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from Health and Whatnot by Marcus M. McGrew

Copyright © 2019–2021 Marcus Montell McGrew

Army fit?

The Army Surgeon General is focused on transitioning Army Medicine from a healthcare system to a system for health. At the heart of this transformation is the Army’s Performance Triad (P3) initiative. The P3 is a Total Army Family initiative to improve performance, health, and readiness. P3 is a holistic health and fitness program that supports the Human Dimension, the Ready and Resilient Campaign, and helps address the Army Warfighting Challenges. P3 improves unit productivity and readiness through optimizing Soldier performance in the realms of physical, emotional, and cognitive dominance through leveraging the leading evidence in sleep, physical activity, and nutrition.

What are the main challenges to personal health readiness?

Poor sleep, activity, and nutrition behaviors are associated with the top challenges to readiness. These include: 1) medically non-deployable Soldiers, 2) first term attrition, 3) obesity and nutrition, 4) musculoskeletal injury (MSKI), and 5) fatigue.

How does personal health readiness impact Army readiness?43K active duty Soldiers (~12 BCTs combat power) are non-deployable due to profiles.20K (36%) of Soldiers do not complete their first term of enlistment.78K active duty Soldiers are considered clinically obese (Body Mass Index > 30) and are 36-86% less likely to be medically ready to deploy.1 in 20 active duty Soldiers annually fail the APFT; they are 279% less likely to be medically ready to deploy.180K active duty Soldiers have at least one MSKI per year; resulting in over 10 million limited duty days. MSKI account for 76% of the medical non-deployable population. Soldiers with MSKI are 81-348% less likely to be medically ready to deploy; based on number of MSKI.Under seven hours of sleep for more than three days correlates to a 20% decrease in cognitive ability (memory and decision-making). 1 in 20 active duty Soldiers are prescribed sleep medications, these Soldiers are 16% less likely to be medically ready to deploy. Fatigue is a leading cause of near misses, accidents, and 25% of all motor vehicle accidents.How is personal health readiness related to sleep, physical activity, and nutrition?Despite the strong evidence that links appropriate sleep, activity, and nutrition to personal readiness; Soldiers are not leveraging these simple behaviors to optimize their performance.In a survey of 176K Soldiers, 55.2%, 34.2% and 57.5% had such poor behaviors in the areas of sleep, physical activity, and nutrition that they were considered high risk (i.e., red) for readiness problems; while only 15.0%, 38.1%, and 13.1% were following optimal practices and were considered green.Among high risk Soldiers with low emotional fitness, 90% get poor sleep, 51% have poor physical activity habits, and 83% do not follow dietary standards or fuel for performance.What are the recurring costs to the Army that may be reduced by implementation of P3?$3B annually in salary costs for Soldiers who cannot deploy.$1B annually to replace Soldiers that fail to complete their first term of enlistment.$137M to replace the 1,800 Soldiers discharged in FY13 due to failure to maintain body composition standards per AR 600-9.$350M annually in salary costs for the 41% of Soldiers discharged for MSKI.$40M in loss personnel/equipment costs from 146 Ground Class A accidents in FY14.$5M in costs for lost duty days from injuries and accidents associated with fatigue.What are the associated medical costs that may be reduced by implementation of P3?$1.1B spent annually by MHS to treat medical conditions associated with obesity.$443M spent annually in physical therapy costs for Soldier related injuries.$47M spent annually on top five medications prescribed for sleep disorders.What are some of the FY14 Pilot results suggestive of P3 effectiveness?The FY14 pilot goals were to develop and test the P3 curriculum and delivery mechanisms, rather than change readiness indicators; initial measures of effectiveness are encouraging.Soldiers’ viewed their first line supervisor as more competent in coaching, mentoring, and teaching at the end of the pilot.Overall, 26 to 40% of the Soldiers improved on each of the seven P3 target behaviors.Overall, the average number of hours of sleep increased to seven hours on weekends with 13% more Soldiers meeting the sleep targets on the weekends after the pilot program.Refueling after exercise and fish consumption statistically increased during the pilot.

Changes observed in the “most improved” group included:

An increase in 2.1 hours of sleep/night during week and an increase of 1.4 hours of sleep/night during weekendAn increase of 4,550 steps/day, an increase of 400 minutes of moderate/vigorous activity/week, and an increase of 2.6 days of resistance training/week.Improved fruits/vegetables consumption by two points on a 1-5 Likert Scale, and an improved refueling after exercise by 1.5 on the Likert Scale.Lessons learned from the FY14 pilot have been applied to improve curriculum, the reach, adoption, implementation, and maintenance of the P3 program and will be tested in the FY15 pilot program.What is the potential Return on Investment (ROI) from implementation of P3?Although the P3 is a developing program, published evidence endorsed by the U.S. National Prevention Strategy suggests the ROI for every dollar spent could reduce limited and lost duty costs by $2.73 and medical costs by $3.27.Based on the selected costs provided, a reduction of only 1% would result in a combination of cost savings/avoidance to the Army of $62M per year.Investing in Soldiers through the P3 enables the Army to reach its vision set by the Army Warfighting Challenges, the Human Dimension, and the Ready and Resilient Campaign. This requires an Army culture in which being a member of the Profession of Arms requires Soldiers to view themselves as Professional Soldier Athletes with the physical, emotional, and cognitive dominance required to achieve squad overmatch. The tenets of proper sleep, physical activity, and nutrition are the building blocks that enable the improvements in Soldier, leader, and team performance required for F2025B.

Based on existing evidence of public health initiatives, any single intervention is likely to have only a small impact on creating and sustaining the behavioral changes required to both optimize human performance and enhance personal readiness. A comprehensive strategy that includes a range of interventions, that can be delivered to scale, will be required to make the health choice the easy and desired choice.

“Readiness is #1, an...

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