Injury reduction

1. Operation Aegis:Operation Aegis:
Injury Control duringInjury Control during
Advanced Individual TrainingAdvanced Individual Training
LTC Annette BergeronLTC Annette Bergeron
MAJ Vicki ConnollyMAJ Vicki Connolly
CPT Allyson PritchardCPT Allyson Pritchard
Dr. Mary Z. MaysDr. Mary Z. Mays
SSG Mark KenyonSSG Mark Kenyon
SSG Shelia MickelsonSSG Shelia Mickelson
Ileana KingIleana King
Darrel GerikDarrel Gerik
Claude LeeClaude Lee
OPE
R A T I O N A
EGIS
INJU
R
Y
C O N T R O L P R O
G
RAM
COL Valerie J. Berg RiceCOL Valerie J. Berg Rice

2. BrigadeBrigade
• COL Larry E. CampbellCOL Larry E. Campbell
• COL Kenneth R. CrookCOL Kenneth R. Crook
• LTC Rosaline CardinelliLTC Rosaline Cardinelli
• LTC Brian AllgoodLTC Brian Allgood
• CPT Marc BustamanteCPT 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

3. OPERATION AEGISOPERATION AEGIS
Conceived 1999Conceived 1999
Implemented 2000Implemented 2000
 LTG James P. PeakeLTG James P. Peake
 Scientifically-basedScientifically-based MusculoskeletalMusculoskeletal
Injury Prevention ProgramInjury Prevention Program
 Goals:Goals:
 Decrease Musculoskeletal Injuries among AITDecrease Musculoskeletal Injuries among AIT
soldiers on Ft. Sam Houstonsoldiers on Ft. Sam Houston
 Develop a Guideline Methodology that can beDevelop a Guideline Methodology that can be
used at other postsused at other posts

4. AUSA Medical
2 JUL 992 JUL 99
Presidential MemoPresidential Memo
Directs Secretary of Labor to lead an initiativeDirects Secretary of Labor to lead an initiative
focusing on Federal workplace injury reductionfocusing 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 injuries1. Reducing the overall occurrence of injuries
by 3 percent per year, while improving theby 3 percent per year, while improving the
timeliness of reporting of injuries and illnessestimeliness of reporting of injuries and illnesses
by agencies to the Department of Labor by 5by agencies to the Department of Labor by 5
percent per yearpercent per year

5. AUSA Medical
2 JUL 992 JUL 99
Presidential MemoPresidential Memo
2.2. For those work sites with the highest ratesFor those work sites with the highest rates
of serious injuries, reducing the occurrenceof 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 days3. 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

6. AUSA Medical
Injury Rates among Recruits
0% 20% 40% 60% 80% 100%
Males
Females

7. AUSA Medical
Studies atStudies 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%

8. AUSA Medical
Macroergonomic andMacroergonomic and
Public Health ApproachesPublic Health Approaches
ErgonomicsErgonomics
 AssessAssess
 DesignDesign
(intervention)(intervention)
 Test & evaluationTest & evaluation
Public HealthPublic Health
 SurveillanceSurveillance
 InterventionIntervention
 EvaluationEvaluation
 DisseminationDissemination

9. AUSA Medical
MacroergonomicsMacroergonomics
 Each system and each level within aEach system and each level within a
systemsystem
 Broad to FocusedBroad to Focused
 Organizational structure, resources, agencies,Organizational structure, resources, agencies,
personnel, policies, procedures, surveillancepersonnel, policies, procedures, surveillance
systems, datasystems, data
 Communication/AdvisorsCommunication/Advisors
Who 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”

10. AUSA Medical
PremisesPremises
 Top Level Support is EssentialTop Level Support is Essential
 Participatory Ergonomics/OrganizationalParticipatory 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

11. AUSA Medical
PremisesPremises
Injury Management is aInjury Management is a
Commander’sCommander’s ResponsibilityResponsibility
Health Care Professionals areHealth Care Professionals are
SME’s/Advisors/ConsultantsSME’s/Advisors/Consultants

12. AUSA Medical
Setting the StageSetting the Stage
(& Assessing)(& Assessing)
Understanding the LiteratureUnderstanding the Literature
Understanding the PeopleUnderstanding the People
Understanding the Rules and theUnderstanding the Rules and the
RolesRoles

