Insights Into the Health of Postpartum Airmen From the U.S. Air Force Fitness Database

Physical fitness is an integral part of military readiness, and failure to meet military Physical Fitness Assessment (PFA) standards can severely damage or end careers. Postpartum active duty service members experience a drop in PFA scores and passing rates compared to their pre-pregnancy assessments. Each branch recently extended recovery time to 12 months, but more research is required to see if this change alone is enough to return both active duty and reserve component postpartum personnel to their own preconception PFA outcomes (scores, passing rates, and injury rates) and those of a control group of nullpartum female airmen.

The Air Force Fitness Management System II database contains PFA records including demographic data and PFA outcomes among airmen from the total force: active duty, Air Force Reserve (AFR), and Air National Guard (ANG). We extracted data from 2015 to 2019 for three successive PFAs per individual, consisting of 12,971 records for perinatal Airmen and 308,155 records for nulliparous female airmen. We calculated overall PFA scores, passing rates, and exemption rates for active duty and AFR/ANG postpartum and nullpartum airmen, and then performed regressions to determine if differences between these groups persisted when accounting for demographic and prior physical fitness variables.

Although 92% of postpartum airmen scored high enough to pass the PFA, their scores decreased from pretest scores by a larger margin than those for nullpartum airmen. Out of a possible 100 points, postpartum AFR/ANG members' scores decreased more (-4.5 points) than active duty scores (-2.8 points), while nullpartum members' scores decreased by -0.4 and -0.7, respectively. Nullpartum passing rates remained stable but decreased for both active duty and AFR/ANG postpartum airmen (-4% and -8%). Active duty postpartum airmen experienced a larger increase in component exemptions, which may indicate injury, (+8%) than nullpartum female airmen (+6%). These results were maintained when we controlled for age, officer status, previous pregnancies, and prior physical fitness. Compared with active duty nullpartum female airmen, active duty and AFR/ANG postpartum women had lower scores (-3.23, -6.79), and more than twice the odds of failure (2.44 and 5.42 times higher). AFR/ANG generally are less than half as likely to have a component exemption, but active duty postpartum airmen had 29% higher odds of having a component exemption than nullpartum active duty airmen.

Even with a 12-month recovery period, postpartum airmen fare worse on all PFA outcome dimensions studied compared to nulliparous airmen and with preconception selves. Perinatal airmen with more experience, education, and access to resources have better PFA outcomes. The U.S. Air Force should consider a comprehensive maternal wellness program including physical fitness programming and medical preventative health accessible to total force perinatal airmen. This would increase operational readiness, retainability, and well-being while decreasing musculoskeletal injuries and associated medical costs.