Initial Entry Training Research Articles

Likelihood of fitness improvements during a standardised physical fitness programme in US Army trainees of different fitness levels

IntroductionUS Army Initial Entry Training (IET) aims to develop general fitness and conditioning among large groups of trainees. Despite group mean improvement in physical fitness during IET, some trainees experience...

Multivitamin Compliance Reduces Injuries of Female Recruits at Air Force Basic Training: A Randomized Controlled Cohort Study.

Department of the Air Force basic military training (BMT) is the 7.5-week initial entry training for all enlisting U.S. Air Force and Space Force recruits. Overuse musculoskeletal injuries (MSKI) during training threaten success in BMT, and trainees with nutritional deficiencies are at higher risk. Several efforts are made at BMT to mitigate these issues to help trainees graduate on time, such as the distribution of multivitamins (MVI) to female recruits. However, trainee compliance with the prescribed MVI has been reported to be low, calling into question the effectiveness of this intervention. This study evaluated the effect of briefing modality offered to these trainees at the time of distribution on educational effectiveness, MVI compliance, and injury rates. This was a randomized controlled cohort study of BMT female trainees. Subjects included all female trainees of a single iteration of BMT concurrently completing training within the same squadron. At the outset of training, cohorts were randomly educated in one of two ways regarding the provided MVI. The control cohort (n = 80) was presented with the standard educational video created by BMT-registered dietitians, while the test cohort (n = 79) was presented the video and then also briefed in-person by a group of subject matter experts. At the end of BMT, the trainees completed a questionnaire regarding their knowledge, confidence, and compliance with the MVI. Additionally, a routinely collected training database was queried and analyzed for differences in injuries and training outcomes using the chi-squared test with significance set to α ≤ 0.05. Although both cohorts found their educational presentation useful, the "in-person" cohort reported significantly higher compliance rates and were found to be diagnosed with MSKI and bone stress injuries at significantly lower rates (43% and 66% relative risk reductions, respectively). Education to female BMT trainees regarding the MVI, which included a face-to-face discussion with subject matter experts, resulted in greater compliance and reduced incidence of MSKI and bone stress injury, compared to a video prepared by registered dietitians alone. Such educational approaches should continue to be strived for in this and other military population health measures. This study's implication of MVI efficacy for injury risk reduction in female trainees should be further studied, verified, and improved upon in this and other populations.

Financial Impact of Embedded Injury-Prevention Experts in US Army Initial Entry Training.

The US Army embedded injury-prevention experts (IPEs), specifically athletic trainers and strength and conditioning coaches, into initial entry training (IET) to limit musculoskeletal (MSK) conditions and their negative consequences. However, little is known about the financial impact of IPEs. To assess whether IPEs were associated with fewer sunk training costs due to MSK-related early discharges from service. Retrospective cohort study. Database of US Army soldiers' administrative, medical, and readiness records. A total of 198 166 soldiers (age = 20.7 ± 3.2 years, body mass index = 24.4 ± 3.5 kg/m2) who began IET during 2014 to 2017. Early discharge from service was defined as occurring within 6 months of beginning IET. All IET sites employed IPEs from 2011 to 2017, except for 2 sites during April to November 2015. Soldiers who began IET at these 2 sites during these times were categorized as not having IPE exposure. All others were categorized as having IPE exposure. The unadjusted association between IPE access and MSK-related early discharge from service was assessed using logistic regression. Financial impact was assessed by quantifying differences in yearly sunk costs between groups with and those without IPE exposure and subtracting IPE hiring costs. Among 14 094 soldiers without IPE exposure, 2.77% were discharged early for MSK-related reasons. Among 184 072 soldiers with IPE exposure, 1.01% were discharged. Exposure to IPEs was associated with reduced odds of MSK-related early discharge (odds ratio = 0.36, 95% CI = 0.32, 0.40, P < .001) and a decrease in yearly sunk training costs of $11.19 to $20.00 million. Employing IPEs was associated with reduced sunk costs because of fewer soldiers being discharged from service early for MSK-related reasons. Evidence-based recommendations should be developed for guiding policy on the roles and responsibilities of IPEs in the military to reduce negative outcomes from MSK conditions and generate a positive return on investment.

Whey Protein Supplementation Effects on Body Composition, Performance, and Blood Biomarkers During Army Initial Entry Training.

