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Ramji AV, Runswick OR, Dommett EJ. Exercise Dependency and Overuse Injuries in Attention Deficit Hyperactivity Disorder. J Nerv Ment Dis 2024; 212:190-195. [PMID: 38412245 DOI: 10.1097/nmd.0000000000001762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
ABSTRACT Attention deficit hyperactivity disorder (ADHD) is a common condition, but current medications have limitations, pushing a drive for alternative approaches. Different exercise-focused approaches have shown promise, but concern has also been raised about individuals with ADHD showing greater risk of addiction, including exercise dependency. Using an online survey, we examined current exercise practices, including exercise dependency and the presence of overuse injury, which could result from overexercising, in 114 adults with ADHD. We found that most were regularly exercising. None were classified as exercise dependent, but 38.9% were deemed symptomatic nondependent. Hyperactive-impulsive symptoms were a predictor of the level of exercise withdrawal experienced, and the co-occurrence of autism spectrum disorder was associated with greater risk of overuse injuries. The data indicate that ADHD may confer some greater risk of exercise dependency, aligning with previous studies investigating other addictions and suggesting further research is critical.
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Affiliation(s)
- Anusha V Ramji
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
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Murphy MC, Stannard J, Sutton VR, Owen PJ, Park B, Chivers PT, Hart NH. Epidemiology of musculoskeletal injury in military recruits: a systematic review and meta-analysis. BMC Sports Sci Med Rehabil 2023; 15:144. [PMID: 37898757 PMCID: PMC10612319 DOI: 10.1186/s13102-023-00755-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/19/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Injuries are a common occurrence in military recruit training, however due to differences in the capture of training exposure, injury incidence rates are rarely reported. Our aim was to determine the musculoskeletal injury epidemiology of military recruits, including a standardised injury incidence rate. METHODS Epidemiological systematic review following the PRISMA 2020 guidelines. Five online databases were searched from database inception to 5th May 2021. Prospective and retrospective studies that reported data on musculoskeletal injuries sustained by military recruits after the year 2000 were included. We reported on the frequency, prevalence and injury incidence rate. Incidence rate per 1000 training days (Exact 95% CI) was calculated using meta-analysis to allow comparisons between studies. Observed heterogeneity (e.g., training duration) precluded pooling of results across countries. The Joanna Briggs Institute Quality Assessment Checklist for Prevalence Studies assessed study quality. RESULTS This review identified 41 studies comprising 451,782 recruits. Most studies (n = 26; 63%) reported the number of injured recruits, and the majority of studies (n = 27; 66%) reported the number of injuries to recruits. The prevalence of recruits with medical attention injuries or time-loss injuries was 22.8% and 31.4%, respectively. Meta-analysis revealed the injury incidence rate for recruits with a medical attention injury may be as high as 19.52 injuries per 1000 training days; and time-loss injury may be as high as 3.97 injuries per 1000 training days. Longer recruit training programs were associated with a reduced injury incidence rate (p = 0.003). The overall certainty of the evidence was low per a modified GRADE approach. CONCLUSION This systematic review with meta-analysis highlights a high musculoskeletal injury prevalence and injury incidence rate within military recruits undergoing basic training with minimal improvement observed over the past 20 years. Longer training program, which may decrease the degree of overload experienced by recruit, may reduce injury incidence rates. Unfortunately, reporting standards and reporting consistency remain a barrier to generalisability. TRIAL REGISTRATION PROSPERO (Registration number: CRD42021251080).
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Affiliation(s)
- Myles C Murphy
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.
- School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, WA, Australia.
