DTIC ADA420942: Evaluation of Two Army Fitness Programs: The TRADOC Standardized Physical Training Program for Basic Combat Training and the Fitness Assessment Program

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by  Defense Technical Information Center

US. Army Center for Health Promotion
and Preventive Medicine [ J

TRADOG STANDARDIZED PHYSICAL TRAINING FROGRAM
FOR BASIC COMBAT TRAINING AND THE FITNESS

EVALUATION OF TWO ARMY FITNESS PROGRAMS: THE S
ASSESSMENT PROGRAM

USACHPPM PROJECT NO. 12-HE-S7726-04 gi

C

U.S. Army Center for Health Promotion and Preventive Medicine
Aberdeen Proving Ground, Maryland

P

U.S. Army Physical Fitness School
Fort Benning, Georgia

U.S. Army Training Center
Fort Jackson, South Carolina

Center for Accessions Research
Fort Knox, Kentucky

Approved for public release; distribution is unfimitec P

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Table of Contents

4. REFERENCES,
2 INTRODUCTION.
3. BACKGROUND LITERAZUIRE.
a. Madificaiions to Physical Training.
L, Fitness Assessment Program in BCT.
4, PURPOSES OF THIS PROJECT.
5. METHODS.
a, Design of the Program Evaluation.
b. TRADOC Standardized Physical Training; Program,
(1) Phases of the Evaluation...
{2) TRADOC Standardized Physical Training Program
, Outcome Maasures..... .
(¥) Training Octeomes.
(2) Physical Fitness Outcomes,
@} Injury Outcomes.
4. Physical Characteristics...
©. Data Analysis...
6. RESULTS: EVALUATION OF THE TRADOG STANDARDIZED PHYSICAL
TRAINING PROGRAM...
‘a, Physical Characteristics,
b. Training Outcomes.
¢. Physical Fitness Outcomes,
(i) Fliness Tests Adminis‘ration Datos
(2) tniual Fitness Asseseman:
{)Indial Fitross Aesessmen! and Second Flinass Assessment
(4) APT Raw Scazes. on
(8) APFT Total Points
(6) APFT Pass Rates.
d. Injury Outoomes....-
(1) Person-Time Injury Incidence Retes......
2) Univariate Anslyets of Injury Risk in NSG and SG..
{@) Mutivaicte Comparison o* mur Rskin NSG and SG
(4) PTRP Injuries,
7. RESULTS: FAP EVALUATION...
‘a, Physical Characteristics.
b. Training Outeames.
©. Physical Fitness Outcomes,
(Initial Fitness Assessment
(2) Initial Fitness Assessment and Week 2 Finess Assessment
(G) APFT Raw Scores. se
(gence Prec No, 12. grTabe Boas

(4) APET Pass Rates. a2

15) APFT Total Points. ene non 4B

4. Injury Outcomes. 46

(i) Person-Time injury inGance Rates... 46

(2) Univariate Analysts of inury Risk... a?

@} Muttivariate Analysis of ilury Risk... ae)

GQ) PTRP Injurles. oe Tne 50

8, DISCUSSION. 50

a, TRADOC Stondardized Physisa Training Program. cB
(1) Physical Fitness Changes... oastvvnicrns St

Q} Injuries... ne 52

(3) Physical Fiiness Testing. 54

b. FAP Evaluation A

(1) Training Outcomes. 58

(2) Physical Fitness 57

@) Injuries, i" sen BB

(4) Other Considerations. . 58

9, RECOMMENDATIONS... . 60

Appendices

Appendix A, References.

‘Appendix B. Changes © Physica Training Program aftar the Pilot Phase.
‘Appendix C. Condtfoning Dif

Appendix D. Condfttoning Dri 2
‘Appendix E. Movernent Dsils

Appendix F. Stretching Dril 1
‘Appendix G. Stretching Brill 2
‘Appendix H. 9-Week Training Schedules.
“Appendix 1. 1CD-9 Codes Used for the Injury irdiecs.
‘Appendix J. Supplemental Data on the FAP Evaluation
‘Appendix K, Acknowledgements. eae
STA 2a

Executive Summary

EVALUATION OF TWO ARMY FITNESS PROGRAMS: THE TRADOC
STANDARDIZED PHYSICAL TRAINING PROGRAM FOR BASIC COMBAT
TRAINING AND THE FITNESS ASSESSMENT PROGRAM