13. AUSA Medical
Broad to FocusedBroad to Focused
 Informal “Advisors” nationwideInformal “Advisors” nationwide
 CDC, Universities, Ergo/Injury PreventionCDC, Universities, Ergo/Injury Prevention
Programs, Professional SocietiesPrograms, Professional Societies
 DoDDoD
 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
 ArmyArmy
 CHPPM, MRMC esp. USARIEM, Safety Center,CHPPM, MRMC esp. USARIEM, Safety Center,
Corps Activities/Committees, other postsCorps Activities/Committees, other posts

14. AUSA Medical
Broad to FocusedBroad to Focused
 PostPost
 MWR, Comm Health Nursing, OccupationalMWR, Comm Health Nursing, Occupational
Health, PTRP, Sports-intramural, WellnessHealth, 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

15. AUSA Medical
Messages toMessages 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 discoverWe 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 asWe’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???

16. Establish CommunicationEstablish 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
 BriefingsBriefings
 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

17. AUSA Medical
Staff’s PerceptionsStaff’s Perceptions
• Only by knowing what theyOnly by knowing what they
think/believe, do you know how tothink/believe, do you know how to
approach and work with them...approach and work with them...
– Drill SergeantsDrill Sergeants
– CadreCadre
– CommandersCommanders

18. AUSA Medical
Are there too many overuse injuriesAre 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

19. AUSA Medical
What do you think is an acceptableWhat do you think is an acceptable
rate of soldiers being on profilerate 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%

20. AUSA Medical
What are the main factorsWhat 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

21. AUSA Medical
Can injuries be decreased byCan injuries be decreased by
changing the way you train?changing the way you train?
0 20 40 60 80
Yes
No
Don't Know
There’s nothing I can do.
It’s not my fault.
It’s BCT.

22. AUSA Medical
All this and we haven’t evenAll this and we haven’t even
started our program yet?started our program yet?
RememberRemember
for this program there was no “solution” yetfor this program there was no “solution” yet
tell them the solution for “their problem” righttell them the solution for “their problem” right
away and they have to feel defensiveaway and they have to feel defensive
it’s perceived as extra work for themit’s perceived as extra work for them
they don’t see the value, esp. for themthey don’t see the value, esp. for them
they aren’t convinced!they aren’t convinced!
they don’t know how to “use you”they don’t know how to “use you”

23. You have been learning, and as youYou have been learning, and as you
learn, you implement.learn, you implement.
It all happens simultaneously…..It all happens simultaneously…..

24. AUSA Medical
At each level:At each level:
What Exists? Who is doing what,What Exists? Who is doing what,
when, and how? How does whatwhen, and how? How does what
they do relate?they do relate?
WhatWhat shouldshould be happening?be happening?
What are their attitudes/opinions?What are their attitudes/opinions?
How can we make what shouldHow can we make what should
happen, happen effectively?happen, happen effectively?

25. AUSA Medical
SurveillanceSurveillance
InprocessingInprocessing
8094 soldiers, 9015 surveys8094 soldiers, 9015 surveys
OutprocessingOutprocessing
6111 soldiers, 6819 surveys6111 soldiers, 6819 surveys
TMC VisitsTMC Visits
3278 soldiers, 4466 surveys3278 soldiers, 4466 surveys
ProfilesProfiles
2172 soldiers, 3194 surveys2172 soldiers, 3194 surveys

26. AUSA Medical
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

27. AUSA Medical
Injury Control AdvisoryInjury Control Advisory
CommitteeCommittee
• Purpose:Purpose: To advise the Commander onTo advise the Commander on
musculoskeletal injury preventionmusculoskeletal injury prevention
• Mission:Mission: To advise the Commander on methodsTo advise the Commander on methods
to reduce and/or maintain an acceptable level ofto reduce and/or maintain an acceptable level of
musculoskeletal injuries and lost duty time withinmusculoskeletal injuries and lost duty time within
the battalion by identifying injury trends andthe battalion by identifying injury trends and
causative factors, andcausative factors, and
recommending/implementing targeted injuryrecommending/implementing targeted injury
prevention programsprevention programs

28. AUSA Medical
ICACICAC
• CompositionComposition
• Tasks/ResponsibilitiesTasks/Responsibilities
• Track injury trendsTrack injury trends
– Standardize data to beStandardize data to be
collected/reportedcollected/reported
– Establish baselinesEstablish baselines
– Interpret findingsInterpret findings
Take Time & Teach
Identify and Solve Problems
No concern left unaddressed!