| | - Joanne Stannard
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Vanessa R Sutton
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Patrick J Owen
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Brendon Park
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Paola T Chivers
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Nicolas H Hart
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, SA, Australia
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
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Clifton DR, Nelson DA, Choi YS, Edgeworth DB, Nelson KJ, Shell D, Deuster PA. Risk factors for musculoskeletal-related occupational disability among US Army soldiers. BMJ Mil Health 2023; 169:327-334. [PMID: 34373349 DOI: 10.1136/bmjmilitary-2021-001900] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/25/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Minimising temporary and permanent disability associated with musculoskeletal conditions (MSK-D) is critical to the mission of the US Army. Prior research has identified potentially actionable risk factors for overall military disability and its MSK-D subset, including elevated body mass index, tobacco use and physical fitness. However, prior work does not appear to have addressed the impact of these factors on MSK-D when controlling for a full range of factors that may affect health behaviours, including aptitude scores that may serve as a proxy for health literacy. Identifying risk factors for MSK-D when providing control for all such factors may inform efforts to improve military readiness. METHODS We studied 494 757 enlisted Army soldiers from 2014 to 2017 using a combined medical and administrative database. Leveraging data from the Army's digital 'eProfile' system of duty restriction records, we defined MSK-D as the first restriction associated with musculoskeletal conditions and resulting in the inability to deploy or train. We used multivariable Cox proportional hazards regression to assess the associations between incident MSK-D and selected risk factors including aptitude scores, physical fitness test scores, body mass index and tobacco use. RESULTS Among the subjects, 281 278 (45.14%) experienced MSK-D. In the MSK-D hazards model, the highest effect size was for failing the physical fitness test (adjusted HR=1.63, 95% CI 1.58 to 1.67, p<0.001) compared with scoring ≥290 points. CONCLUSIONS The analysis revealed the strongest associations between physical fitness and MSK-D. Additional efforts are warranted to determine potential mechanisms for the observed associations between selected factors and MSK-D.
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Affiliation(s)
- Daniel R Clifton
- Department of Military and Emergency Medicine, Consortium for Health and Military Performance, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
- Womack Army Medical Center, Fort Bragg, North Carolina, USA
| | - D A Nelson
- Department of Military and Emergency Medicine, Consortium for Health and Military Performance, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
- Womack Army Medical Center, Fort Bragg, North Carolina, USA
| | - Y S Choi
- Womack Army Medical Center, Fort Bragg, North Carolina, USA
| | - D B Edgeworth
- Department of Military and Emergency Medicine, Consortium for Health and Military Performance, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
- Womack Army Medical Center, Fort Bragg, North Carolina, USA
| | - K J Nelson
- Womack Army Medical Center, Fort Bragg, North Carolina, USA
| | - D Shell
- Health Services Policy and Oversight, Office of the Assistant Secretary of Defense for Health Affairs, Falls Church, Virginia, USA
| | - P A Deuster
- Department of Military and Emergency Medicine, Consortium for Health and Military Performance, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Cheever K, Nedimyer AK, Dewig D, Register-Mihalik JK, Kossman MK. The Identification and Comparison of Factors Affecting Musculoskeletal and Concussion Injury Disclosure. J Athl Train 2023; 58:563-572. [PMID: 36252227 PMCID: PMC10496445 DOI: 10.4085/1062-6050-0291.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Despite the increased risk of musculoskeletal (MSK) injury after a concussion, little is known about the determinants of such a risk. Moreover, the authors of previous reports of increased risk of MSK injury after a concussion have neglected to account for the high level of undisclosed concussions. OBJECTIVE To explore the association between the intention to disclose a possible concussion and the intention to disclose an MSK injury. DESIGN Cross-sectional study. SETTING Online survey. PATIENTS OR OTHER PARTICIPANTS One hundred seven National Collegiate Athletic Association Division I athletes (females = 79%, age = 19.4 ± 1.4 years). MAIN OUTCOME MEASURE(S) Online survey exploring determinants such as injury knowledge, attitudes, perceived social norms, and perceived behavioral control surrounding concussive and MSK injury disclosure. RESULTS A significant association between high intention to disclose a concussion and high intention to disclose an MSK injury (χ2 = 19.276, P < .001, Cramer V = 0.482) was observed. Spearman rank correlations suggested no correlation between concussion nondisclosure (25%) and MSK injury nondisclosure (52%). Multivariate binomial regressions indicated that perceived social norms were the strongest determinant (β = 1.365, P = .002) of high intention to disclose concussion, while attitudes toward MSK injury (β = 1.067, P = .005) and perceived social norms (β = 1.099, P = .013) were the strongest determinants of high intention to report MSK injury. CONCLUSIONS Individuals with high intention to report concussion symptoms also demonstrated high intention to report MSK injury. Strong positive associations were seen between known determinants of intention to disclose concussion and adapted versions of those same determinant domains in intention to disclose MSK injury. As those with high intention to disclose concussion also displayed high intention to disclose MSK injury, intention to disclose injuries generally may play a role in explaining the increase in MSK injury after a concussion.
