Introduction Musculoskeletal injuries (MSIs) have direct impact on occupational readiness and task performance in military populations. Until this date, no epidemiologic data have been published concerning MSI incidence in the Netherlands Armed Forces (NAF). The aim of this study was to assess the MSI incidence and related costs in the NAF. Methods In this descriptive epidemiologic study, we collected injury surveillance data from the electronic patient records of multiple military units of the NAF. Using data of all new consultations with a military physician from January 1, 2014 to December 31, 2016, we calculated MSI incidence rates per 100 person-years, with a 95% confidence interval (CI). Physician care costs were determined based on the number of physician consults and the charge per appointment. We used two methods to determine productivity costs; the top-down microcosting method and the friction cost method. Results Our study sample included 22% (n = 8,847) of the total NAF population of 2016 (n =40,178). In this sample, consultations of MSIs accounted for 23.2% (n = 7,815) of all new consultations (n = 33,666). MSI incidence rates per unit ranged from 12.5 to53.3 per 100 person-years. In the total sample, MSI incidence rates were highest in the back (6.73, 95% CI 6.39–7.10), knee (5.04, 95% CI 4.74–5.35), and foot (4.79, 95% CI 4.50–5.10). The estimated costs for physician visits for MSIs in our sample were €0.69 million. Limited duty days accounted for €1.10 million productivity costs using top-down microcosting method. Conclusion Our study provided evidence that MSIs result in substantial financial burden. Injuries of the back, knee, and foot account for the majority of demands on curative care for MSIs.

IntroductionMusculoskeletal injuries (MSIs) are among the main causes of dropout from military training. The main purpose of this study was to provide an overview of dropout rates and MSI incidence rates during elite military training. Second, this study aimed to explore restricted training days due to MSIs and to describe MSI-care by military physicians.MethodsIn a retrospective observational study, we collected dropout rates and injury surveillance data from the electronic patient records of two elite units of the Netherlands Armed Forces (NAF): the Royal Netherlands Marine Corps (RNLMC) and the Airmobile Brigade (AMB), from 1 January 2015 until 31 December 2017.ResultsIn the RNLMC, total dropout rate was 53.9% and dropout due to MSIs was 23%. The most frequently affected locations were foot, knee and leg. In the AMB total dropout rate was 52.6% and dropout due to MSIs was 25%. In the AMB, the most frequently affected locations were back, knee and leg. Average restricted training days due to MSIs ranged between 8.3 and 20.8 days/injury. MSI-care by military physicians consisted mostly of the provision of injury-specific information and (self-)management options, imposing a specific activity restriction and referral to physiotherapy.ConclusionOur study findings showed that one out of four recruits who dropout from elite military training in the NAF, do so due to MSIs. Redesigning training programmes with the objective to reduce MSIs should be given high priority, as this may reduce dropout substantially.

N ew research is continuously emerging on COVID-19 and its variants. As it turns out, several new studies have also recently been published regarding the ramifications of COVID-19 on physical activity (PA) and sedentariness. A longitudinal study by Yang and Koenigstorfer (1), published in the Translational Behavioral Medicine journal, explored changes in PA before and during the COVID-19 pandemic; the authors were particularly interested in the influence of smartphone apps on PA.I imagine that all readers of this journal have been affected by fitness facility closures, social/physical distancing, and the necessity of wearing masks even while exercising, due to the pandemic. These inconveniences, among others, have influenced many people to reduce or abandon their previous PA routines. But by how much? And how have fitness apps mitigated the declining PA situation, if at all?In the Yang and Koenigstorfer (1) study, 431 participants (49% female) completed a total of two surveys in 45 U.S. states. Most respondents were younger adults (average age, 39.1 years); 69% of participants had at least a bachelor's degree, and 47% were overweight or obese. All were required to own a smartphone and had downloaded at least one PA app.Online self-reported surveys were conducted in two waves: 1) between March 12 and March 17, 2020, and 2) at least 4 weeks after U.S. states responded to the COVID-19 pandemic by imposing lockdowns and other restrictions (the dates varied by state). This design ensured that participants had each experienced lockdown for at least 28 days between data collection points. For both survey

Objective: To evaluate the effect of exercise programs on reduction of musculoskeletal injury (MSI) risk in military populations. Design: Systematic review and meta-analysis. Literature Survey: A database search was conducted in PubMed/MEDLINE, EMBASE, Cochrane Library, CINAHL, SPORTdiscus, WHO International Clinical Trials Registry Platform Search Portal, Open Gray, National Technical Reports Library, and reference lists of included articles up to July 2019. Randomized and cluster-randomized controlled trials evaluating exercise programs as preventive interventions for MSIs in armed forces compared to other exercise programs or to usual practice were eligible for inclusion. Methodology: Two authors independently assessed risk of bias and extracted data. Data were adjusted for clustering if necessary and pooled using the random-effects model when appropriate. Synthesis: We included 15 trials in this review, with a total number of 14 370 participants. None of the included trials appeared to be free of any risk of bias. Meta-analysis and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessment could be performed for static stretching compared to no stretching (3532 participants), showing low quality of evidence indicating no favorable effect of stretching. Gait retraining, an anterior knee-pain targeted program, and resistance exercises showed cautious favorable effects on reducing injury risk in military personnel. Conclusion: The current evidence base for exercise-based MSI prevention strategies in the military is of low quality. Areas worthy of further exploration include the effects of gait retraining, anterior knee-pain targeted programs, agility training, and resistance training programs, on medial tibial stress syndrome incidence, anterior knee pain incidence, attrition due to injuries and any type of MSI, respectively.

Context: This study evaluates the effect of nonexercise interventions on the reduction of risk for musculoskeletal injuries in armed forces.