This study assesses if a lower dose of whey protein can provide similar benefits to those shown in previous work supplementing Army Initial Entry Training (IET) Soldiers with two servings of whey protein (WP) per day. Eighty-one soldiers consumed one WP or a calorie matched carbohydrate (CHO) serving/day during IET (WP: n = 39, height = 173 ± 8 cm, body mass = 76.8 ± 12.8 kg, age = 21 ± 3 years; CHO: n = 42, 175 ± 8 cm, 77.8 ± 15.3 kg, 23 ± 4 years). Physical performance (push-ups, sit-ups, and a two-mile run) was assessed during weeks two and eight. All other measures (dietary intake, body composition, blood biomarkers) at weeks one and nine. There was a significant group difference for fat mass (p = 0.044) as WP lost 2.1 ± 2.9 kg and had a moderate effect size (Cohen's d: −0.24), whereas the CHO group lost 0.9 ± 2.5 kg and had only a small effect size (d: −0.1). There was no significant group-by-time interaction on fat-free mass (p = 0.069). WP gained 1.2 ± 2.4 (d: 0.1) and CHO gained 0.1 ± 3 (d: 0) kg of FFM on average. There was a significant group by week 1-fat free mass interaction (p = 0.003) indicating individuals with higher initial fat-free mass benefitted more from WP. There were no group differences for push-up (p = 0.514), sit-up (p = 0.429) or run (p = 0.313) performance. For all biomarkers there was a significant effect of time as testosterone (p < 0.01), testosterone to cortisol ratio (p = 0.39), and IGF-1 (p < 0.01) increased across training and cortisol (p = 0.04) and IL-6 (p < 0.01) decreased. There were no differences in groups across IET for any of the biomarkers. We conclude one WP serving is beneficial for FM and for FFM in soldiers with high baseline FFM but may not significantly alter biomarker response or physical performance of IET soldiers who have high relative dietary protein intakes.

Serological and RT-PCR Surveillance for COVID-19 in an Asymptomatic US Army Trainee Population.

BackgroundSignificant variability exists in the application of infection control policy throughout the US Army initial entry training environment. To generate actionable information for the prevention of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)/coronavirus disease 2019 (COVID-19) transmission among new recruits, active enhanced surveillance was conducted for evidence of and exposure to SARS-CoV-2/COVID-19.MethodsWe serially tested recruits with a reverse transcriptase polymerase chain reaction (RT-PCR) COVID-19 and/or total antibody to SARS-CoV-2 tests at days 0, 14, and week 10 upon arrival for basic combat training at a location in the Southern United States.ResultsAmong 1403 recruits who were enrolled over a 6-week period from August 25 through October 11, 2020, 84 recruits tested positive by RT-PCR, with more than half (55%, 46/84) testing positive at arrival and almost two-thirds (63%, 53/84) also testing seropositive at arrival. Similarly, among an overall 146 recruits who tested seropositive for SARS-CoV-2 during the period of observation, a majority (86%) tested seropositive at arrival; no hospitalizations were observed among seropositive recruits, and antibody response increased at week 10.ConclusionsThese findings that suggest serological testing may complement current test-based measures and provide another tool to incorporate in COVID-19 mitigation measures among trainees in the US Army.

Financial costs to the U.S. Army for suicides by newly enlisted Soldiers.

To estimate the financial burden to the U.S. Army of suicide by enlisted Soldiers during their first year of service. This analysis included new Army enlisted Soldiers who started initial entry training from October 2012 through September 2016 and subsequently died by suicide within their first year of service. Outpatient and inpatient direct medical, direct nonmedical, recruiting, and training costs to the Army were calculated. During the 48-month observational study period, 29 Soldiers died by suicide within their respective first year of service. The described financial costs accrued by the Army as a result of these deaths were $152,271-with an average of $6,091 per healthcare utilizer. Recruiting and training costs were $1,115,860 for all suicide cases. Average direct cost per healthcare utilizer increased during a Soldier's first year of service. This may be associated with the transition through different phases of training and to the first operational duty station. Results obtained through this cost-of-illness analysis may serve as baseline metrics to inform future cost-effectiveness studies.

Markers of Bone Health and Impact of Whey Protein Supplementation in Army Initial Entry Training Soldiers: A Double-Blind Placebo-Controlled Study.