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Affiliation(s)
- Kelly Cheever
- Applied Biomechanics Laboratory, Department of Kinesiology, University of Texas at San Antonio
| | - Aliza K. Nedimyer
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina at Chapel Hill
| | - Derek Dewig
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown
| | - Johna K. Register-Mihalik
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina at Chapel Hill
- STAR Heel Performance Laboratory, University of North Carolina at Chapel Hill
- Motion Science Institute, University of North Carolina at Chapel Hill
- Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | - Melissa K. Kossman
- School of Health Professions, University of Southern Mississippi, Hattiesburg
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Li N, Zhang Y, Hou S. Stress exposure status and associated factors among Chinese People's Armed Police personnel: A cross-sectional study. Front Psychiatry 2022; 13:1000981. [PMID: 36405900 PMCID: PMC9669384 DOI: 10.3389/fpsyt.2022.1000981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND MG (Mass gathering) deployment is one of the primary duties of Chinese People's Armed Police (PAP) personnel. Due to prolonged and repeated deployments in difficult conditions and harsh climates, military personnel are exposed to multiple stressors. OBJECTIVES This study aims to understand the stress exposure status of armed police personnel during MG deployment and to explore its influencing factors. METHODS A cross-sectional study was conducted among PAP in 2021. We used a cluster random sampling to select 960 PAP personnel. Binary logistic regression was used to examine whether the stress exposure status was associated with factors such as demographics, health service utilization, and MG deployment. RESULTS Among 960 PAP personnel,83% of PAP personnel participated in MG in the past month, and 23.1% of PAP personnel suffered stress. The chi-square test showed that there were significant differences in MG'cycle time (p < 0.05). The binary logistic regression results showed that satisfaction with medical skills (p = 0.008), satisfaction with health environment (p = 0.031), satisfaction with medicine (OR = 0.640, 95%CI:0.436,0.938), and seeking health services (OR = 5.36, 95%CI:2.316,12.402) were associated with stress exposure status. However, age, and length of military service did not have any association with the stress exposure status of PAP personnel in this study. CONCLUSION This study demonstrated that stress exposure status among PAP personnel was associated with MG deployment, and health service utilization. These findings can help policy-makers and clinicians to relieve the stress of the armed police personnel, as well as provide a basis for developing military health service security plans.
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Affiliation(s)
- Nan Li
- College of Management and Economics, Tianjin University, Tianjin, China
| | - Yongzhong Zhang
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
| | - Shike Hou
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
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Sammito S, Hadzic V, Karakolis T, Kelly KR, Proctor SP, Stepens A, White G, Zimmermann WO. Risk factors for musculoskeletal injuries in the military: a qualitative systematic review of the literature from the past two decades and a new prioritizing injury model. Mil Med Res 2021; 8:66. [PMID: 34886915 PMCID: PMC8662851 DOI: 10.1186/s40779-021-00357-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 11/12/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Musculoskeletal injuries (MSkIs) are a leading cause of health care utilization, as well as limited duty and disability in the US military and other armed forces. MSkIs affect members of the military during initial training, operational training, and deployment and have a direct negative impact on overall troop readiness. Currently, a systematic overview of all risk factors for MSkIs in the military is not available. METHODS A systematic literature search was carried out using the PubMed, Ovid/Medline, and Web of Science databases from January 1, 2000 to September 10, 2019. Additionally, a reference list scan was performed (using the "snowball method"). Thereafter, an international, multidisciplinary expert panel scored the level of evidence per risk factor, and a classification of modifiable/non-modifiable was made. RESULTS In total, 176 original papers and 3 meta-analyses were included in the review. A list of 57 reported potential risk factors was formed. For 21 risk factors, the level of evidence was considered moderate or strong. Based on this literature review and an in-depth analysis, the expert panel developed a model to display the most relevant risk factors identified, introducing the idea of the "order of importance" and including concepts that are modifiable/non-modifiable, as well as extrinsic/intrinsic risk factors. CONCLUSIONS This is the qualitative systematic review of studies on risk factors for MSkIs in the military that has attempted to be all-inclusive. A total of 57 different potential risk factors were identified, and a new, prioritizing injury model was developed. This model may help us to understand risk factors that can be addressed, and in which order they should be prioritized when planning intervention strategies within military groups.
