT Greer M. Evans-

ChristopherChristopher

MedicalMedical• COL Gemryl SammuelsCOL Gemryl Sammuels• LTC Suzanne E. CudaLTC Suzanne E. Cuda• LTC Stanley H. UnserLTC Stanley H. Unser• CPT Deanna S. PekarekCPT Deanna S. Pekarek

All company commanders, all drill sergeants, cadre, All company commanders, all drill sergeants, cadre, All TMC providers, OT/PT, Community Health NursingAll TMC providers, OT/PT, Community Health Nursing

OPERATION AEGISOPERATION AEGISConceived 1999Conceived 1999

Implemented 2000Implemented 2000

LTG James P. PeakeLTG James P. Peake Scientifically-basedScientifically-based Musculoskeletal Musculoskeletal

Injury Prevention ProgramInjury Prevention Program Goals:Goals:

Decrease Musculoskeletal Injuries among AIT Decrease Musculoskeletal Injuries among AIT soldiers on Ft. Sam Houstonsoldiers on Ft. Sam Houston Develop a Guideline Methodology that can be Develop a Guideline Methodology that can be used at other postsused at other posts

AUSA Medical Symposium 2002

2 JUL 99 2 JUL 99 Presidential MemoPresidential Memo

Directs Secretary of Labor to lead an initiative Directs Secretary of Labor to lead an initiative focusing on Federal workplace injury reduction focusing on Federal workplace injury reduction over a period of 5 years with 3 measurable goals.over a period of 5 years with 3 measurable goals.

1. Reducing the overall occurrence of injuries 1. Reducing the overall occurrence of injuries by 3 percent per year, while improving the by 3 percent per year, while improving the timeliness of reporting of injuries and illnesses timeliness of reporting of injuries and illnesses by agencies to the Department of Labor by 5 by agencies to the Department of Labor by 5 percent per yearpercent per year


2 JUL 99 2 JUL 99 Presidential MemoPresidential Memo

2. 2. For those work sites with the highest rates For those work sites with the highest rates of serious injuries, reducing the occurrence of serious injuries, reducing the occurrence of such injuries by 10 percent per year; andof such injuries by 10 percent per year; and

3. Reducing the rate of lost production days 3. Reducing the rate of lost production days (i.e. the number of days employees spend (i.e. the number of days employees spend away from work) by 2 percent per yearaway from work) by 2 percent per year


Injury Rates among Recruits

0% 20% 40% 60% 80% 100%

Males

Females


Studies at Studies at Ft. Sam HoustonFt. Sam Houston

• BCTBCT HendersonHenderson RiceRice– menmen 26% 26% 28%28%– womenwomen 52% 52% 48%48%

• AITAIT– menmen 24% 24% 24%24%– womenwomen 30% 30% 24%24%


Macroergonomic and Macroergonomic and Public Health ApproachesPublic Health Approaches

ErgonomicsErgonomics

AssessAssess Design Design

(intervention)(intervention) Test & evaluationTest & evaluation

Public HealthPublic Health

SurveillanceSurveillance InterventionIntervention EvaluationEvaluation DisseminationDissemination


MacroergonomicsMacroergonomics

Each system and each level within a Each system and each level within a systemsystem

Broad to Focused Broad to Focused Organizational structure, resources, agencies, Organizational structure, resources, agencies,

personnel, policies, procedures, surveillance personnel, policies, procedures, surveillance systems, datasystems, data

Communication/AdvisorsCommunication/AdvisorsWho will be of assistance?Who will be of assistance?For or against?For or against?Participatory: They should “own it”Participatory: They should “own it”


PremisesPremises

Top Level Support is EssentialTop Level Support is Essential Participatory Ergonomics/Organizational Participatory Ergonomics/Organizational

EffectivenessEffectiveness Dictated changes, unless they are Army-wide, Dictated changes, unless they are Army-wide,

do not last - attitude/belief changes do lastdo not last - attitude/belief changes do last Locally dictated changes are often sabotagedLocally dictated changes are often sabotaged Top down, bottom up, sidewaysTop down, bottom up, sideways Everyone is involved & has responsibilitiesEveryone is involved & has responsibilities


PremisesPremises

Injury Management is a Injury Management is a Commander’s Commander’s ResponsibilityResponsibility

Health Care Professionals are Health Care Professionals are SME’s/Advisors/ConsultantsSME’s/Advisors/Consultants


