The Relationship Between Functional Motor Competence and Performance on the Army Combat Fitness Test in Army Reserve Officer Training Corps Cadets.

INTRODUCTION: The development of functional motor competence (FMC; i.e., neuromuscular coordination and control required to meet a wide range of movement goals) is critical to long-term development of health- and performance-related physical capacities (e.g., muscular strength and power, muscular endurance, and aerobic endurance). Secular decline in FMC among U.S. children and adolescents presents current and future challenges for recruiting prospective military personnel to successfully perform the physical demands of military duty. The purpose of the current study was to examine the relationship between FMC and physical military readiness (PMR) in a group of Cadets enrolled in an Army Reserve Officer Training Corps program. MATERIALS AND METHODS: Ninety Army Reserve Officer Training Corps Cadets from a southeastern university and a military college in the southeast (females = 22; Mage = 19.5 ± 2.5) volunteered for participation in the study. Cadets performed a battery of eight FMC assessments consisting of locomotor, object projection, and functional coordination tasks. To assess PMR, Cadets performed the Army Combat Fitness Test (ACFT).Values from all FMC assessments were standardized based on the sample and summed to create a composite FMC score. ACFT scores were assigned to Cadets based upon ACFT scoring standards. We used Pearson correlations to assess the relationships between individual FMC assessment raw scores, FMC composite scores, and total ACFT points. We also evaluated the potential impact of FMC on ACFT in the entire sample and within each gender subgroup using hierarchical linear regression. Finally, we implemented a 3 × 2 chi-squared analysis to evaluate the predictive utility of FMC level on pass/fail results on the ACFT by categorizing Cadets' composite FMC score into high (≥75th percentile) moderate (≥25th percentile and <75th percentile), and low (<25th percentile) based on the percentile ranks within the sample. ACFT pass/fail results were determined using ACFT standards, requiring a minimum of 60 points on each the ACFT subtests. RESULTS: FMC composite scores correlated strongly with total ACFT performance (r = 0.762) with individual FMC tests demonstrating weak-to-strong relationships ACFT performance (r = 0.200-0.769). FMC uniquely accounted for 15% (95% CI: -0.07 to 0.36) of the variance in ACFT scores in females (R2 = 0.516, F2,19 = 10.11, P < 0.001) and 26% (95% CI: 0.09-0.43) in males (R2 = 0.385, F2,65 = 20.37, P < 0.001), respectively, above and beyond the impact of age. The 3 × 2 chi-squared analysis demonstrated 74% of those with low, 28% with moderate, and 17% with high FMC failed the ACFT (χ2 [1, N = 90] = 27.717, V = 0.555, P < 0.001). CONCLUSION: FMC composite scores are strongly correlated with ACFT scores, and low levels of FMC were a strong predictor of ACFT failure. These data support the hypothesis that the development of sufficient FMC in childhood and adolescence may be a critical antecedent for PMR. Efforts to improve FMC in children and adolescents may increase PMR of future military recruits.

The Potential Role of Functional Motor Competence to Promote Physical Military Readiness: A Developmental Perspective.

Decreased physical fitness in military recruiting populations is problematic for the development of physical military readiness (PMR) and presents a threat to national security. The demonstration of low levels of fitness may be an indicator of a more foundational problem in the physical development of military recruits. We propose the development of functional motor competence (FMC) across childhood and adolescence as a necessary antecedent to advanced PMR training and military-specific tasks (i.e., rucking and obstacle course navigation) and as an integral part of sustained PMR. The development of FMC supports increases in cardiovascular and muscular endurance through repeated efforts performed during practice and in sport, as well as muscular power as many FMC movements mimic plyometrics in a strength in conditioning sense. We posit that an inadequate foundation in FMC will serve as a barrier to achieving sufficient PMR and combat success of the fighting force. We propose three possible solutions to ensure sufficient PMR levels through the implementation of developmentally appropriate FMC-based training. First would be promoting FMC-based training in junior reserve officer training corp and ROTC programs. Second would be a more global approach, on the scale of the National Defense Education Act, specifically focusing on promoting quality daily physical education that could reach millions of children. Third, individual branches could begin promoting the tenets of foundational FMC training concepts in their physical training manuals, which ideally would address FMC before and throughout basic training, as well as subsequent active duty training.

A prospective field study of U.S. Army trainees to identify the physiological bases and key factors influencing musculoskeletal injuries: a study protocol.

BACKGROUND: Musculoskeletal injuries (MSKIs) are common in military trainees and present a considerable threat to occupational fitness, deployability, and overall military readiness. Despite the negative effects of MSKIs on military readiness, comprehensive evaluations of the key known and possible risk factors for MSKIs are lacking. The U.S. Army Research Institute of Environmental Medicine (ARIEM) is initiating a large-scale research effort, the ARIEM Reduction in Musculoskeletal Injury (ARMI) Study, to better understand the interrelationships among a wide range of potential MSKI risk factors in U.S. Army trainees in order to identify those risk factors that most contribute to MSKI and may be best targeted for effective mitigation strategies. METHODS: This prospective study aims to enroll approximately 4000 (2000 male and 2000 female) U.S. Army trainees undergoing Basic Combat Training (BCT). Comprehensive in-person assessments will be completed at both the beginning and end of BCT. Participants will be asked to complete surveys of personal background information, medical history, physical activity, sleep behaviors, and personality traits. Physical measurements will be performed to assess anthropometrics, tibial microarchitecture and whole body bone mineral density, muscle cross-sectional area, body composition, and muscle function. Blood sampling will be also be conducted to assess musculoskeletal, genetic, and nutritional biomarkers of risk. In addition, participants will complete weekly surveys during BCT that examine MSKI events, lost training time, and discrete risk factors for injury. Participants' medical records will be tracked for the 2 years following graduation from training to identify MSKI events and related information. Research hypotheses focus on the development of a multivariate prediction model for MSKI. DISCUSSION: Results from this study are expected to inform current understanding of known and potential risk factors for MSKIs that can be incorporated into solutions that optimize Soldier health and enhance military readiness.

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

Background: 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. Methods: 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). Findings: 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. Discussion: 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.