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Affiliation(s)
- Stefan Sammito
- Section Experimental Aerospace Medicine Research, German Air Force Centre of Aerospace Medicine, Flughafenstraße 1, 51147 Cologne, Germany
- Occupational Medicine, Faculty of Medicine, Otto-Von-Guericke-University of Magdeburg, 39120 Magdeburg, Germany
| | - Vedran Hadzic
- Faculty of Sport, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Thomas Karakolis
- Defence Research and Development Canada, Toronto, ON M3K 2C9 Canada
| | - Karen R. Kelly
- Warfighter Performance, Naval Health Research Center, San Diego, CA 92106-3599 USA
| | - Susan P. Proctor
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA 01760 USA
- Research Service, VA Boston Healthcare System, Boston, MA 02130 USA
| | - Ainars Stepens
- Centre for Military Medicine Research, Riga Stradins University, Riga, 1007 Latvia
| | - Graham White
- Human and Social Sciences Group, Defense Science and Technology Laboratory, Portsdown Hill Road, Fareham, PO17 6AD UK
| | - Wes O. Zimmermann
- Department of Military Sports Medicine, Royal Netherlands Army, 3584 AB Utrecht, The Netherlands
- Department of Military/Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814 USA
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Barbeau P, Michaud A, Hamel C, Rice D, Skidmore B, Hutton B, Garritty C, da Silva DF, Semeniuk K, Adamo KB. Musculoskeletal Injuries Among Females in the Military: A Scoping Review. Mil Med 2021; 186:e903-e931. [PMID: 33367692 DOI: 10.1093/milmed/usaa555] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/04/2020] [Accepted: 12/10/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Musculoskeletal injuries (MSKi) are a common challenge for those in military careers. Compared to their male peers, reports indicate that female military members and recruits are at greater risk of suffering MSKi during training and deployment. The objectives of this study were to identify the types and causes of MSKi among female military personnel and to explore the various risk factors associated with MSKi. MATERIALS AND METHODS A scoping review was conducted over a 4-month time frame of English language, peer-reviewed studies published from 1946 to 2019. Search strategies for major biomedical databases (e.g., MEDLINE; Embase Classic + Embase; and the following EBM Reviews-Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Health Technology Assessment, and the NHS Economic Evaluation Database) were developed by a senior medical information specialist and included 2,891 titles/abstracts. Study selection and data collection were designed according to the Population, Concept, and Context framework. Studies were included if the study population provided stratified data for females in a military context. RESULTS From a total of 2,287 citations captured from the literature searches, 168 peer-reviewed publications (144 unique studies) were eligible for inclusion. Studies were identified from across 10 countries and published between 1977 and 2019. Study designs were primarily prospective and retrospective cohorts. Most studies assessed both prevalence/incidence and risk factors for MSKi (62.50%), with few studies assessing cause (13.69%). For MSKi of female recruits compared to active female members, the prevalence was higher (19.7%-58.3% vs. 5.5%-56.6%), but the incidence (0.02%-57.7% vs. 13.5%-71.9%) was lower. The incidence of stress fractures was found to be much higher in female recruits than in active members (1.6%-23.9% vs. 2.7%). For anthropometric risk factors, increased body fat was a predictor of MSKi, but not stress fractures. For physiological risk factors for both female military groups, being less physically fit, later menarche, and having no/irregular menses were predictors of MSKi and stress fractures. For biomechanical risk factors, among female recruits, longer tibial length and femoral neck diameter increased the risk of stress fractures, and low foot arch increased risk of an ankle sprain. For female active military members, differences in shoulder rotation and bone strength were associated with risk of MSKi. For biological sex, being female compared to male was associated with an increased risk of MSKi, stress fractures, and general injuries. The consequences of experiencing MSKi for active military included limited duties, time off, and discharge. For recruits, these included missed training days, limited duty days, and release. CONCLUSIONS This scoping review provides insight into the current state of the evidence regarding the types and causes of MSKi, as well as the factors that influence MSKi among females in the military. Future research endeavors should focus on randomized controlled trials examining training paradigms to see if women are more susceptible. The data presented in the scoping review could potentially be used to develop training strategies to mitigate some of the identified barriers that negatively impact women from pursuing careers in the military.