Training civilians to be soldiers is a challenging task often resulting in musculoskeletal injuries, especially bone stress injuries. This study evaluated bone health biomarkers (P1NP/CTX) and whey protein or carbohydrate supplementations before and after Army initial entry training (IET). Ninety male IET soldiers participated in this placebo-controlled, double-blind study assessing carbohydrate and whey protein supplementations. Age and fat mass predicted bone formation when controlling for ethnicity, explaining 44% (p < 0.01) of bone formation variations. Age was the only significant predictor of bone resorption (p = 0.02) when controlling for run, fat, and ethnicity, and these factors together explained 32% of the variance in bone resorption during week one (p < 0.01). Vitamin D increased across training (p < 0.01). There was no group by time interaction for supplementation and bone formation (p = 0.75), resorption (p = 0.73), Vitamin D (p = 0.36), or calcium (p = 0.64), indicating no influence of a supplementation on bone biomarkers across training. Age, fitness, fat mass, and ethnicity were important predictors of bone metabolism. The bone resorption/formation ratio suggests IET soldiers are at risk of stress injuries. Male IET soldiers are mildly to moderately deficient in vitamin D and slightly deficient in calcium throughout training. Whey protein or carbohydrate supplementations did not affect the markers of bone metabolism.

Hip Pain In A Female Military Trainee: A Cautionary Tale Of Catastrophic Complications

Hx: A 31 y/o F client presented to a PT by self-referral, with a primary c/o R hip and groin pain. The client was a previously competitive runner and triathlete and was currently undergoing US Army Initial Entry Training. PE: The client presented with a moderately antalgic gait, exhibiting a “compensated gluteus medius” gait pattern. Grossly limited ROM in the R hip complex due to pain. No apparent edema, erythema, ecchymosis, atrophy, or deformity on observation. Positive heel tap, fulcrum, patellar-pubic percussion test. DDx: 1. Femoral Neck Stress Fx 2. Pelvic stress fx 3. Adductor strain/avulsion 4. Hip flexor strain/avulsion 5. Femoral shaft stress fx 6. Lumbar spinal referral 7. Non-organic etiology Tests & Results: Plain radiography, bone scan, and MRI: consistent with the primary clinical hypothesis following the clinical examination, a FNSF. Final Diagnoses: FNSF, mid-femur fx, osteomyelitis Treatment & Outcomes: Pre-op the client was given crutches and instructed in a NWB gait. She underwent an uncomplicated ORIF. The immediate post-op course, including PT, was uneventful and included reinforcement of the importance of compliance with the post-op instructions, including NWB progressing to TTWB gait with crutches. The client experienced a fall shortly after being d/c’d from her inpatient stay, which resulted in a fx of the ipsilateral femur. She underwent a 2nd uncomplicated ORIF of her R femur fx. Again, the immediate post-op course, including PT, was uneventful. However, approximately 2 weeks following her d/c from the inpatient stay, the client began to report vague constitutional symptoms including fatigue, fever, and nausea. The PT ordered lab studies including CBC/diff, CMP, and ESR. Results were broadly abnormal and the ortho surgical service was contacted directly and a same-day referral made. Subsequent imaging and serial lab studies confirmed an infection and the patient was taken back for a 3rd surgery, ultimately resulting in an osteotomy and revision of the FNSF ORIF. After a brief stay in the ICU, the patient was transferred to the ortho floor and remained there for several weeks, while receiving IV antibiotics and serial imaging and lab studies. The client was d/c’d and transferred to the medical hold unit to begin the process to be removed from military service.

Musculoskeletal Injuries and United States Army Readiness. Part II: Management Challenges and Risk Mitigation Initiatives