29. AUSA Medical
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

30. ICAC Identified ProblemsICAC Identified Problems
BN 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 duringNo difference in # of profiles, profile length during
the course, pass rate on RAPFT, holdoversthe course, 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 -40% of those on profile went on in the first week -
48% passed RAPFT, 58% on profile later - 80%48% passed RAPFT, 58% on profile later - 80%
passed RAPFTpassed RAPFT
– Identify “Porcelain” SoldiersIdentify “Porcelain” Soldiers

31. AUSA Medical
Porcelain SoldiersPorcelain Soldiers
• Profile*Profile*
• SymptomsSymptoms
– More than one*More than one*
– Lower Extremity*Lower Extremity*
– Injured in BCT or lastInjured in BCT or last
90 days*90 days*
– Upper ExtremityUpper Extremity
SymptomsSymptoms
– (That interferes w/(That interferes w/
duty*)duty*)
• Moderate/HighModerate/High
Stress*Stress*
• Female*Female*
• Poor/Fair PhysicalPoor/Fair Physical
Fitness*Fitness*
• Over 24 yrs of ageOver 24 yrs of age
* predictive of injury during AIT

32. AUSA Medical
ICACICAC
BN Commander ConsultingBN Commander Consulting
• One ability group injured more?One ability group injured more?
• Did they REALLY pass the PT test duringDid they REALLY pass the PT test during
basic?basic?
• Injuries during field problemsInjuries during field problems
• Early intervention clinicEarly intervention clinic

33. AUSA Medical
ICACICAC
BN Commander ConsultingBN Commander Consulting
• Drill Sergeant RecertificationDrill Sergeant Recertification
• In-processing ClassesIn-processing Classes
• Other Classes, as requestedOther Classes, as requested
– InjuriesInjuries
– Physical TrainingPhysical Training
– NutritionNutrition
– Special Population PTSpecial Population PT

34. AUSA Medical
ICACICAC
ConsultingConsulting
• ClassesClasses
– Running (form, breathing, etc.)Running (form, breathing, etc.)
– Shoe FitShoe Fit
• Soldiers on sick call immediatelySoldiers on sick call immediately
after exodusafter exodus
• Fear factor when changing runningFear factor when changing running
routesroutes

35. ResultsResults
232nd Battalion
Change in "Per Course Musculoskeletal Injury Rates"
During Operation Aegis
67
49
36 38
49
54
42
46
53
28
58
41
46
71
34
43
0
10
20
30
40
50
60
70
80
90
100
9/11
9/25
10/10
10/23
11/6
11/20
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 Control
Committees Started
New Physical Training
SOP Started
Running
Template
Started
NumberofClinicVisitsfor
MusculoskeletalInjury
per100SoldiersintheTen-weekCourse
10.8%10.8%
reductionreduction
360 fewer clinic visits
$26,280 annual savings

36. ResultsResults
232nd Battalion
Change in "Per Course Musculoskeletal Injury Rates"
During Operation Aegis
46
25
10
4
7
46
30
9
3 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
NumberofClinicVisitsfor
MusculoskeletalInjury
per100SoldiersinTraining
Injury Control Committees
Started (n = 2070)
New Physical Training SOP
Started (n = 2626)
Running Template Started
(n = 666)
80% strain/sprain
60% decrease
288 visits/yr/BN
$31, 536/yr/BN

37. 232nd Battalion
Change in "Per Course Musculoskeletal
Sprain/Strain Rates" During Operation Aegis
12
13
8
10 10
11
10
7
9
3
11
9
10
5
3
20
0
5
10
15
20
25
30
9/11
9/25
10/10
10/23
11/6
11/20
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 Control
Committees Started
New Physical Training
SOP Started
Running
Template
Started
NumberofClinicVisitsfor
MusculoskeletalInjury
per100SoldiersintheTen-weekCourse
60%
decrease
Sprain/StrainSprain/Strain