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Affiliation(s)
- Pauline Barbeau
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Alan Michaud
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Candyce Hamel
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Danielle Rice
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Becky Skidmore
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Brian Hutton
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Chantelle Garritty
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Danilo F da Silva
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Kevin Semeniuk
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Kristi B Adamo
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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Rhon DI, Molloy JM, Monnier A, Hando BR, Newman PM. Much work remains to reach consensus on musculoskeletal injury risk in military service members: A systematic review with meta-analysis. Eur J Sport Sci 2021; 22:16-34. [PMID: 33993835 DOI: 10.1080/17461391.2021.1931464] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Musculoskeletal injuries are the most common reason military service members cannot perform their military duties. Not only are they costly and associated with long-term disability, often long after completion of military service, but injuries also adversely affect the military readiness of a nation. This can be seen as a threat to national security and part of the impetus behind many efforts to better understand, predict, and mitigate injury risk in the military. A systematic review of the literature published between 1995 and October 31, 2020 was conducted to identify significant risk factors of musculoskeletal injury in military populations across the world. 74 out of 170 eligible studies addressed comprehensive injuries, providing 994 unique risk factors. 46 of these studies provided data that could be included in a meta-analysis, which was possible for 15 predictor variables. Seven predictors were significant in meta-analysis: female sex(RR=1.46;95CI 1.30,1.64), high body mass index(RR=1.36;95CI 1.21,1.53), functional movement screen pain (RR=1.70;95CI 1.55,1.87) or scores ≤ 14(RR=1.42 95CI 1.29,1.56), prior injury(RR=1.54;95CI 1.32,1.80), slower running performance(RR=1.33;95CI 1.18,1.51), and poorer push-up performance(RR=1.15;95CI 1.04,1.27). Low BMI, height, weight, smoking, physical activity scores, and sit-up and jump performance were not significant risk factors in the meta-analysis. Most studies had a high risk of bias. Lack of raw data and large heterogeneity in definitions of predictors and injury outcomes limited comparison across many studies.Highlights Female sex, high body mass index, pain with functional movement screen or a score of ≤ 14, prior injury, slower running performance and poorer push-up performance were all significant predictors of musculoskeletal injury.Low body mass index, height, weight, smoking, physical activity scores, and sit-up and jump performance were not significant predictors of musculoskeletal injury.Many other predictors were present only in single studies, but large heterogeneity in definitions of both outcomes and predictors limited comparison across studies.Overall, studies assessing risk factors to predict musculoskeletal injuries in the military were at high risk for bias, especially in regards to statistical approaches.
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Affiliation(s)
- Daniel I Rhon
- Military Performance Division, United States Army Research Institute of Environmental Medicine (USARIEM), Natick, MA, USA.,Department of Rehab Medicine, Uniformed Services University of Health Sciences, Bethesda, MD, USA
| | - Joseph M Molloy
- Physical Performance Service Line, G 3/5/7, U.S. Army Office of the Surgeon General, Falls Church, VA, USA
| | - Andreas Monnier
- Military Academy Karlberg, Swedish Armed Forces, Solna, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Ben R Hando
- Human Performance Support Group, U.S. Air Force Special Warfare Training Wing, Joint Base San Antonio-Lackland, San Antonio, TX, USA
| | - Phillip M Newman
- University of Canberra, Research Institute for Sport and Exercise, Canberra, Australia
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Risk factors for musculoskeletal injuries in military personnel: a systematic review with meta-analysis. Int Arch Occup Environ Health 2021; 94:1173-1189. [PMID: 33987772 DOI: 10.1007/s00420-021-01700-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/25/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate the risk factors for musculoskeletal injuries in military personnel. METHODS A systematic literature search was carried out in August 2019 and updated in July 2020 without language or time filters. The inclusion criteria were prospective studies that investigated the risk factors for injuries in military personnel. Only risk factors analyzed by at least ten studies were selected for the meta-analysis. For data analysis, the RevMan5.3 program was used to compare the number of participants with injuries between high- or low-risk groups. The measurement of dichotomous variables was one of the selected parameters for the analysis, as well as the Mantel-Haenszel statistical method, random-effects model, and analysis with a relative risk (RR) and 95% confidence interval for the included studies. RESULTS A total of 2,629 studies were identified through databases. Thirty-four studies met the inclusion criteria. The groups considered at risk were the oldest [RR = 1.22; (95% CI 1.06-1.41)], with overweight or obesity [RR = 1.27; (95% CI 1.08-1, 48)], with previous injuries [RR = 1.15; (95% CI 1.01-1.30)], and with the worst performance in running tests of 1,600-3,200 m [RR = 1.87; (95% CI 1.28-2.71)]. Gender, ethnicity, and smoking were not associated with injuries. However, a subgroup analysis showed that among studies with a follow-up of fewer than 12 months, women presented RR = 2.44 (95% CI 1.65-3.60) more likely to develop injuries. CONCLUSION Age, overweight or obesity, previous injuries, and performance in the 1600-3200 m run are associated with an increased risk of injury in the military.