USACHPPM Project Number 12-H.5772b-04

4, INTRODUCTION. L1G Dennis Cavin, Contmander of Acsesslons Command,
tasked the LLS. Army Physical Fitness School (USAPFS) and the Center for
Accession Research (CAR) to deve'op and tast the abilty of a standardized physical
training {PT} program ta improve fitness and reduce injuries and attrition during BCT.
‘The program devetoped by the USAPFS folowed the principles in Army Fiold
‘manual 21-20 plus incorporated injury rectuction principles involving reduced runing
mileage and e grealer variely of exercises. LTG Cavin also wanted to determine #
the new Titres program cauplad with an administrative change might eliminate tho
necessity for the Fiiness Assessment Program (FAP) o reduce the number oF
trainges who enter the FAP, New recruits who fail a basic fitness test at the
Receplian Station enter the FAP and irain until they can pass the test and enter
BCT. The proposed administrative change was to conduct the basic filness test at
Week 2 of BCT rather than in the Reception Station, This report examines attrt‘oa,
fitness and injuries 1) during implementation of the standardized physical training
program, and 2) among lav-fit trainees who did and did nat enter the FAP prior to
Bor.

2. METHODS. To evaluate the new PT program, a standardized group (SG, n=516
men, 416 women) that implemented the new PT program was compared to a nan-
standardized group {NSG, n=G56 men, 482 women) that performed a traditional BCT
PT program. Both groups consisted of 5 BCT companies. Prior to starting BCT, a
minimal fines tast was conducted in the Reception Station and recruits were
classified according to the results and whether ar not they physically trained prior to
entering a BCT unit, NoLFAP trainees were those who passed the Reception
Station Fitness Tes! end entered BCT. FAP Control group comprisad trainees who
failed the test, waned in the FAP (about 2 weeks on average), and then entered
BCT. FAP Test trainees were thase who failed the tost but entered BCT without
training in the FAP. Blth the NSG and SG contained FAP Control snd No-FAP
{tainees but only the SG contained FAP Test trainees.

‘Tho evaluation of the etanda‘dized PT program procesded in three major
phases: 1) train-the-trainer, 2} pot, and 3) evaluation. The train-the-trainer phase
involved a 16-hour block of instructian given to the training cadre in the SG by the
USAPFS, The pilot phase involved an entire 9-weak BCT cycle in which the drill
sergeants from the SG implemented the exercises they had been taught and
changes were made basod on drill sergeant feedback. The evaluation phrase
USACHPPALeoninc No 12 HE S77Ab.08 2006

Incorporated lessons leamed during the pilot and is the main topic of this paper.
Daring the evaluation phage, the NSG group command siall and drill sergeants were
briefed en the project and told nat to alter thelr taaltional PT pragram. The SG
training program consistad of candldoning ciflls, movement dil, strelching dls,
speed running, and ability group running, The NSG training program involved
Patisthenios, push-Upisi-up improvement, and ably group running. The SG
program contained fewe: total miles of runniag and a greater varlety of exercises.

Attrition was determined by examining group differences in the proportion af
trainzes who completed the S-week BCT cycle (full eyole trainaes). An intial Fines
Assessment was given on amival at the BCT company and consisted of a ‘-minute
PU event, a t-minute S) event, and 2 {-mile mun (4/1H1 test). The SG also took the
same Fitness Assessment at Week 2, Aa Army Physical Fitness Test (APFT) was
administered lo all groups at Weeks $ and 7 of the BCT Cycle. On the Week 7
APFT, trainees had to meet specific age- and gender-adjasted requirements to pass
tha teat, Trainees who fallod fo pass the Week 7 APFT were allowed to retake the
teat several times. Injuries that oocurred during BGT were obtained from the
Standard Ambulatory Data Record (SADR} which recorded outpatian: medical visits
to the traon medical clinic and hospital but did not include visits to Ballalion Aid
Stations, International Classification of Diseases, Version 9 (ICD-9) codes indicative
af injury were selected and trainees with one or more injuries were compared among
groups. Trainae age, gender, height, and welght were obtainad from the training
companies and the Reception Battalion Automatad Report System (RECBAS).

Body mase index (BMI) wae calculated as waighthheight

3. RESULTS,

a, TRADOC Standardized PT Program. Analysis of the SG conducted with
‘and without the FAP Test personnel are reported in the paper. However, because
the lower intial fitness of te FAP Test personne! disadvantaged the SG, and
because the FAP evaluation was a separate investigation, this summary only
includes the analysis of the SG without the FAP Test personnel.

