Increases in Musculoskeletal Diagnosis Rates Corresponding with the Transition to the Army Combat Fitness Test- MHSRS 2024

schermerhorn j, rich e, kazman j, clifton d, nelson a

Abstract accepted for oral presentation at the 2024 Military Health System Research Symposium

Non-combat musculoskeletal (MSK) disorders are a major cause of morbidity in the U.S. Army. Physical fitness tests are required for training and readiness but they may be accompanied by injury risks. The Army recently transitioned from the Army Physical Fitness Test (APFT) to the Army Combat Fitness Test (ACFT). We hypothesize that this transition, and associated changes in individual and group training regimens, are associated with increased MSK diagnoses.

We conducted a retrospective review of recently enlisted active-duty Service Members from 2016 to 2022 and analyzed the incidence of MSK diagnoses within the first six months of military service.  The three cohorts were control APFT (2016–2019), COVID (2020–2021), and ACFT (April 2022–October 2022). All cohorts began in April. Survival analyses were used to compare ACFT and COVID cohorts with the control APFT.

Among new enlistees, risk for MSK conditions has fluctuated over years, likely in response to the introduction of the ACFT in April 2022 and to COVID lockdowns. Consistent with much prior research, women had much higher rates of MSK conditions than men, which might mask trends over time (e.g., due to a ceiling effect). Continued monitoring of MSK trends over time and practices around the ACFT is necessary to maximize force readiness and minimize overall MSK disorder burden.