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This uncontrolled observational study examined the injury and medical discharge outcomes in 318 female and 1,634 male recruits as a result of changes to the Australian Army recruit physical training program. Changes included cessation of road runs, introduction of 400- to 800-m interval training, reduction in test run distance from 5 to 2.4 km, standardization of route marches, and the introduction of deep-water running. There was a 46.6% reduction in the rate of total injury presentation (chi^sup 2^ = 14.31, p = 0.0002) after the change. The annual rate of male medical discharges decreased 40.8% from 81.1/ 1,000 recruits in 1994/1995 to 47.0/1,000 recruits in 1995/ 1996 (chi^sup 2^ = 26.33, p = 0.0001). Female rates increased 58.3% from 104/1,000 recruits to 164.2/1,000 recruits (chi^sup 2^ = 6.09, p = 0.014). The decrease in the male medical discharge rate resulted in an estimated saving of $1,267,805 Australian. Bone scans were reduced by 50%, resulting in an estimated annual saving of $61,539 Australian. The disparity between male and female injury rates is a concern. The merits of mixed-gender physical training should be reviewed in the light of these observations, and the establishment of initial entry fitness standards for recruit training may need to be considered.

Introduction

High rates of injury have been reported in recruits from a number of different western armies. Reported injury rates were 27.4% in male and 44.6% in female U.S. Army recruits,1 31% in male South African recruits,2 33.5% in male British Marines,3 and 47.2% and 37.9% in two groups of male Australian recruits.4 Most of these injuries were ascribed to physical training.

Women have been noted to have higher morbidity during U.S. Army recruit training. The incidence of stress fracture is higher,5 and the rate of sick call visits for injury in female recruits was found to be twice that of male recruits.6 Limited duty rates for injury were 16 days/100 recruits/month in males and 77 days/100 recruits/month in females. However, several well-- designed studies of injury in civilian runners have shown no differences in the rates of injury between men and women.7-9 There would appear to be a disproportionate rate and impact of injury in female U.S. Army recruits.

Most researchers have sought to identify risk factors for injury. Jones et al.1 identified a number of risk factors, including low levels of past activity, low levels of physical fitness, previous history of injury, high running mileage, smoking, and age. Most of these risk factors are intrinsic in nature and could be controlled only by a process of exclusion at the enlistment stage. This would be difficult to justify without high relative risk values and would also reduce the available pool of potential recruits. Running distance has been consistently identified as a major risk for injury in civilian runners8,10 and recently in military recruits.1,4

As a result of previous research findings,1,4 the Commandant of the 1st Recruit Training Battalion (IRTB) directed that the physical training program be completely revised in the belief that reduced injury rates would result. These changes were developed and implemented within 8 weeks. This paper presents a retrospective review of the outcomes of these changes, specifically, the effect on male and female injury and medical discharge rates.

Methods

Study Design

This was a retrospective, uncontrolled observational study comparing the rates of injury and medical discharge before the change in the standard Australian Army physical training (PT) program with the rates after the change.

Platoons that entered the 1st Recruit Training Battalion during financial year 1995/1996 were divided into three groups. The platoons that arrived during the 3-month period from July to September 1995 (N = 708) represented group 1, or the prechange sample. Group 2 (October 1, 1995, to January 17, 1996 [N = 667]) entered training when the two physical training programs were in concurrent use. Group 3 (January 24, 1996, to May 6, 1996 [N = 579]) commenced training when the new program was universal. It was assumed that the 3-month period before the change was representative of the preexisting training cycle.

This analytical approach was adopted because of a perceived staff need to adapt to the new physical training regimen. Because of the concurrent physical training systems in place, it was felt that there may have been some "lapses" into old ways during the group 2 training.

Calculation of Injury Rates and Data

Presentations to the physiotherapy department were used to calculate injury rates. All recruits were initially assessed by a single medical officer, and any injury requiring sick leave, hospitalization, or 3 days of restricted duty was automatically referred for physiotherapy. The only exception to this was recruits with undisclosed preexisting injuries, who were rapidly discharged for failure to disclose.

All physiotherapy attendance records were reviewed, and individuals were identified by their date of arrival (or group). Although the true incidence of injury was likely to have been higher, the use of physiotherapy attendance was considered representative of more severe injury, because any injury requiring only 3 days of restriction is likely to have been minor.

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