38. AUSA Medical
Early InterventionEarly Intervention
• 12% reduction in clinic visits12% reduction in clinic visits
> 3 days> 3 days < 3 days< 3 days
42/10042/100 37/10037/100
12% reduction12% reduction
120 less visits/month120 less visits/month
$8760/month = $105,120/year$8760/month = $105,120/year

39. AUSA Medical
Break TimeBreak Time
• RehydrationRehydration
• NutritionNutrition
• MovementMovement

40. AUSA Medical
Ft. Sam Houston AITFt. Sam Houston AIT
SurveillanceSurveillance
TMC Visits: 56% for MSITMC Visits: 56% for MSI
TMC Visit Overuse InjuriesTMC Visit Overuse Injuries
~~55% men55% men
~69% women~69% women
Profile Overuse InjuriesProfile Overuse Injuries
~61% men~61% men
~72% women~72% women

41. AUSA Medical
Ft. Sam HoustonFt. 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

42. AUSA Medical
Ft. Sam Houston AITFt. Sam Houston AIT
 70% injuries due to lower70% injuries due to lower
extremity sprain, strain, painextremity 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%

43. AUSA Medical
ResultsResults
 Half of the MSIs originated at FSHHalf of the MSIs originated at FSH
 Clinic visits and profiles primarily for LEClinic visits and profiles primarily for LE
MSI and overuse injuriesMSI and overuse injuries
 Top cause appeared to be running portionTop cause appeared to be running portion
of unit directed trainingof unit directed training

44. AUSA Medical
ExistingExisting
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 perFormation cadence runs, two motivational runs per
class (2.5 and 3.0 miles)class (2.5 and 3.0 miles)

45. AUSA Medical
Risk FactorsRisk Factors
 Increasing distance run per weekIncreasing 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 womenBCT: 23-37% for men 42-67% for women
(Canham-Chervak, et al., 2000)(Canham-Chervak, et al., 2000)
 Anecdotal: lack of knowledge ofAnecdotal: lack of knowledge of
appropriate running progressionappropriate running progression
(progressing too quickly, insufficient(progressing too quickly, insufficient
recovery periods)recovery periods)
 Too much, too soon, too fastToo much, too soon, too fast
 (shoes, dark, sleep…)(shoes, dark, sleep…)

46. AUSA Medical
Arriving SoldiersArriving Soldiers
 24% of men arrive w/ injuries24% of men arrive w/ injuries
and 24-30% of womenand 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 BCT57% of those reporting BCT
injuries also reported arrivinginjuries also reported arriving
w/ symptoms that interfered w/w/ symptoms that interfered w/
daily duty performancedaily duty performance

47. AUSA Medical
Arriving SoldiersArriving Soldiers
 Generally physically fitGenerally physically fit
 Have worked up to running 2 miles for theHave worked up to running 2 miles for the
PT test; but not running 2 miles on aPT test; but not running 2 miles on a
regular basisregular basis
 Have passed the APFT w/ 50 pts for eachHave 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 trainingweek break from PT: field training
activity, out/in-processing, travel, waitactivity, out/in-processing, travel, wait

48. AUSA Medical
The TestThe 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

49. Pre-RTPre-RT RTRT
Initial Running DistanceInitial Running Distance 2.7 miles2.7 miles
(2.3-3.5)(2.3-3.5)
1.5 building1.5 building
to 2.7**to 2.7**
Running TimeRunning Time 20 min, build20 min, build
to 30**to 30**
DeterminedDetermined
by distanceby distance
and speedand speed
SpeedSpeed DeterminedDetermined
by NCO thatby NCO that
dayday
DeterminedDetermined
by abilityby ability
groupgroup
diagnosticdiagnostic
scores**scores**
Distance runs markingDistance runs marking
significant training eventssignificant training events
3 - 4 miles3 - 4 miles NoneNone
Distance Runs/Week:Distance Runs/Week: 33 2-32-3
(fast, slow)(fast, slow)

50. Pre-RTPre-RT RTRT
Interval training sessions/wkInterval training sessions/wk Differed byDiffered by
companycompany
1/wk, begin wk1/wk, begin wk
44
Hill run or speed trainingHill run or speed training 1/wk1/wk See intervalSee interval
training, no hilltraining, 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 ondepended on
availableavailable
supervision)supervision)
7 or more,7 or more,
spread timesspread times
no more thanno more than
1.5-2 min1.5-2 min
Cadence RunsCadence Runs BN run only,BN run only,
full distancefull distance
BN run only atBN run only at
prescribedprescribed
distancedistance