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10
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Markers of Bone Health and Impact of Whey Protein Supplementation in Army Initial Entry Training Soldiers: A Double-Blind Placebo-Controlled Study. Nutrients 2020; 12:nu12082225. [PMID: 32722609 PMCID: PMC7468883 DOI: 10.3390/nu12082225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 12/13/2022] Open
Abstract
Training civilians to be soldiers is a challenging task often resulting in musculoskeletal injuries, especially bone stress injuries. This study evaluated bone health biomarkers (P1NP/CTX) and whey protein or carbohydrate supplementations before and after Army initial entry training (IET). Ninety male IET soldiers participated in this placebo-controlled, double-blind study assessing carbohydrate and whey protein supplementations. Age and fat mass predicted bone formation when controlling for ethnicity, explaining 44% (p < 0.01) of bone formation variations. Age was the only significant predictor of bone resorption (p = 0.02) when controlling for run, fat, and ethnicity, and these factors together explained 32% of the variance in bone resorption during week one (p < 0.01). Vitamin D increased across training (p < 0.01). There was no group by time interaction for supplementation and bone formation (p = 0.75), resorption (p = 0.73), Vitamin D (p = 0.36), or calcium (p = 0.64), indicating no influence of a supplementation on bone biomarkers across training. Age, fitness, fat mass, and ethnicity were important predictors of bone metabolism. The bone resorption/formation ratio suggests IET soldiers are at risk of stress injuries. Male IET soldiers are mildly to moderately deficient in vitamin D and slightly deficient in calcium throughout training. Whey protein or carbohydrate supplementations did not affect the markers of bone metabolism.
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Monnier A, Larsson H, Nero H, Djupsjöbacka M, Äng BO. A longitudinal observational study of back pain incidence, risk factors and occupational physical activity in Swedish marine trainees. BMJ Open 2019; 9:e025150. [PMID: 31092646 PMCID: PMC6530317 DOI: 10.1136/bmjopen-2018-025150] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To evaluate the occurrence of low back pain (LBP) and LBP that limits work ability, to identify their potential early risks and to quantify occupational physical activity in Swedish Armed Forces (SwAF) marines during their basic 4 month marine training course. DESIGN Prospective observational cohort study with weekly follow-ups. PARTICIPANTS Fifty-three SwAF marines entering the training course. OUTCOMES Incident of LBP and its related effect on work-ability and associated early risks. Occupational physical activity, as monitored using accelerometers and self-reports. RESULTS During the training course, 68% of the marines experienced at least one episode of LBP. This yielded a LBP and LBP limiting work ability incidence rate of 13.5 (95% CI 10.4 to 17.8) and 6.3 (95% CI 4.2 to 10.0) episodes per 1000 person-days, respectively. Previous back pain and shorter body height (≤1.80 m) emerged as independent risks for LBP (HR 2.5, 95% CI 1.4 to 4.3; HR 2.0, 95% CI 1.2 to 3.3, respectively), as well as for LBP that limited work ability (HR 3.6, 95% CI 1.4 to 8.9; HR 4.5, 95% CI 2.0 to 10.0, respectively). Furthermore, managing fewer than four pull-ups emerged as a risk for LBP (HR 1.9, 95% CI 1.2 to 3.0), while physical training of fewer than three sessions per week emerged as a risk for LBP that limited work ability (HR 3.0, 95% CI 1.2 to 7.4). More than 80% of the work time measured was spent performing low levels of ambulation, however, combat equipment (≥17.5 kg) was carried for more than half of the work time. CONCLUSIONS Incidents of LBP are common in SwAF marines' early careers. The link between LBP and previous pain as well as low levels of exercise highlights the need for preventive actions early on in a marine's career. The role of body height on LBP needs further investigation, including its relationship with body-worn equipment, before it can effectively contribute to LBP prevention.