Noncombat injuries ("injuries") threaten soldier health and United States (U.S.) Army medical readiness, accounting for more than twice as many outpatient medical encounters among active component (AC) soldiers as behavioral health conditions (the second leading cause of outpatient visits). Noncombat musculoskeletal injuries (MSKIs) account for more than 80% of soldiers' injuries and 65% of medically nondeployable AC soldiers. This review focuses on MSKI risk reduction initiatives, management, and reporting challenges within the Army. The authors will summarize MSKI risk reduction efforts and challenges affecting MSKI management and reporting within the U.S. Army. This review focuses on (1) initiatives to reduce the impact of MSKIs and risk for chronic injury/pain or long-term disability and (2) MSKI reporting challenges. This review excludes combat or battle injuries. Primary risk reduction Adherence to standardized exercise programming has reduced injury risk among trainees. Preaccession physical fitness screening may identify individuals at risk for injury or attrition during initial entry training. Forward-based strength and conditioning coaching (provided in the unit footprint) and nutritional supplementation initiatives are promising, but results are currently inconclusive concerning injury risk reduction. Forward-based access to MSKI care provided by embedded athletic trainers and physical therapists within military units or primary care clinics holds promise for reducing MSKI-related limited duty days and nondeployability among AC soldiers. Early point-of-care screening for psychosocial risk factors affecting responsiveness to MSKI intervention may reduce risk for progression to chronic pain or long-term disability. Operational MSKI metrics enable commanders and clinicians to readily identify soldiers with nonresolving MSKIs. Monthly injury reports to Army leadership increase command focus on soldiers with nonresolving MSKIs. Standardized exercise programming has reduced trainee MSKI rates. Secondary risk reduction initiatives show promise for reducing MSKI-related duty limitations and nondeployability among AC soldiers; timely identification/evaluation and appropriate, early management of MSKIs are essential. Tertiary risk reduction initiatives show promise for identifying soldiers whose chronic musculoskeletal conditions may render them unfit for continued military service.Clinicians must document MSKI care with sufficient specificity (including diagnosis and external cause coding) to enable large-scale systematic MSKI surveillance and analysis informing focused MSKI risk reduction efforts. Historical changes in surveillance methods and injury definitions make it difficult to compare injury rates and trends over time. However, the U.S. Army's standardized injury taxonomy will enable consistent classification of current and future injuries by mechanism of energy transfer and diagnosis. The Army's electronic physical profiling system further enablesstandardized documentation of MSKI-related duty/work restrictions and mechanisms of injury. These evolving surveillance tools ideally ensure continual advancement of military injury surveillance and serve as models for other military and civilian health care organizations.

U.S. Army physical demands study: Accuracy of occupational physical assessment test classifications for combat arms soldiers.

Beginning in 2017, successfully passing the four-part pre-enlistment Occupational Physical Assessment Test (OPAT) became a requirement for all U.S. Army recruits. To ensure the test accurately identifies individuals who are qualified for their job, it was necessary to examine classification errors. The objectives were to 1) determine the accuracy of OPAT cut-scores for combat arms Soldiers, and 2) determine which events contribute to the individuals that are misclassified as passing or failing the OPATMETHODS:A total of 741 trainees were tested on the OPAT within two weeks of entering their initial entry training. At the end of their training, trainees were tested on simulations of the most physically demanding tasks of their job. There was a high classification concordance (76.5%) between success on the OPAT and job task simulations. False positives (6.7%) were misclassified because they did not perform as well on the strength-dominant task simulations. While the interval aerobic run was the greatest contributor to false negatives (16.8%), previous studies indicated high performance on this event as a potential key indicator of injury and attrition risk. The findings provide insight on how the accuracy of the OPAT, and similar pre-employment tests, could be improved.

U.S. Army Physical Demands Study: Differences in Physical Fitness and Occupational Task Performance Between Trainees and Active Duty Soldiers

Canino, MC, Foulis, SA, Zambraski, EJ, Cohen, BS, Redmond, JE, Hauret, KG, Frykman, PN, and Sharp, MA. U.S. Army Physical Demands Study: Differences in physical fitness and occupational task performance between trainees and active duty soldiers. J Strength Cond Res 33(7): 1864-1870, 2019-U.S. Army initial entry training (IET) is designed to prepare trainees for the military environment and subsequent training, including specific programs to increase physical fitness to perform job-specific tasks to the minimal acceptable performance standard (MAPS). The aim of this study was to compare physical fitness and occupational task performance of trainees at the end of IET to that of active duty soldiers. One hundred seventy-nine male combat arms trainees at the end of IET and 337 male combat arms active duty soldiers performed a sandbag carry (SBC), casualty drag (CD), and move under direct fire (MUF). Physical fitness was assessed using Army Physical Fitness Test scores. A questionnaire was administered to determine frequency of task performance. Active duty soldiers compared with trainees were older (p < 0.01) and performed more push-ups (p < 0.01) and sit-ups (p < 0.01). Trainees performed the 2-mile run faster (p < 0.01). Ninety-four percent of trainees and 99% of active duty soldiers performed the 3 tasks to the MAPSs. Active duty soldiers performed significantly faster on both the SBC (p < 0.01) and CD (p < 0.01) and reported a higher task frequency on the SBC (p = 0.03) and CD (p < 0.01). No difference in MUF performance (p = 0.16) and task frequency (p = 0.13) was detected. Initial entry training seems to provide sufficient physical training as most trainees were able to meet the MAPSs; however, performance differences were still apparent between trainees and active duty soldiers. Additional practice performing the physically demanding tasks may help maximize performance on the physically demanding job requirements.