51. ExampleExample
• Wk One - 1.5 mile total miles includingWk One - 1.5 mile total miles including
warm up and cool downwarm up and cool down
– Wed – Slow Continuous RunWed – Slow Continuous Run
• 2 min/mile slower than 2 mile diagnostic APFT, easy2 min/mile slower than 2 mile diagnostic APFT, easy
pace, no falloutspace, no fallouts
• 16:31-19:30 ¼ mile very easy, gradual increase to 1116:31-19:30 ¼ mile very easy, gradual increase to 11
min/mile for 1 mile, ¼ mile easy pacemin/mile for 1 mile, ¼ mile easy pace
– Fri – Fast Continuous RunFri – Fast Continuous Run
• 30-40 sec slower than 2 mile diagnostic APFT, more30-40 sec slower than 2 mile diagnostic APFT, more
challenging, if trouble keeping up slow until all arechallenging, if trouble keeping up slow until all are
with the groupwith the group
• 16:31-19:30 ½ mile easy, gradual increase to 1016:31-19:30 ½ mile easy, gradual increase to 10
min/mile for ¾ mile, ¼ mile at easy pacemin/mile for ¾ mile, ¼ mile at easy pace
– Sat – 1.5 mile fitness walk in PRT uniformSat – 1.5 mile fitness walk in PRT uniform

52. AUSA Medical
Dependent MeasuresDependent Measures
(SPSS)(SPSS)
 EOC Company ReviewsEOC Company Reviews
(Descriptive, Pearson Chi(Descriptive, Pearson Chi22
))
 New and accumulated profiles forNew and accumulated profiles for
MSIMSI
 Troop Medical ClinicTroop 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)

53. 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

54.  EOC ReviewEOC Review
New Profiles
0
2
4
6
8
10
1 2 3 4 5 6 7 8 9
Week of Training
MSIProfiles(%)
Pre-RT
RT
λ2 = 15, p < 0.01

55. AUSA Medical
Rate of New ProfilesRate of New Profiles
Pre-RTPre-RT
GroupGroup
(n = 175)(n = 175)
RTRT
GroupGroup
(n = 344)(n = 344)
ChangeChange %%
ReductionReduction
ChiChi
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

56. EOC ReviewEOC Review
Weeks 1, 4-9, p < 0.01
Accumulated Profiles
0
5
10
15
20
25
30
35
1 2 3 4 5 6 7 8 9
Week of Training
MSIProfiles(%)
Pre-RT
RT

57. AUSA Medical
Accumulated ProfilesAccumulated Profiles
Men
0
5
10
15
20
25
30
1 2 3 4 5 6 7 8 9
Week of Training
MSIProfiles(%)
Pre-RT
RT
Women
0
10
20
30
40
50
1 2 3 4 5 6 7 8 9
Week of Training
MSIProfiles(%)
Pre-RT
RT
Weeks 5-9, p < 0.01

58. EOC and TMC DataEOC and TMC Data
Held overHeld over pre-RTpre-RT RTRT
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

59. AUSA Medical
Surveillance TMC DataSurveillance TMC Data
Pre-RTPre-RT RTRT
New Profile RateNew Profile Rate 3.9/100 2.0/1003.9/100 2.0/100
70 visits/wk 36 visits/wk70 visits/wk 36 visits/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

60. AUSA Medical
Diagnostic and RecordDiagnostic and Record
APFT PAPFT Pass Ratesass Rates
0
20
40
60
80
100
DAPF RAPFT
Pre-RT Men
RT Men
Pre-R Women
RT Women
p > 0.05p > 0.05

61. AUSA Medical
Diagnostic and RecordDiagnostic and Record
APFTAPFT Profile RatesProfile Rates
0
10
20
30
40
DAPFT RAPF
Pre-RT Men
RT Men
Pre-RT Women
RT Women
p > 0.05p > 0.05
Retakes:
30% vs 15%

62. Total Score on the RAPFT - NSD
238 240 239
248
180
200
220
240
260
280
300
pre-RT (n = 48) RT (n = 93) pre-RT (n = 67) RT (n = 159)
Wome
n
Men
Co A/232 BN
Mean+/-SE