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Affiliation(s)
- Andreas Monnier
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
- Swedish Armed Forces, Military Academy Karlberg, Stockholm, Sweden
| | - Helena Larsson
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Swedish Armed Forces, Headquarters, Medical Services, Stockholm, Sweden
| | - Håkan Nero
- Department of Orthopedics, Faculty of Medicine, Lund University, Lund, Sweden
| | - Mats Djupsjöbacka
- Centre for Musculoskeletal Research, Department of Occupational Health Science and Psychology, University of Gävle, Gävle, Sweden
| | - Björn O Äng
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
- Center for Clinical Research, Uppsala University, Falun, Sweden
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Müller-Schilling L, Gundlach N, Böckelmann I, Sammito S. Physical fitness as a risk factor for injuries and excessive stress symptoms during basic military training. Int Arch Occup Environ Health 2019; 92:837-841. [PMID: 30895369 DOI: 10.1007/s00420-019-01423-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 03/12/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of basic military training (BMT) is to enable the recruited soldiers to acquire basic military skills and develop the required physical fitness. This training is accompanied by heightened physical stress and the risk of injury and excessive stress symptoms (I&ESS). The objective of this study was to examine the extent to which the level of physical fitness at the beginning of BMT affects the incidence of I&ESS and resultant absence from duty. METHODS The data of a total of 774 subjects (age 20.5 ± 2.2) from 8 subsequent BMT quarters were analysed. The medical diagnoses made during the consulting hours of the unit physicians were reviewed for I&ESS and the kinds of injuries incurred and the sick leave pronounced were documented. The level of physical fitness per quarter was then categorised by means of the total numbers of points achieved during the standard basic fitness test (BFT). This categorisation was finally used as a basis for an analysis of the lost days in relation to the level of physical fitness. RESULTS 255 of the 774 subjects (32.9%) suffered an I&ESS. 60% of all the I&ESS were located at lower extremity. There was a significant increase in the length of absence from duty among the group with the lowest level of physical fitness. CONCLUSIONS The analysis revealed that the level of physical fitness at the beginning of BMT has a significant influence on the length of absence from duty due to I&ESS. Moreover, 60% of the injuries were lower extremity injuries, which show the specific significance they have for limitations during BMT. Overall, this reveals the necessity for appropriate preventive measures (additional fitness training, adjustment of requirements) to be implemented so that recruits with a low level of fitness can complete BMT with as few injuries as possible.
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Affiliation(s)
- Lisa Müller-Schilling
- Department I Internal Medicine, Bundeswehr Hospital Berlin, Berlin, Germany.,Department of Occupational Medicine, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Nils Gundlach
- Medical Clinic Rotenburg (Wümme), Rotenburg (Wümme), Germany
| | - Irina Böckelmann
- Department of Occupational Medicine, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Stefan Sammito
- Department of Occupational Medicine, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany. .,Bundeswehr Medical Service Headquarters, Section VI 3.3 Occupational Health Management System, Sports and Nutrition Medicine, Von-Kuhl-Straße 50, 56070, Koblenz, Germany.
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Bedno SA, Nelson DA, Kurina LM, Choi YS. Gender differences in the associations of body mass index, physical fitness and tobacco use with lower extremity musculoskeletal injuries among new US Army soldiers. Inj Prev 2018; 25:295-300. [PMID: 29572263 DOI: 10.1136/injuryprev-2017-042669] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 02/27/2018] [Accepted: 03/03/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Musculoskeletal (MSK) injuries are a leading cause of morbidity among US Army soldiers, especially among women and the newly enlisted. While extremes of body mass index (BMI), low physical fitness and tobacco use have been identified as risk factors, no prior studies have determined the combined effects of these risk factors or tested for gender differences in the associations. METHODS We conducted a retrospective cohort study utilising the Stanford Military Data Repository to study all enlisted soldier accessions to the US Army between January 2011 and January 2014, with follow-up through December 2014 (n=238 772). We used discrete-time logistic regression to test for associations between demographic, socioeconomic and health behaviour-related predictors and incident lower extremity injuries. We included interaction terms to test for gender differences. RESULTS Among men, there were greater adjusted odds of injury among underweight (OR 1.27), overweight (OR 1.14) and obese soldiers (OR 1.54) (all p<0.001) relative to normal-weight soldiers. No statistically significant differences in the odds of injury on the basis of BMI were observed for female soldiers. Physical fitness was a significantly stronger predictor of injury for female as compared with male soldiers, while the association between tobacco use and injury was stronger for men (OR 1.47) than for women (OR 1.30) (p<0.001 for both). CONCLUSION This is the largest known study to simultaneously assess important, modifiable musculoskeletal injury risk factors and to test for gender differences in these associations. These findings provide critical gender-related nuances for clinicians and leaders seeking to reduce the risk of these problems.