Setting the StageSetting the Stage(& Assessing)(& Assessing)

Understanding the LiteratureUnderstanding the Literature

Understanding the PeopleUnderstanding the People

Understanding the Rules and the RolesUnderstanding the Rules and the Roles


Broad to FocusedBroad to Focused

Informal “Advisors” nationwideInformal “Advisors” nationwide CDC, Universities, Ergo/Injury Prevention Programs, CDC, Universities, Ergo/Injury Prevention Programs,

Professional Societies Professional Societies DoD DoD

IOIPC (Ill & Occ Injury Prev Comm) IOIPC (Ill & Occ Injury Prev Comm) Ergonomics Committee, MWRErgonomics Committee, MWR Navy/Marines/AF/Corps of Engineers, CGNavy/Marines/AF/Corps of Engineers, CG

Army Army CHPPM, MRMC esp. USARIEM, Safety Center, CHPPM, MRMC esp. USARIEM, Safety Center,

Corps Activities/Committees, other postsCorps Activities/Committees, other posts


Broad to FocusedBroad to Focused

PostPost MWR, Comm Health Nursing, Occupational MWR, Comm Health Nursing, Occupational

Health, PTRP, Sports-intramural, Wellness Health, PTRP, Sports-intramural, Wellness Center, OH&S, Ergo CommitteeCenter, OH&S, Ergo Committee

US Army Medical Center and SchoolUS Army Medical Center and School Center BrigadeCenter Brigade BattalionsBattalions CompaniesCompanies

Organizational structure, resources, agencies, personnel, policies, procedures,

surveillance systems, data


Messages to Messages to CommandCommand

• We think we can reduce injuries.We think we can reduce injuries.• We are here to try it.We are here to try it.• We will use a scientific approach to discover We will use a scientific approach to discover

why injuries occur and how to decrease them.why injuries occur and how to decrease them.• We’ll do all we can to interfere as little as We’ll do all we can to interfere as little as

possible.possible.• We are here as allies, not adversaries.We are here as allies, not adversaries.

What are you, the PT Police???

Establish Communication Establish Communication PatternsPatterns

Regular meetings at all levelsRegular meetings at all levels Matching rank w/ rank, mixing too!Matching rank w/ rank, mixing too! Matching civilians w/ rank and/or groupsMatching civilians w/ rank and/or groups Briefings Briefings

a lot or a little?a lot or a little? iterativeiterative topicstopics

Consultants not dictators!Consultants not dictators! 0

1

2

3

4

Months 1-6 Months 7-12 Months 13 -18

Coordinating Meetings/Week


Staff’s PerceptionsStaff’s Perceptions

• Only by knowing what they Only by knowing what they think/believe, do you know how to think/believe, do you know how to approach and work with them... approach and work with them...

– Drill SergeantsDrill Sergeants

– CadreCadre

– CommandersCommanders


Are there too many overuse injuries Are there too many overuse injuries occurring in your unit?occurring in your unit?

0 10 20 30 40 50

Yes

No

Don't Know

Most don’t think it’s a problem


What do you think is an acceptable What do you think is an acceptable rate of soldiers being on profile rate of soldiers being on profile

for injury at any given time?for injury at any given time?

0 10 20 30 40

0-.9%

1-5%

6-10%

11-15%

16-20%

21-25%

26-30%

~ 20% at the extreme

~ 60% at 1-10%


What are the main factors What are the main factors contributing to injuries in your unit?contributing to injuries in your unit?

0 20 40 60 80

Injured in BCT

PT

Field Training

Recreation/Sports

MVA

Other


Can injuries be decreased by Can injuries be decreased by changing the way you train?changing the way you train?

0 20 40 60 80

Yes

No

Don't KnowThere’s nothing I can do.

It’s not my fault.It’s BCT.


All this and we haven’t even All this and we haven’t even started our program yet?started our program yet?

RememberRememberfor this program there was no “solution” yetfor this program there was no “solution” yettell them the solution for “their problem” right away tell them the solution for “their problem” right away

and they have to feel defensiveand they have to feel defensiveit’s perceived as extra work for themit’s perceived as extra work for themthey don’t see the value, esp. for themthey don’t see the value, esp. for themthey aren’t convinced!they aren’t convinced!they don’t know how to “use you”they don’t know how to “use you”

You have been learning, and as you You have been learning, and as you learn, you implement.learn, you implement.

It all happens simultaneously…..It all happens simultaneously…..