‘There were no significant differences between the SG and NSG in the
proportion of men (NSG= 87%, S@=87%, p=0.88) or women (NSC
-0.28) wo campletad the cycle. PU perfurmance of tha SG was highe: than that
of the NSG at both Weeks § and 7, SU performance of the SG at Week 5 was lower
than thal of the NSG but by Week ? the performance of the two groups was si
‘Two-mile tun performance of the men in the SG and NSG was similar as were
improvements from Weck $ to Week 7. Two-mile run performancs of the wamen in
tha NSG was fower than that of the SG al Week 5 and Week 7, the NSG women
improved thele performance more than the SG women fram Week & to Week 7 but
did nat reach the same periarmance level as the SG women,
{CBPLL Pied Np. 22

nazz, 20

‘The SG women had a grester proportion of trainees passing the final APFT at
Week 7 {NSG=79%, SG=B64%, p=0.02}: the trond among the men was weaker but
sirilar (NSG=8B%, SG=G0%, p=9.31), When men and women wore combined In a
single analysis, the SG had more individuals passing the fest than the NSG
(NSG=84%, SG=88%, p=0.02). After all APFT retakes were completed, the SG men
had fewor final APFT failures (N&G=2.9%, SG=0.B%, p=0.011}: the trend in tho
women's data was weaker but similar (NSG=3,7%, SG=2.9%, p=0.52). When men
and women were combined, the SG had fewer final APFT failures than the NSG.

(8.3% vs 1.7%, 2=0.08).

‘After adjustment for covariates (inital ness and physical characteristics)
using Cox ragression (a survival analysis technique), the relative sk of an injury
was 1,6 {95% confidence interval (CI)=1.2-2.0} times higher in the NSG men than
the SG men. The relative tisk of an injury was 1.5 {26% Ci=1.2-1.8) tires higher in
the NSG women compared to the SG women.

b. FAP Evaluation. The proportion of male FAP test, FAP Control and Not-
FAP who completed the BOT cycle were 59%, 83% and 87%, respectively (p<0.01}.
For women, these numbers were 52%, 69%, and 78%, respactively {p<0.01). There
were no differences in attrition betwen Nok FAP and FAP Gontrol mon (p=0.22) but
thera fended to be fewer FAP Gantrol women who cornpleted the cycle campared to
NObFAP women (p=0.06}. More of the FAP Control group completed the cyole than
the FAP Test group (0.01 for both mea and woren), Fewer FAP Test personnel
‘completed the cycle because they had more newstarts and discharges.

On the Weak 2 Fitness Assessment given to the SS, the proportion of
trainees passing the test based on the Reception Stalion Physical Fitness Test
standards was 28%, 46%, and 85% for the FAP Test, FAP Contrat, and NotFAP
groups (p<0.01).

Because of attrition, only 63% of FAP Test trainees took the Week 7 APFT.
‘compared to 84% and 86% of the FAP Control and Not-FAP, respectively (p<0.01)
Afler APFT raw scares at Weeks 6 and 7 were adjusted for differences in Initial
Fiiness Assessment scores (analysis of covariance), the Not-FAP demonstrated
higher performance than the FAP Test and FAP Control an all 5 test events for both
men and women (p<0.01). There were no differences between the FAP Tast and
FAP Control on any test event (29.58).

At Week 7 the proportion of male trainees passing the test was 55%, 64%
‘and 90% in the FAP Test, FAP Control and Nat-FAP groups, respectively (9<0.01}.
‘The proportion of famate trainees passing the test was 55%, 60% and 85%,
respectively, On the Week 7 APFT. te No-FAP had a larger proportion of trainees
passing the test compared to the FAP Test and Control (p<0.01 for alt comparisons}.
Proportions passing the test among the FAP Test and Control were similar (p=0.42
LUSACHPEM Ponies M12

for men, p#0.54 for women}. After all APFT retakes had been complete the
proportion of man who fslled the test was 12.5%, 7.8%, and 41.7% in the FAP Test,
FAP Control, and NotFAP, respectively, The proportion of women falling the test
was 11.0%, 8,5% and 2.7%, respectively, The NoLFAP had fevver failures than the
FAP Test and Gantra! (2<0.01 for all comesrisans). The difference in the proportion
of FAP Test and Contvol failuros was net statlsticaly significent (p=0.46 far men,
p=0.59 for worten).