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Affiliation(s)
- Sheryl A Bedno
- Department of Preventive Medicine, Womack Army Medical Center, Fort Bragg, North Carolina, USA
| | - D Alan Nelson
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Lianne M Kurina
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Y Sammy Choi
- Departments of Medicine and Pediatrics, Womack Army Medical Center, Fort Bragg, North Carolina, USA
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BEDNO SHERYLA, JACKSON RHONDA, FENG XIAOSHU, WALTON IMANIL, BOIVIN MICHAELR, COWAN DAVIDN. Meta-analysis of Cigarette Smoking and Musculoskeletal Injuries in Military Training. Med Sci Sports Exerc 2017; 49:2191-2197. [DOI: 10.1249/mss.0000000000001349] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Psaila M, Ranson C. Risk factors for lower leg, ankle and foot injuries during basic military training in the Maltese Armed Forces. Phys Ther Sport 2016; 24:7-12. [PMID: 28038317 DOI: 10.1016/j.ptsp.2016.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 07/29/2016] [Accepted: 09/05/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Basic military training is physically and psychologically demanding placing recruits at high risk of injury and premature discharge. This study aimed to identify risk factors for lower leg, ankle and foot injury in Maltese military recruits during basic training. DESIGN This was a prospective cohort study. SETTING An armed forces barracks. PARTICIPANTS 127 recruits commencing one basic military training course agreed to participate in the study. The cohort comprised 114 males and 13 females with a mean age of 21.7 ± 2.4 years. MAIN OUTCOME MEASURES All injuries to the lower leg, ankle and foot were recorded using the Orchard Sports Injury Classification System. Injuries were analysed for associations with fitness scores, smoking status, body mass index and foot type. RESULTS A total of 34 (26.2%) recruits sustained at least one injury, with 10 recruits (7.9%) terminating their training prematurely (three due to musculoskeletal injury). Smoking history, body mass index and foot type were not associated with injury risk. Lower fitness levels at the commencement of basic military training compared with fitness levels measured six months prior, were associated with higher injury risk. CONCLUSIONS Lower fitness at the commencement of basic training was associated with higher injury risk in army recruits. Thus, conditioning programmes aimed at improving recruit fitness should be considered within an injury prevention strategy.
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Affiliation(s)
- Matthew Psaila
- Armed Forces of Malta, Medical Centre, Luqa Barracks, Malta.
| | - Craig Ranson
- Sports Injury Research Group, Cardiff School of Sport, Cardiff Metropolitan University, UK
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Robinson M, Siddall A, Bilzon J, Thompson D, Greeves J, Izard R, Stokes K. Low fitness, low body mass and prior injury predict injury risk during military recruit training: a prospective cohort study in the British Army. BMJ Open Sport Exerc Med 2016; 2:e000100. [PMID: 27900170 PMCID: PMC5117064 DOI: 10.1136/bmjsem-2015-000100] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2016] [Indexed: 11/18/2022] Open
Abstract
Background Injuries sustained by military recruits during initial training impede training progression and military readiness while increasing financial costs. This study investigated training-related injuries and injury risk factors among British Army infantry recruits. Methods Recruits starting infantry training at the British Army Infantry Training Centre between September 2008 and March 2010 were eligible to take part. Information regarding lifestyle behaviours and injury history was collected using the Military Pre-training Questionnaire. Sociodemographic, anthropometric, physical fitness and injury (lower limb and lower back) data were obtained from Army databases. Univariable and multivariable Cox regression models were used to explore the association between time to first training injury and potential risk factors. Results 58% (95% CI 55% to 60%) of 1810 recruits sustained at least 1 injury during training. Overuse injuries were more common than traumatic injuries (65% and 35%, respectively). The lower leg accounted for 81% of all injuries, and non-specific soft tissue damage was the leading diagnosis (55% of all injuries). Injuries resulted in 122 (118 to 126) training days lost per 1000 person-days. Slower 2.4 km run time, low body mass, past injury and shin pain were independently associated with higher risk of any injury. Conclusions There was a high incidence of overuse injuries in British Army recruits undertaking infantry training. Recruits with lower pretraining fitness levels, low body mass and past injuries were at higher risk. Faster 2.4 km run time performance and minimal body mass standards should be considered for physical entry criteria.
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Affiliation(s)
- Mark Robinson
- Public Health Science Directorate, NHS Health Scotland, Glasgow, UK; Department for Health, University of Bath, Bath, UK
| | | | - James Bilzon
- Department for Health , University of Bath , Bath , UK
| | | | - Julie Greeves
- Department of Occupational Medicine, Headquarters Army Recruiting and Training Division, Upavon , UK
| | - Rachel Izard
- Department of Occupational Medicine, Headquarters Army Recruiting and Training Division, Upavon , UK
| | - Keith Stokes
- Department for Health , University of Bath , Bath , UK
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