Background Specialized training for elite US military units is associated with high attrition due to intense psychological and physical demands. The need to graduate more service members without degrading performance standards necessitates the identification of factors to predict success or failure in targeted training interventions. Objective The aim of this study was to continuously quantify the mental and physical status of trainees of an elite military unit to identify novel predictors of success in training. Methods A total of 3 consecutive classes of a specialized training course were provided with an Apple iPhone, Watch, and specially designed mobile app. Baseline personality assessments and continuous daily measures of mental status, physical pain, heart rate, activity, sleep, hydration, and nutrition were collected from the app and Watch data. Results A total of 115 trainees enrolled and completed the study (100% male; age: mean 22 years, SD 4 years) and 64 (55.7%) successfully graduated. Most training withdrawals (27/115, 23.5%) occurred by day 7 (mean 5.5 days, SD 3.4 days; range 1-22 days). Extraversion, positive affect personality traits, and daily psychological profiles were associated with course completion; key psychological factors could predict withdrawals 1-2 days in advance (P=.009). Conclusions Gathering accurate and continuous mental and physical status data during elite military training is possible with early predictors of withdrawal providing an opportunity for intervention.

BACKGROUND Specialized training for elite US military units is associated with high attrition due to intense psychological and physical demands. The need to graduate more service members without degrading performance standards necessitates the identification of factors to predict success or failure in targeted training interventions. OBJECTIVE The aim of this study was to continuously quantify the mental and physical status of trainees of an elite military unit to identify novel predictors of success in training. METHODS A total of 3 consecutive classes of a specialized training course were provided with an Apple iPhone, Watch, and specially designed mobile app. Baseline personality assessments and continuous daily measures of mental status, physical pain, heart rate, activity, sleep, hydration, and nutrition were collected from the app and Watch data. RESULTS A total of 115 trainees enrolled and completed the study (100% male; age: mean 22 years, SD 4 years) and 64 (55.7%) successfully graduated. Most training withdrawals (27/115, 23.5%) occurred by day 7 (mean 5.5 days, SD 3.4 days; range 1-22 days). Extraversion, positive affect personality traits, and daily psychological profiles were associated with course completion; key psychological factors could predict withdrawals 1-2 days in advance (<i>P</i>=.009). CONCLUSIONS Gathering accurate and continuous mental and physical status data during elite military training is possible with early predictors of withdrawal providing an opportunity for intervention.