At each level:At each level:

What Exists? Who is doing what, What Exists? Who is doing what, when, and how? How does what when, and how? How does what they do relate? they do relate?

What What shouldshould be happening? be happening?What are their attitudes/opinions?What are their attitudes/opinions?How can we make what should How can we make what should

happen, happen effectively?happen, happen effectively?


SurveillanceSurveillance

Inprocessing Inprocessing 8094 soldiers, 9015 surveys8094 soldiers, 9015 surveys

Outprocessing Outprocessing 6111 soldiers, 6819 surveys6111 soldiers, 6819 surveys

TMC Visits TMC Visits 3278 soldiers, 4466 surveys3278 soldiers, 4466 surveys

ProfilesProfiles2172 soldiers, 3194 surveys2172 soldiers, 3194 surveys


Initial InterventionsInitial Interventions

• Command ClimateCommand Climate– Injury preventionInjury prevention– PerformancePerformance

• Injury Control Advisory CommitteeInjury Control Advisory Committee• BN Standard Operating ProceduresBN Standard Operating Procedures• Education on Latest InformationEducation on Latest Information• Reporting & Accountability SystemReporting & Accountability System


Injury Control Advisory Injury Control Advisory CommitteeCommittee

• Purpose:Purpose: To advise the Commander on To advise the Commander on musculoskeletal injury preventionmusculoskeletal injury prevention

• Mission:Mission: To advise the Commander on methods To advise the Commander on methods to reduce and/or maintain an acceptable level of to reduce and/or maintain an acceptable level of musculoskeletal injuries and lost duty time within musculoskeletal injuries and lost duty time within the battalion by identifying injury trends and the battalion by identifying injury trends and causative factors, and causative factors, and recommending/implementing targeted injury recommending/implementing targeted injury prevention programsprevention programs


ICACICAC

• CompositionComposition• Tasks/ResponsibilitiesTasks/Responsibilities• Track injury trendsTrack injury trends

– Standardize data to be Standardize data to be collected/reportedcollected/reported

– Establish baselinesEstablish baselines– Interpret findingsInterpret findings

Take Time & TeachIdentify and Solve ProblemsNo concern left unaddressed!


ICAC Problem SolvingICAC Problem Solving

• Poorly written profilesPoorly written profiles

– Each company turn in copiesEach company turn in copies

– Reviewed by SMEsReviewed by SMEs

– Taken to TMC ChiefTaken to TMC Chief

– Coordinated solutionCoordinated solution

• Training course for health care practitionersTraining course for health care practitioners

ICAC Identified ProblemsICAC Identified ProblemsBN Commander ConsultingBN Commander Consulting

• Injuries during/after DAPFTInjuries during/after DAPFT– Arrival screening (HCP, DS, Traditional)Arrival screening (HCP, DS, Traditional)

• Positive Prediction HCP 92%, DS 80% Positive Prediction HCP 92%, DS 80% • Negative Prediction HCP 91%, DS 95%Negative Prediction HCP 91%, DS 95%• Initial profiles increasedInitial profiles increased• No difference in # of profiles, profile length during the No difference in # of profiles, profile length during the

course, pass rate on RAPFT, holdoverscourse, pass rate on RAPFT, holdovers• 30% on profile w/ profile of 3 wks30% on profile w/ profile of 3 wks• 40% of those on profile went on in the first week - 48% 40% of those on profile went on in the first week - 48%

passed RAPFT, 58% on profile later - 80% passed RAPFTpassed RAPFT, 58% on profile later - 80% passed RAPFT

– Identify “Porcelain” SoldiersIdentify “Porcelain” Soldiers


Porcelain SoldiersPorcelain Soldiers

• Profile*Profile*• SymptomsSymptoms

– More than one*More than one*– Lower Extremity*Lower Extremity*– Injured in BCT or last 90 Injured in BCT or last 90

days*days*– Upper Extremity Upper Extremity

SymptomsSymptoms– (That interferes w/ duty*)(That interferes w/ duty*)

• Moderate/High Moderate/High Stress*Stress*

• Female*Female*• Poor/Fair Physical Poor/Fair Physical

Fitness*Fitness*• Over 24 yrs of ageOver 24 yrs of age

* predictive of injury during AIT


ICACICACBN Commander ConsultingBN Commander Consulting

• One ability group injured more?One ability group injured more?

• Did they REALLY pass the PT test during Did they REALLY pass the PT test during basic?basic?