Effects of Nutritional Supplementation on Body Composition and Bio-markers during Army Initial Entry Training

Effects of Nutritional Supplementation on Body Composition and Bio-markers during Army Initial Entry Training

Perceptions and Response to Conservative Treatment of Low Back Pain in Soldiers During Initial Entry Training: A Convergence Mixed Methods Study.

Low back pain (LBP) is a common condition suffered by military personnel. Psychosocial factors play a role in LBP prognosis and can be addressed with self-management tools. This study's purpose was to (1) describe clinical changes in psychosocial factors of LBP following a self-management intervention and (2) explore the LBP experience of military trainees. Ten participants in Initial Entry Training (IET) were included in this mixed methods study. A self-management intervention of exercises and psychosocial education was provided. Quantitative instruments assessing psychosocial factors were delivered at baseline and 6 weeks. Qualitative data were gathered after treatment and analyzed using a phenomenological approach. Low levels of psychosocial risk factors were reported. Patient satisfaction (COPM-Satisfaction subscale) was the only outcome that achieved statistical significance at 6 weeks (p = 0.037). Three themes emerged from the qualitative results: the influence of the military culture on recovery from LBP, the LBP experience of a trainee, and promoting the self-management of LBP. While this cohort of IET soldiers exhibited low levels of psychosocial risk factors, qualitative reports indicate that LBP has a negative impact on participation in training, academics, and interpersonal relationships. The constraints of military training make seeking care and applying treatment strategies challenging.

Surveyed Reasons for Not Seeking Medical Care Regarding Musculoskeletal Injury Symptoms in US Army Trainees.

Musculoskeletal injuries (MSKIs) pose a significant threat to military readiness and are difficult to monitor due to Soldiers' reluctance to seek medical treatment. There is high risk of developing MSKIs while going through initial entry training (IET), many of which go unreported. The purposes of this study were to identify the contributing factors that influence US Army trainees to not seek medical care for self-reported symptoms of musculoskeletal injury (SMSKI) and establish how those factors may differ by sex, training school, and installation site. Data were collected from 739 trainees (607 males, 132 females) completing IET at either Fort Benning, GA, Fort Sill, OK or Fort Leonard-Wood, MO, USA. Male trainees were in combat arms jobs while female trainees were from both combat arms and other physically demanding jobs. All surveys were completed within 5 weeks of graduation from Advanced Individual Training and One Station Unit Training. Trainees answered a series of questions about SMSKIs sustained during IET that lasted seven or more days. Using a Likert-type scale (1-strongly disagree through 5-strongly agree), trainees rated the influence that each of the following seven statements contributed to their decision not to seek medical care: "graduating on time," "avoiding negative perceptions associated with injuries," "avoiding profile," "inconvenience in seeing a provider," "self-managing the injury based on past experience," "severity of the injury," and "prior negative experiences seeking medical care in the military." Pearson's Chi-square test was used to assess significant relationships among SMSKI reporting across sex, training school and training installation. Overall, SMSKI incidence was 36.1% and 58.3% among IET male and female trainees, respectively (40% overall). Nearly two-thirds (64%) of all trainees injured during IET had a SMSKI that they did not report to leadership or a medical provider. Across sex, female trainees were more likely to report SMSKIs than male trainees (p < 0.01), but there was no difference in SMSKI reporting rates by sex (p = 0.48). There was a difference in SMSKI rates by training school (p < 0.01), where infantry had higher SMSKI rates than field artillery (p < 0.01). There were no differences across training schools in how often trainees sought medical care (p = 0.58). The most common reasons selected for not reporting SMSKIs (i.e., not seeking medical care) included "I wanted to graduate on time" and "I wanted to avoid a profile." "I had prior negative experiences seeking medical care in the military" was consistently rated as the least important reason. Female trainees were more likely to not report SMSKIs in order "to avoid a profile" than male trainees (p < 0.05). Over 64% of trainees' did not seek medical care for their SMSKI during IET. As early detection, better reporting and timely treatment may result in reductions in SMSKI severity, reduced IET attrition, and lower medical expenses, trainees should be encouraged to report SMSKIs for proper early stage treatment. These study findings could be used to assist military leadership to create a positive environment for reporting and seeking care for SMSKIs.

