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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
AUSA Medical Symposium 2002
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
AUSA Medical Symposium 2002
Injury Rates among Recruits
0% 20% 40% 60% 80% 100%
Males
Females
AUSA Medical Symposium 2002
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%
AUSA Medical Symposium 2002
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
AUSA Medical Symposium 2002
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”
AUSA Medical Symposium 2002
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
AUSA Medical Symposium 2002
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
AUSA Medical Symposium 2002
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
AUSA Medical Symposium 2002
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
AUSA Medical Symposium 2002
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
AUSA Medical Symposium 2002
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
AUSA Medical Symposium 2002
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
AUSA Medical Symposium 2002
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
AUSA Medical Symposium 2002
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%
AUSA Medical Symposium 2002
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
AUSA Medical Symposium 2002
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.
AUSA Medical Symposium 2002
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…..
AUSA Medical Symposium 2002
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?
AUSA Medical Symposium 2002
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
AUSA Medical Symposium 2002
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
AUSA Medical Symposium 2002
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
AUSA Medical Symposium 2002
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!
AUSA Medical Symposium 2002
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
AUSA Medical Symposium 2002
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
AUSA Medical Symposium 2002
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
AUSA Medical Symposium 2002
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
AUSA Medical Symposium 2002
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
AUSA Medical Symposium 2002
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
AUSA Medical Symposium 2002
Break TimeBreak Time
• RehydrationRehydration
• NutritionNutrition
• MovementMovement
AUSA Medical Symposium 2002
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
AUSA Medical Symposium 2002
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
AUSA Medical Symposium 2002
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%
AUSA Medical Symposium 2002
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
AUSA Medical Symposium 2002
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)
AUSA Medical Symposium 2002
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…)
AUSA Medical Symposium 2002
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
AUSA Medical Symposium 2002
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
AUSA Medical Symposium 2002
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
AUSA Medical Symposium 2002
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
AUSA Medical Symposium 2002
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
AUSA Medical Symposium 2002
Accumulated ProfilesAccumulated Profiles
Men
05
1015202530
1 2 3 4 5 6 7 8 9Week of Training
MSI
Pro
files
(%) Pre-RT
RT
Women
01020
304050
1 2 3 4 5 6 7 8 9Week of Training
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
AUSA Medical Symposium 2002
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
AUSA Medical Symposium 2002
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
AUSA Medical Symposium 2002
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
pre-RT (n = 48) RT (n = 93) pre-RT (n = 67) RT (n = 159)
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
pre-RT (n = 48) RT (n = 93) pre-RT (n = 67) RT (n = 159)
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
pre-RT (n = 48) RT (n = 93) pre-RT (n = 67) RT (n = 159)
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
pre-RT (n = 25) RT (n = 45) pre-RT (n = 31) RT (n = 96)
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
pre-RT (n = 22) RT (n = 29) pre-RT (n = 22) RT (n = 49)
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
AUSA Medical Symposium 2002
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
AUSA Medical Symposium 2002
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
AUSA Medical Symposium 2002
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.
AUSA Medical Symposium 2002
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.
AUSA Medical Symposium 2002
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
AUSA Medical Symposium 2002
RecommendationsRecommendations
• 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
AUSA Medical Symposium 2002
RecommendationsRecommendations
• 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
RecommendationsRecommendations
• 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”