• Injuries during field problemsInjuries during field problems

• Early intervention clinicEarly intervention clinic


ICACICACBN Commander ConsultingBN Commander Consulting

• Drill Sergeant RecertificationDrill Sergeant Recertification• In-processing ClassesIn-processing Classes• Other Classes, as requested Other Classes, as requested

– InjuriesInjuries– Physical TrainingPhysical Training– NutritionNutrition– Special Population PTSpecial Population PT


ICACICACConsultingConsulting

• ClassesClasses– Running (form, breathing, etc.)Running (form, breathing, etc.)– Shoe FitShoe Fit

• Soldiers on sick call immediately after Soldiers on sick call immediately after exodusexodus

• Fear factor when changing running Fear factor when changing running routesroutes

ResultsResults232nd Battalion

Change in "Per Course Musculoskeletal Injury Rates" During Operation Aegis

67

49

36 38

4954

4246

53

28

58

4146

71

34

43

0

10

20

30

40

50

60

70

80

90

100

9/11

9/25

10/1

010

/23

11/6

11/2

012

/4 1/8

1/16

1/29

2/12

2/26

3/12

3/26 4/9

4/23 5/7

5/21 6/4

E F A B C D E F A B C D E F A B C D E

Injury ControlCommittees Started

New Physical TrainingSOP Started

RunningTemplateStarted

Num

ber o

f Clin

ic V

isits

for

Mus

culo

skel

etal

Inju

ry

per 1

00 S

oldi

ers

in th

e Te

n-w

eek

Cou

rse

10.8% 10.8% reductionreduction

360 fewer clinic visits$26,280 annual savings

ResultsResults

232nd Battalion Change in "Per Course Musculoskeletal Injury Rates"

During Operation Aegis

46

25

104 7

46

30

93 4

41

28

4 3 6

0

10

20

30

40

50

60

70

80

90

100

Total Pain/Soreness Strain/Sprain Tendonitis All Other

Num

ber o

f Clin

ic V

isits

for

Mus

culo

skel

etal

Inju

ry

per 1

00 S

oldi

ers

in T

rain

ing

Injury Control CommitteesStarted (n = 2070)New Physical Training SOPStarted (n = 2626)

Running Template Started(n = 666)

80% strain/sprain60% decrease

288 visits/yr/BN$31, 536/yr/BN

232nd Battalion Change in "Per Course Musculoskeletal

Sprain/Strain Rates" During Operation Aegis

12 13

810 10 11 10

79

3

119 10

53

20

0

5

10

15

20

25

309/

119/

2510

/10

10/2

311

/611

/20

12/4 1/8

1/16

1/29

2/12

2/26

3/12

3/26 4/9

4/23 5/7

5/21 6/4

E F A B C D E F A B C D E F A B C D E

Injury ControlCommittees Started

New Physical TrainingSOP Started

RunningTemplateStarted

Num

ber o

f Clin

ic V

isits

for

Mus

culo

skel

etal

Inju

ry

per 1

00 S

oldi

ers

in th

e Te

n-w

eek

Cou

rse 60%

decrease

Sprain/StrainSprain/Strain


Early InterventionEarly Intervention

• 12% reduction in clinic visits12% reduction in clinic visits

> 3 days> 3 days < 3 days< 3 days 42/10042/100 37/100 37/10012% reduction12% reduction120 less visits/month120 less visits/month$8760/month = $105,120/year$8760/month = $105,120/year


Break TimeBreak Time

• RehydrationRehydration

• NutritionNutrition

• MovementMovement


Ft. Sam Houston AITFt. Sam Houston AITSurveillanceSurveillance

TMC Visits: 56% for MSITMC Visits: 56% for MSITMC Visit Overuse InjuriesTMC Visit Overuse Injuries

~~55% men 55% men ~69% women~69% women

Profile Overuse InjuriesProfile Overuse Injuries~61% men~61% men~72% women~72% women


Ft. Sam Houston Ft. Sam Houston AIT MSI’sAIT MSI’s

• Initially IdentifiedInitially Identified– 43% BCT43% BCT– 48% AIT48% AIT

• InjuriesInjuries– 80% received a profile80% received a profile

• 50% were longer than 7 days50% were longer than 7 days


Ft. Sam Houston AITFt. Sam Houston AIT

70% injuries due to lower 70% injuries due to lower extremity sprain, strain, pain extremity sprain, strain, pain Two of 5 for knee and lower legTwo of 5 for knee and lower leg Top Causes:Top Causes:

