Increases in Musculoskeletal Diagnosis Rates Corresponding With the Transition to the Army Combat Fitness Test

Area of Science:

• Military Medicine
• Musculoskeletal Health
• Physical Fitness Assessment

Background:

• Musculoskeletal (MSK) disorders are a significant cause of morbidity in the U.S. Army.
• Physical fitness tests are crucial for military readiness but carry injury risks.
• The U.S. Army transitioned from the Army Physical Fitness Test (APFT) to the Army Combat Fitness Test (ACFT).

Purpose of the Study:

• To investigate the association between the transition to the Army Combat Fitness Test (ACFT) and musculoskeletal diagnoses.
• To analyze changes in MSK diagnoses related to new training regimens.
• To compare MSK injury incidence between APFT, COVID-19 pandemic, and ACFT cohorts.

Main Methods:

• Retrospective review of recently enlisted active duty service members from 2016 to 2022.
• Analysis of musculoskeletal diagnoses within the first 6 months of service.
• Comparison of three cohorts: APFT (control), COVID-19 pandemic, and ACFT using survival analyses.

Main Results:

• The ACFT cohort showed significantly elevated hazard ratios for acute and cumulative MSK conditions in men compared to controls.
• Women in the ACFT group also had elevated MSK risks, though less pronounced than in men.
• The COVID-19 cohort exhibited reduced rates of cumulative MSK conditions for both men and women compared to controls. Women consistently presented with nearly double the MSK diagnosis rates of men.

Conclusions:

• The introduction of the ACFT and COVID-19 lockdowns appear to have influenced MSK condition risks among new enlistees.
• Higher baseline MSK rates in women may obscure temporal trends, highlighting the need for sex-specific analysis.
• Continuous monitoring of MSK trends and ACFT practices is essential for optimizing military readiness and minimizing the burden of MSK disorders.