Univariate Cox regression demonstrated that injury risk was higher in both the
FAP Test and Control groups compared tc the Nof-FAP for both men (re'ative risk
(RR) (FAP TestNot-FAP}=1.7, 95%Cl=1.0-3.1; RR (FAP ControlNot FAP)=1.5,
(959%CI=1.0-2.3) and wamen (RR (FAP TestINOLFAP)= 1.5, 95%CI=1.1-2.1; RR
(FAP Contral/Not FAP)=1.2, 9S%4Cl=9.6-1.6), Differences between FAP Test and
Control men or women ware generally smaller (RR (FAP Tes¥NoL-FAP)=1.1,
95%CI=0.6-2.3 for men and 1.3, 95%CIs0.9-2.0 for women). Affer controlling for
initia! fines, age and BM, using Cax regression, thare were no differences in injury
risk among the three grcups (RR=0.8 to 1.2),

4, DISCUSSION. FAP Tost trainess were nested within the group undergoing the
TRADOC PT program because it wes hypothesized that certain characteristics of
the new PT program, coupled with moving the Reception Station Basic Fitness Test
to Week 2 of BCT, might serve to reduce attrition and fower injuries in lower ft
trainees. Itwas found that 72% of FAP Test group failed the Week 2 test, More
interesting was the fact that a large proportion af the FAP Control and Not-FAP also
failed the Week 2 test. The total number of failures in all 3 FAP groups was over 3-
{old higher than the number of trainces who actually failed the test in the Reception
‘Station (.e,, FAP Test trainees). The reasons for this are not clear but may relate to
the fact ina! the Week 2 test was not conducted in exactly the same manner as in
the Reception Station,

a, Evaluation of the TRADOC Standardized PT Program. The SG that
used the TRADOC Standardized PT Program had mare favorable fines and injury
‘autcomes than the NSG that used a traditional PT programs, The SG had higher raw
so0fes on the PU, @ higher APFT pass rate at Weck 7, and a higher pass rate atter
all APPT retakes had been corapleted. Injury ask in the SG was substantially lower
than i the NSG.

‘The similar Week 7 2-mile run performances were achieved with fewer total
running miles on the partof the SG, The 8G ran an estimated 13% to 31% fewer
milgs than the NSG during BCT. Speed running performed by SG trainees probably
assisted in improving 2-mila run times since running of this type has been shown to
result in greater improvements in speed than long-distance running alone. The
owar injury rates may also be associated wi the lower running miles since past
studies in basic training have shown less running mileage is associated with lower
CHOP Pres st, 2008

injury rates, Other foatures of the TRADOC Standardized PT Program that may
‘nave reduced injury risk include the gradusl, progressive introduction of exercise
stress and the greater variety of exorcise in the program {cross-training}.

b. FAP Evaluation, The mnst significant finding trom the FAP evaluation was
the fact thul the FAP Test group had mare attrion than the FAP Controt and Not-
FAP. FAP Test personnel were 1 5 times less fkely tp complete BCT than Not-FAP
personsel {men and women combined). FAP Control personne! were only 1.1 times
less likaly to complete training cormpared to the No-FAP (men and women
vombined}, Thus, the major advantage of the FAP appears to be its ability to
“screen” out the lower fit trainees belore they enter BCT. Training cadre and
bommanders appreciated thls furctlon and desired to retain the FAP for this reason.

‘nc problem with determining changes in finess In the FAP Test group was
that only trainees wha took the test could be evaluated. Attrifion was high in this
{group and fitness changes in thase who left BCT could not be evaluated. The FAP
‘Test and Contro! trainees who took the APFTs demonstrated atmilar performance
and similar pass rates.

Injury isk in the FAP Test and Control groups wore uniformly higher than for
the No-FAP, When the FAP Tast and Control were compared, there was title
difference in injury risk between the groups. The aerobic fiiness level of the FAP
Test and Control groups were substantially lower than that of the Nol-FAP at the
start of BCT. A previous study of the FAP shawed that when the aerobic fitness
level of a group coming out of the FAP vas similar to that of othar trainees, injury
rick during BCT was similar. Thus, the level of aerobic fitness on entry to BCT may
bo more important factor In risk reduction than the ammount of PT. In the present
evaluation, trainees wera in the FAP an average of about 18 days and traized 6
dayshveak, This training period was not suicient to bring the average fitness level
cof the FAP Control group io the average level of the Nol-FAP at tha start of BCT.

5, RECOMMENDATIONS.
1, Adapt the new TRADOG Standardized PT Program for BCT. Companies

using the program demonstrated a higher APFT pass rate, lower injury risk, and
9 attrtion whan compared fo a traditional PT program,

2. Ratain fhe FAP. The largest advantage of the FAP appears to be that it
serves ag a prescreening for vary low fit individuals and itentifics those likely to drop
tout of BCT early in the process. It is possible to move this atintian into BCT but this
‘would increase the administrative burden on the BCT companies and distract from
the training mission. Further stady coutd be conducted on the feasibllty of
banducting the fitness test as part of the recnuiting process.