63. Run Score on the RAPFT - NSD
74
77 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/232Bn
Mean+/-SE

64. Sit-up Score on the RAPFT - NSDSit-up Score on the RAPFT - NSD
78 77 77
83
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
Mean+/-SE
Co A/232Bn

65. 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 BnMean+/-SE

66. Change in Total Score for Men
DAPFT to RAPFT
20
16
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
Mean+/-SE Co A/232 BN

67. Change in Total Score DAPFT to
RAPFT for Women
18
10
5
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 BN
Mean+/-SE

68. 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 thanLow score groups improved more than
high score groupshigh score groups
• Pre-RT group improved slightly more thanPre-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 sameMen in high score group showed same
level of improvement in both pre-RT andlevel of improvement in both pre-RT and
RT groupsRT groups

69. Discussion: Provide a Training
Program that will Result in:
• Appropriate Level of ChallengeAppropriate Level of Challenge
– Soldiers achieved equal performance on theSoldiers 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

70. AUSA Medical
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 duty24,490 limited duty
days/yr per BN,days/yr per BN,
• ~50,000 for 2 BNs at FSH~50,000 for 2 BNs at FSH

71. AUSA Medical
SummarySummary
• Using macroergonomic and public healthUsing macroergonomic and public health
approaches resulted in:approaches resulted in:
– developing an environment conducive todeveloping an environment conducive to
implementing injury control initiativesimplementing injury control initiatives
– developing a network of individuals “dedicateddeveloping a network of individuals “dedicated
to the cause”to the cause”
– overall and targeted reductions inoverall and targeted reductions in
musculoskeletal injuries and lost duty daysmusculoskeletal injuries and lost duty days
– implementing changes which can lastimplementing changes which can last

72. AUSA Medical
SummarySummary
• The running template was designed as aThe running template was designed as a
conservative approach, which allowed soldiersconservative approach, which allowed soldiers
to improve performance incrementally, withoutto improve performance incrementally, without
developing musculoskeletal injuries.developing musculoskeletal injuries.
• Even with this cautious approach, performanceEven 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.

73. AUSA Medical
ProblemsProblems
• Accomplished in a microcosmAccomplished in a microcosm
• Hard work in an overall system that doesHard work in an overall system that does
not support this “new culture”not support this “new culture”
• 50% turn-over in a year means constant50% turn-over in a year means constant
“re-indoctrination”“re-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 inEvery soldier thinks s/he is an expert in
physical fitnessphysical fitness
• Other items: sleep, boots, shoes, etc.Other items: sleep, boots, shoes, etc.

74. AUSA Medical
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 intoSlow build through BCT, AIT, and into
permanent stationspermanent stations

75. AUSA Medical
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 atemphasize soldiers’ fitness level on arrival at
BCT and follow an appropriate progressionBCT and follow an appropriate progression
during and from BCT to AIT and to permanentduring 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 toaccording to their mission, and not left up to
the individual discretion of the leadershipthe individual discretion of the leadership

76. AUSA Medical
RecommendationsRecommendations
• Army physical training programs shouldArmy physical training programs should
– Integrate progressive training into theirIntegrate progressive training into their
training, for all soldiers who have breaks intraining, 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 toLeadership 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 denyingrather 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

77. RecommendationsRecommendations
• The AIT APFT achievement missionThe AIT APFT achievement mission
should be to have the greatest number ofshould be to have the greatest number of
soldiers achieve 60 points per event, withsoldiers achieve 60 points per event, with
the fewest injuries and profiles.the fewest injuries and profiles.
• The goal should NOT be to see whichThe goal should NOT be to see which
commander’s troops achieve the highestcommander’s troops achieve the highest
overall APFT scores regardless of injuryoverall APFT scores regardless of injury
and profile rates.and profile rates.

78. • KeysKeys
– AccountabilityAccountability
– Realistic GoalsRealistic Goals
– Culture ChangeCulture Change

79. They have to come to:They have to come to:
believe itbelieve it
live itlive it
teach itteach it
preach itpreach it
make it part of their daily lifestylemake it part of their daily lifestyle

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

81. ToTo
“Living to Fight Another Day”“Living to Fight Another Day”