Running - 37%Running - 37%Marching - 13%Marching - 13%Calisthenics - 5%Calisthenics - 5%


ResultsResults

Half of the MSIs originated at FSHHalf of the MSIs originated at FSH

Clinic visits and profiles primarily for LE Clinic visits and profiles primarily for LE MSI and overuse injuriesMSI and overuse injuries

Top cause appeared to be running portion Top cause appeared to be running portion of unit directed trainingof unit directed training


Existing Existing Physical TrainingPhysical Training

4-5 days/week (M, Tu, W, F)4-5 days/week (M, Tu, W, F) 1 hour1 hour NCO’s (FM 21-20)NCO’s (FM 21-20) Bulk of time spent running 2+ miles (M, W, F), Bulk of time spent running 2+ miles (M, W, F),

occasional Sat run/marchoccasional Sat run/march Calisthenics, focus toward muscle failure (Tu, Fr)Calisthenics, focus toward muscle failure (Tu, Fr) 4-6 ability groups w/ whatever spread occurred4-6 ability groups w/ whatever spread occurred Formation cadence runs, two motivational runs per Formation cadence runs, two motivational runs per

class (2.5 and 3.0 miles)class (2.5 and 3.0 miles)


Risk FactorsRisk Factors

Increasing distance run per week Increasing distance run per week (Alameida (Alameida et al., 1997; Jones et al., 1993, Rudzki, 1997)et al., 1997; Jones et al., 1993, Rudzki, 1997)

Low levels of physical fitnessLow levels of physical fitness BCT: 23-37% for men 42-67% for women BCT: 23-37% for men 42-67% for women

(Canham-Chervak, et al., 2000)(Canham-Chervak, et al., 2000) Anecdotal: lack of knowledge of appropriate Anecdotal: lack of knowledge of appropriate

running progression (progressing too running progression (progressing too quickly, insufficient recovery periods)quickly, insufficient recovery periods)

Too much, too soon, too fast Too much, too soon, too fast (shoes, dark, sleep…)(shoes, dark, sleep…)


Arriving SoldiersArriving Soldiers

24% of men arrive w/ injuries 24% of men arrive w/ injuries and 24-30% of women and 24-30% of women (Henderson, et al., 2000; Rice, Mays, (Henderson, et al., 2000; Rice, Mays, and Connolly, 2001)and Connolly, 2001)

57% of those reporting BCT 57% of those reporting BCT injuries also reported arriving injuries also reported arriving w/ symptoms that interfered w/ w/ symptoms that interfered w/ daily duty performancedaily duty performance


Arriving SoldiersArriving Soldiers

Generally physically fitGenerally physically fit Have worked up to running 2 miles for the Have worked up to running 2 miles for the

PT test; but not running 2 miles on a PT test; but not running 2 miles on a regular basisregular basis

Have passed the APFT w/ 50 pts for each Have passed the APFT w/ 50 pts for each event, now must pass w/ 60event, now must pass w/ 60

2-32-311//22 week break from PT: field training week break from PT: field training activity, out/in-processing, travel, waitactivity, out/in-processing, travel, wait


The Test The Test Running TemplateRunning Template

Pre-RT: January 2001 ClassPre-RT: January 2001 Class• 175 soldiers (90 men, 85 women)175 soldiers (90 men, 85 women)• Expert feedback, class by APFS, Expert feedback, class by APFS, New SOPNew SOP

RT: April 2001 ClassRT: April 2001 Class• 344 soldiers ( 196 men, 148 women)344 soldiers ( 196 men, 148 women)

Same unit, leadership (supervisors, commander), Same unit, leadership (supervisors, commander), location, ruleslocation, rules

10 weeks, 3-14 days after BCT completion10 weeks, 3-14 days after BCT completion

Pre-RTPre-RT RTRT

Initial Running DistanceInitial Running Distance 2.7 miles2.7 miles(2.3-3.5)(2.3-3.5)

1.5 building 1.5 building to 2.7**to 2.7**

Running TimeRunning Time 20 min, build 20 min, build to 30**to 30**

Determined Determined by distance by distance and speedand speed

SpeedSpeed Determined Determined by NCO that by NCO that dayday

Determined Determined by ability by ability group group diagnostic diagnostic scores**scores**

Distance runs marking Distance runs marking significant training eventssignificant training events

