US Army’s Combat Fitness Test Event Failure Frequency And Associations To Musculoskeletal Injuries

The Army Combat Fitness Test (ACFT) was designed to evaluate U.S. Army Service member’s (SM) physical capabilities that relate to occupational demands. ACFT performance may influence musculoskeletal injury (MSKI) risk. PURPOSE: To determine ACFT event failure frequency and their associations with lower extremity and back MSKI risks. METHODS: We conducted a retrospective cohort study on 4,222 SMs (12.2% females, age = 24.3 ± 5.6 y, mass = 78.7 ± 12.0 kg, height = 175.4 ± 8.7 cm). SMs completed a self-report clinical-based MSKI risk assessment when in-processing to a U.S. Army unit from December 2020 to March 2022. SMs self-reported ACFT event failures during their most recent ACFT and if they sustained a MSKI in the past year. ACFT events included: 3-repetition max deadlift (DL; weight), sprint/drag/carry (SDC; time), standing power throw (SPT; distance), hand release push-ups (HRP; repetitions), leg tucks (LTK; repetitions), and two-mile run (2MR; time). MSKI data (ICD-10 codes) were extracted from the Military Health System Management Analysis and Reporting Tool (M2) for 6-months following the SM’s in-processing date. Separate Cox proportional hazard regressions (COXPH) were performed on each ACFT event (pass or fail) adjusting for gender, age, and previous lower extremity and back MSKI within the past year. RESULTS: MSKI incidence rate during the 6-month surveillance period was 691.60 MSKIs per 1000 person-years. The proportions of failures among the events were, LTK: 6.09%, 2MR: 5.00%, SPT: 4.74%, DL: 3.33%, HRP: 2.39%, SDC: 2.00%. 2MR was the only event significantly associated with MSKI risk (HR[95%CI]: 1.33[1.07-1.70], p = 0.009). CONCLUSIONS: The ACFT is a novel assessment to quantify a SM’s physical abilities. SMs who failed the 2MR were 1.3 times more likely to sustain a MSKI, which agrees with previous research. Future studies should evaluate the associations between the raw ACFT event outcome values (i.e., pounds, time, distance), rather than the Army’s adjusted “pass” or “fail” and MSKI risks. The views expressed in this abstract are of those of the authors, and do not necessarily reflect the views, opinions, or policies of the Uniformed Services University of the Health Sciences, the US Departments of Army/Navy/Air Force, Department of Defense, nor the US Government.