Response to and Perceptions of Low Back Pain Treatment in Initial Entry Training Soldiers: A Mixed Methods Study

Abstract Date Presented 4/20/2018 This mixed methods study explored the experience of low back pain (LBP) and effects of a self-management intervention for active duty service members in Initial Entry Training. Satisfaction with occupational performance increased significantly; levels of psychosocial risk factors remained low. Primary Author and Speaker: Enrique V. Smith-Forbes. Contributing Authors: Cortney M. Schoonover, Dan I. Rhon

Harnessing Inertia to Improve Army Enlisted Service Length: A Case for Opt-Out Enlistment Contracts

Army recruiting, initial entry training, and retention enterprises consume tremendous manpower resources and become disproportionately more expensive and challenging as the size of the Army increases. Fortunately, empirical evidence suggests that the Army could readily improve enlisted continuation rates by changing enlistment contracts from its present form, requiring soldiers to reenlist or opt-in to continue service, to open-ended enlistment contracts that require soldiers to opt-out of service upon fulfilling their service obligations. Changing enlistment contracts to an opt-out paradigm—similar to how officer populations are currently managed—could greatly increase the number of soldiers who continue service past their initial enlistment obligation. Improved continuation rates could save the Army hundreds of millions in recruiting and reenlistment incentives, as well as freeing thousands of Non-Commissioned Officers serving as recruiters, drill sergeants, and retention specialist to support other operational requirements.

Injury Surveillance and Reporting for Trainees with Bone Stress Injury: Current Practices and Recommendations.

Musculoskeletal injuries, including lower extremity bone stress injuries (BSI) significantly impact initial entry training (IET) in the U.S. Army due to limited duty days, trainee attrition, early medical discharge, and related financial costs. Factors complicating trainee BSI surveillance include inconsistent BSI coding practices, attrition documentation as both administrative separations and medical discharges and the inability to code for BSI grade or severity when using International Statistical Classification of Diseases and Related Health Problems 10th revision (ICD-10) codes. A multidisciplinary expert panel developed policy guidance to enhance clinical and administrative management of BSI, following extensive analysis of current, peer-reviewed literature. Policy guidance incorporates leading practices concerning clinical BSI management, including imaging procedures, recommended notifications, early intervention, and ICD-10 diagnostic coding procedures. Policy guidance also standardizes BSI grading criteria for magnetic resonance imaging and skeletal scintigraphy (bone scan). Multidisciplinary expert opinion indicates inconsistent BSI diagnosis and management across IET due to variability in trainee BSI grading, documentation, and coding practices. Injury surveillance conducted by the United States Army Medical Command (USAMEDCOM) will benefit from routine, standardized musculoskeletal injury data base searches by BSI severity/grade and anatomical location upon implementation of BSI policy guidance. Effective injury surveillance is critical for determining trainee BSI incidence and attrition, developing anticipated return to duty (RTD) timelines, and assessing long-term outcomes. BSI RTD timelines should account for gender, BSI grade/severity, anatomical location, and type of intervention. Well-defined RTD timelines would benefit administrative decision-making purposes, including whether to grant convalescent leave or enroll in the Warrior Training and Rehabilitation Program during BSI recovery. Enhanced management procedures may improve initial enlistment completion rates for trainees sustaining at least one BSI who eventually complete IET.