3 - 4 miles 3 - 4 miles NoneNone

Distance Runs/Week:Distance Runs/Week: 3 3 2-3 2-3 (fast, slow)(fast, slow)

Pre-RTPre-RT RTRT

Interval training sessions/wkInterval training sessions/wk Differed by Differed by companycompany

1/wk, begin wk 1/wk, begin wk 44

Hill run or speed trainingHill run or speed training 1/wk1/wk See interval See interval training, no hill training, no hill runs per seruns per se

Runs/wkRuns/wk 3-43-4 33

Ability GroupsAbility Groups 4 – 6 (typical 6, 4 – 6 (typical 6, depended on depended on available available supervision)supervision)

7 or more, 7 or more, spread times spread times no more than no more than 1.5-2 min1.5-2 min

Cadence RunsCadence Runs BN run only, BN run only, full distancefull distance

BN run only at BN run only at prescribed prescribed distancedistance

ExampleExample

• Wk One - 1.5 mile total miles including warm up Wk One - 1.5 mile total miles including warm up and cool downand cool down– Wed – Slow Continuous Run Wed – Slow Continuous Run

• 2 min/mile slower than 2 mile diagnostic APFT, easy pace, no 2 min/mile slower than 2 mile diagnostic APFT, easy pace, no falloutsfallouts

• 16:31-19:30 ¼ mile very easy, gradual increase to 11 min/mile for 16:31-19:30 ¼ mile very easy, gradual increase to 11 min/mile for 1 mile, ¼ mile easy pace1 mile, ¼ mile easy pace

– Fri – Fast Continuous RunFri – Fast Continuous Run• 30-40 sec slower than 2 mile diagnostic APFT, more challenging, 30-40 sec slower than 2 mile diagnostic APFT, more challenging,

if trouble keeping up slow until all are with the groupif trouble keeping up slow until all are with the group• 16:31-19:30 ½ mile easy, gradual increase to 10 min/mile for ¾ 16:31-19:30 ½ mile easy, gradual increase to 10 min/mile for ¾

mile, ¼ mile at easy pacemile, ¼ mile at easy pace– Sat – 1.5 mile fitness walk in PRT uniformSat – 1.5 mile fitness walk in PRT uniform


Dependent Measures Dependent Measures (SPSS)(SPSS)

EOC Company Reviews EOC Company Reviews (Descriptive, Pearson Chi(Descriptive, Pearson Chi22)) New and accumulated profiles for New and accumulated profiles for

MSIMSI Troop Medical Clinic Troop Medical Clinic

Clinic visits and profiles for MSIClinic visits and profiles for MSI APFT Cards (DA Form 705) APFT Cards (DA Form 705)

(ANOVA)(ANOVA) Diagnostic and final (record)Diagnostic and final (record)

Group DifferencesGroup Differences

• Ethnicity: NSDEthnicity: NSD• BMI: NSDBMI: NSD• Status (active duty vs. guard/reserve): NSDStatus (active duty vs. guard/reserve): NSD• Physical Fitness: NSDPhysical Fitness: NSD• Smoking: NSDSmoking: NSD• AgeAge: p < 0.01, RT group slightly older: p < 0.01, RT group slightly older• StressStress: p < 0.001, RT group higher stress level: p < 0.001, RT group higher stress level• Injured in BCTInjured in BCT: p < 0.05, RT group had greater : p < 0.05, RT group had greater

number of injuriesnumber of injuries• Current symptoms that interfereCurrent symptoms that interfere: p = 0.05, RT : p = 0.05, RT

group had more frequent reportsgroup had more frequent reports

EOC ReviewEOC Review

New Profile s

02468

1 0

1 2 3 4 5 6 7 8 9W eek of Training

MS

I P

rofi

les

(%)

Pre-RT R T

2 = 15, p < 0.01


Rate of New ProfilesRate of New Profiles

Pre-RT Pre-RT Group Group (n = 175)(n = 175)

RT RT GroupGroup(n = 344)(n = 344)

ChangeChange % % ReductionReduction

Chi Chi SquareSquare

Men 29% 11% -18% -62% p < 0.01

Women 54% 45% - 9% -17% p > 0.05

Total 43% 26% -17% -40% p < 0.01

EOC ReviewEOC Review

Weeks 1, 4-9, p < 0.01

Accumulated Profiles

05

101520253035

1 2 3 4 5 6 7 8 9Week of Training

MS

I Pro

files

(%)

Pre-RT RT


Accumulated ProfilesAccumulated Profiles

Men

05

1015202530


MSI

Pro

files

(%) Pre-RT

RT

Women

01020

304050


MSI

Pro

files

(%) Pre-RT

RT

Weeks 5-9, p < 0.01

EOC and TMC DataEOC and TMC DataHeld overHeld over pre-RT pre-RT RT RT

RAPFT FailureRAPFT Failure 6%6% 5% 5%MedicalMedical 2%2% 3% 3%

WaiverWaiver 13% 13% 7% 7%

Clinic Visit RateClinic Visit Rate 3.5/100 2.2/1003.5/100 2.2/100 63 visits/wk 40 visits/wk63 visits/wk 40 visits/wk

Rate of Clinic Visits Reduced by 36.5%Rate of Clinic Visits Reduced by 36.5%Cost Savings of $1679/wkCost Savings of $1679/wk


Surveillance TMC DataSurveillance TMC Data

Pre-RTPre-RT RT RTNew Profile RateNew Profile Rate 3.9/100 2.0/100 3.9/100 2.0/100

70 visits/wk 36 70 visits/wk 36 visits/wkvisits/wk

Rate of Profiles Reduced by 48.6%Rate of Profiles Reduced by 48.6%Savings of 612 limited duty days/weekSavings of 612 limited duty days/week


Diagnostic and Record Diagnostic and Record APFT PAPFT Pass Ratesass Rates

0

20

40

60

80

100

DAPF RAPFT

Pre-RT MenRT MenPre-R WomenRT Women

p > 0.05p > 0.05


Diagnostic and Record Diagnostic and Record APFT APFT Profile RatesProfile Rates

0

10

20

30

40

DAPFT RAPF

Pre-RT MenRT MenPre-RT WomenRT Women

p > 0.05p > 0.05

Retakes:30% vs 15%

Total Score on the RAPFT - NSD

238 240 239248

180

200

220

240

260

280

300

pre-RT (n = 48) RT (n = 93) pre-RT (n = 67) RT (n = 159)

Women

Men

Co A/232 BNM

ean

+/- S

E

Run Score on the RAPFT - NSD

7477 78 79

60

65

70

75

80

85

90

95

100


Women Men

Co A/232 BnM

ean

+/- S

E

Sit-up Score on the RAPFT - NSDSit-up Score on the RAPFT - NSD

78 77 7783

60

65

70

75

80

85

90

95

100


Women Men

Mea

n +/

- SE

Co A/232 Bn

Push-up Score RAPFT - NSDPush-up Score RAPFT - NSD

87 87 84 86

60

65

70

75

80

85

90

95

100


Women Men

Co A/232 BnM

ean

+/- S

E

Change in Total Score for Men DAPFT to RAPFT

2016

5 6

-5

0

5

10

15

20

25

30


Low Scorers High Scorers

Mea

n +/

- SE

Co A/232 BN

Change in Total Score DAPFT to RAPFT for Women

18

105

1-5

0

5

10

15

20

25

30


Low Scorers High Scorers

Co A/232 BNM

ean

+/- S

E

2X2X2 Anova (group X ability X gender)

• Men improved slightly more than women, Men improved slightly more than women, but both improvedbut both improved

• Low score groups improved more than Low score groups improved more than high score groups high score groups

• Pre-RT group improved slightly more than Pre-RT group improved slightly more than the RT group, but NSD and both improvedthe RT group, but NSD and both improved

• Men in high score group showed same Men in high score group showed same level of improvement in both pre-RT and level of improvement in both pre-RT and RT groupsRT groups

Discussion: Provide a Training Program that will Result in:

• Appropriate Level of ChallengeAppropriate Level of Challenge– Soldiers achieved equal performance on the Soldiers achieved equal performance on the

APFT w/ both training regimens (pass rates & APFT w/ both training regimens (pass rates & scores)scores)

– More soldiers available for participation (RT)More soldiers available for participation (RT)• PTPT• DAPFT, RAPFTDAPFT, RAPFT

• Fewer “injuries”Fewer “injuries”– Clinic Visits for MSI’sClinic Visits for MSI’s– Profiles for MSI’sProfiles for MSI’s


Estimated SavingsEstimated Savings

• $67,000/yr per BN$67,000/yr per BN• $137,000/yr for 2 BNs at $137,000/yr for 2 BNs at