Differences between U.S. Army Trainees and Active Duty Soldiers in Performing Physically Demanding Occupational Tasks

The training implemented during initial entry training (IET) for combat arms trainees (up to 16 weeks) is designed to sufficiently optimize performance of physically demanding occupational tasks. Trainees must be physically capable of performing the tasks within their jobs to the minimal acceptable performance standard, as delineated by U.S. Army Training and Doctrine Command. PURPOSE: To compare U.S. Army trainees to active duty soldiers performing physically demanding occupational tasks. METHODS: 192 U.S. Army male combat arms trainees (TRs) at the end of their IET and 369 active duty male combat arms soldiers (ADs) both performed the sandbag carry (SBC), casualty drag (CD) and move under direct fire (MUF) tasks. During the SBC, subjects wore personal protective equipment (PPE; ~32 kg) while lifting and carrying 16 pre-filled 18-kg sandbags a distance of 10m to build a fighting position (4 long x 2 wide x 2 high) as fast as possible (min). For the CD, subjects wore PPE and a weapon while dragging a 123-kg simulated casualty 15m as fast as possible (60-sec time limit). Time was recorded and later calculated as velocity (m·s-1). During MUF subjects wore PPE and a weapon to perform a series of combat rushes covering 100m as fast as possible (min). The MUF course cycled between one prone and two kneeling positions, each 6.6 m apart. Univariate ANCOVA (height and body mass as covariates) were used to compare differences in performances on the three tasks between TRs and ADs. RESULTS: 94% of TRs and 99% of ADs performed the three tasks to the minimal acceptable performance standards. ADs performed significantly faster than TRs on SBC (AD: 1.73 ± 0.29 min, TR: 2.09 ± 0.46 min; p<0.01) and CD (AD: 1.14 ± 0.28 m·s-1, TR: 0.80 ± 0.30 m·s-1; p<0.01) with no differences in MUF performance (AD: 2.24 ± 0.15 min, TR: 2.27 ± 0.22 min; p=0.09). CONCLUSIONS: Although majority of the TRs met the minimal acceptable performance standards on the three tasks, ADs performed the SBC and CD faster. This could be due to ADs having more experience performing the tasks. While further training occurs at TRs first duty station, TRs may benefit from additional occupational task training during IET. The views expressed in this abstract are those of the authors and do not reflect the official policy of the Department of Army, Department of Defense, or the U.S. Government.

Evaluation of Dietary Intake &amp;lt Training Volume During Army Initial Entry Training

Evaluation of Dietary Intake &amp;lt Training Volume During Army Initial Entry Training

Estimation of energy balance and training volume during Army Initial Entry Training

BackgroundAdequate dietary intake is important for promoting adaptation and prevention of musculoskeletal injury in response to large volumes of physical training such as Army Initial Entry Training (IET). The purpose of this study was to evaluate training volume and dietary intake and estimate energy balance in Army IET soldiers.MethodsDietary intake was assessed by collecting diet logs for three meals on each of three, non-consecutive days during the first week of IET. Training volume was measured across 13 weeks of training using Actigraph wGT3X accelerometers. Training intensity was classified using Sasaki vector magnitude three cut points. Energy expenditure estimates were calculated during weeks two and three of training using the modified Harris-Benedict equation and by estimation of active energy expenditure using metabolic equivalents for each classification of physical activity. All data is presented as mean ± standard deviation.ResultsA total of 111 male soldiers (ht. = ± 173 ± 5.8 cm, age = 19 ± 2 years, mass = 71.6. ± 12.4 kg) completed diet logs and were monitored with Actigraphs. IET soldiers performed on average 273 ± 62 min low, 107 ± 42 min moderate, 26 ± 22 min vigorous, and 10 ± 21 min of very vigorous intensity physical activity daily across 13 weeks. The estimated total daily energy expenditure was on average 3238 ± 457 kcals/d during weeks two and three of IET. Compared to week one caloric intake, there was a caloric deficit of 595 ± 896 kcals/d on average during weeks two and three of IET. Regression analysis showed that body weight was a significant predictor for negative energy balance (adj. R2 = 0.54, p < 0.001), whereby a 1 kg increase in body mass was associated with a 53 kcal energy deficit.ConclusionsBased on week one dietary assessment, IET soldiers did not consume adequate calories and nutrients to meet training needs during red phase (weeks one through three). This may directly affect soldier performance and injury frequency. IET soldiers undergo rigorous training, and these data may help direct future guidelines for adequate nourishment to optimize soldier health and performance.