FSHFSH

• 24,490 limited duty days/yr 24,490 limited duty days/yr per BN, per BN,

• ~50,000 for 2 BNs at FSH~50,000 for 2 BNs at FSH


SummarySummary

• Using macroergonomic and public health Using macroergonomic and public health approaches resulted in:approaches resulted in:

– developing an environment conducive to developing an environment conducive to implementing injury control initiativesimplementing injury control initiatives

– developing a network of individuals “dedicated developing a network of individuals “dedicated to the cause”to the cause”

– overall and targeted reductions in overall and targeted reductions in musculoskeletal injuries and lost duty daysmusculoskeletal injuries and lost duty days

– implementing changes which can lastimplementing changes which can last


SummarySummary

• The running template was designed as a The running template was designed as a conservative approach, which allowed soldiers conservative approach, which allowed soldiers to improve performance incrementally, without to improve performance incrementally, without developing musculoskeletal injuries. developing musculoskeletal injuries.

• Even with this cautious approach, performance Even with this cautious approach, performance gains were essentially equal between the Pre-gains were essentially equal between the Pre-RT (traditional PT) and RT groups.RT (traditional PT) and RT groups.


ProblemsProblems

• Accomplished in a microcosmAccomplished in a microcosm• Hard work in an overall system that does not Hard work in an overall system that does not

support this “new culture”support this “new culture”• 50% turn-over in a year means constant “re-50% turn-over in a year means constant “re-

indoctrination”indoctrination”• Each commander is in command!Each commander is in command!

– S/he can keep or discard changesS/he can keep or discard changes• Every soldier thinks s/he is an expert in Every soldier thinks s/he is an expert in

physical fitnessphysical fitness• Other items: sleep, boots, shoes, etc.Other items: sleep, boots, shoes, etc.


RecommendationsRecommendations

• ““Must Haves”Must Haves”– Cultural ChangeCultural Change– CommunicationCommunication– Performance StandardsPerformance Standards– High Education - SME’sHigh Education - SME’s– Clear Decision Making on our GoalsClear Decision Making on our Goals

• High pre-entry physical requirementsHigh pre-entry physical requirements• Push hard, select fittestPush hard, select fittest• Longer BCT/IETLonger BCT/IET• Slow build through BCT, AIT, and into Slow build through BCT, AIT, and into permanent stationspermanent stations



• Army physical training programs shouldArmy physical training programs should

– decrease emphasis on endurance runningdecrease emphasis on endurance running– emphasize soldiers’ fitness level on arrival at emphasize soldiers’ fitness level on arrival at

BCT and follow an appropriate progression BCT and follow an appropriate progression during and from BCT to AIT and to permanent during and from BCT to AIT and to permanent duty stationsduty stations

– PT programs should be standardized per BN, PT programs should be standardized per BN, according to their mission, and not left up to according to their mission, and not left up to the individual discretion of the leadershipthe individual discretion of the leadership



• Army physical training programs shouldArmy physical training programs should

– Integrate progressive training into their Integrate progressive training into their training, for all soldiers who have breaks in training, for all soldiers who have breaks in their physical fitness regimen for TDY, their physical fitness regimen for TDY, vacation, injury, etc.vacation, injury, etc.

– Leadership should alter their own training to Leadership should alter their own training to demonstrate taking care of their own injuries, demonstrate taking care of their own injuries, rather than “working through” them or denying rather than “working through” them or denying their existence. It sets a negative example.their existence. It sets a negative example.

SMOKE EM!SMOKE EM!

No time, bad exampleNo time, bad example


• The AIT APFT achievement mission should The AIT APFT achievement mission should be to have the greatest number of soldiers be to have the greatest number of soldiers achieve 60 points per event, with the fewest achieve 60 points per event, with the fewest injuries and profiles.injuries and profiles.

• The goal should NOT be to see which The goal should NOT be to see which commander’s troops achieve the highest commander’s troops achieve the highest overall APFT scores regardless of injury and overall APFT scores regardless of injury and profile rates.profile rates.

• KeysKeys

– AccountabilityAccountability– Realistic GoalsRealistic Goals– Culture ChangeCulture Change

They have to come to:They have to come to:

believe itbelieve itlive itlive it

teach itteach itpreach itpreach it

make it part of their daily lifestylemake it part of their daily lifestyle

Culture Change from:Culture Change from:Survival of the FittestSurvival of the Fittest

To To “Living to Fight Another Day”“Living to Fight Another Day”

Health & Medicine

Operation Aegis 2002