{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T18:54:42Z","timestamp":1793213682260,"version":"4.5.0"},"reference-count":223,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T00:00:00Z","timestamp":1770854400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T00:00:00Z","timestamp":1770854400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sports Med"],"published-print":{"date-parts":[[2026,7]]},"abstract":"Abstract<\/jats:title>\n \n Purpose<\/jats:title>\n Holistic Health and Fitness (H2F) is the United States Army\u2019s largest force modernization initiative aimed at preserving combat power by optimizing soldier readiness across five domains: physical, mental, nutritional, sleep, and spiritual. At the core of this effort are H2F Performance Teams (HPTs): embedded, interdisciplinary subject matter experts, composed of strength and conditioning coaches, athletic trainers, physical\u00a0and\u00a0occupational therapists, registered dietitians, and mental readiness professionals. These teams operate within brigades to deliver proactive, preventive, and performance-enhancing interventions that reduce injury risk, accelerate rehabilitation, improve fitness and cognitive performance, and sustain deployability. This evaluation quantified the return on investment (ROI) of embedded HPTs across 56 matched active-duty brigades (28 HPT-resourced, 28 controls), encompassing over 1,000,000 soldiers from fiscal year (FY) 2019 through FY2023.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A quasi-experimental, presence-based difference-in-differences framework estimated multiyear treatment effects for musculoskeletal injury (MSKI) referrals and profiles, behavioral health (BH) and substance abuse (SA) profiles, Army Combat Fitness Test (ACFT) pass\/failure rates, Army Body Composition Program (BCP) noncompliance, and Rifle Marksmanship Qualification (RMQ). Outcome deltas were monetized using validated cost-per-case benchmarks from military\/government reports and peer-reviewed studies. A 10,000-draw Monte Carlo simulation, incorporating triangular distributions and a\n \u03c1<\/jats:italic>\n \u2009=\u20090.15 Gaussian copula, modeled fiscal uncertainty, interdomain dependency, and force-wide extrapolation.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Despite significantly worse baseline odds pre-resourcing, HPT brigades reversed all major readiness disadvantages by FY2023. MSKI referral odds declined 61% (odds ratio [OR] 1.16\u2009\u2192\u20090.45), SA profile odds dropped 79% (OR 1.92\u2009\u2192\u20090.41), and BH\u2009>\u200990-day profile odds fell 44% (OR 1.51\u2009\u2192\u20090.84). ACFT failure odds decreased 22% (OR 1.05\u2009\u2192\u20090.82), RMQ expert qualification odds increased 33% (OR 1.21\u2009\u2192\u20091.60), BCP failure odds decreased 12%, and RMQ failure odds declined 28%. Annually, per brigade, these effects translated to 1363 adverse events avoided and 37,484 duty days restored.<\/jats:p>\n Using domain-specific cost estimates, a 10,000-draw Monte Carlo simulation estimated mean annual cost avoidance of $14.06\u00a0M per brigade (95% CI $12.25\u201316.19 million), with 99.05% of draws exceeding a 4:1 ROI. Duty day restoration and expert RMQ gains added $10.38 million (95% CI $8.15\u201313.00 million) in readiness value. Combined, annual total economic value reached $24.44 million per brigade (ROI\u2009=\u20098.15:1; 95% CI 7.17\u20139.27), with force-wide extrapolation yielding $5.28 billion in annual total Army returns. Every $1 invested in HPTs\u00a0returns $8.15 in value\u00a0($4.69 in cost\u00a0avoidances and $3.46 in readiness improvements).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Embedded HPTs produce robust, statistically significant, multidomain improvements in readiness, performance, and cost efficiency. These estimates exclude long-horizon returns such as retention, disability deferral, or downstream system savings\u2014suggesting total ROI is significantly underestimated. This study indicates HPTs are core readiness infrastructure. Their full-scale implementation is a strategic imperative for modernizing force sustainment and preserving the Army\u2019s most critical asset: the soldier.<\/jats:p>\n <\/jats:sec>","DOI":"10.1007\/s40279-026-02399-3","type":"journal-article","created":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T11:27:05Z","timestamp":1770895625000},"page":"1801-1831","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Evaluating the Return on Investment of U.S. Army Holistic Health and Fitness Performance Teams: A Matched Difference-in-Differences Study of Readiness and Economic Outcomes"],"prefix":"10.1007","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2251-1384","authenticated-orcid":false,"given":"Andrew G.","family":"Thompson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manoj","family":"Subedi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander E.","family":"Morrow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chance L.","family":"Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin A.","family":"Bigelman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,12]]},"reference":[{"key":"2399_CR1","volume-title":"National security strategy","author":"T Whitehouse","year":"2022","unstructured":"Whitehouse T. 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The results of the present study do not constitute endorsement by the United States Army or Department of Defense. All opinions are those of the authors and not official positions, though they are employed by an organization which stands to benefit from the reporting of these results.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The datasets generated during and\/or analyzed during the current study are not publicly available due to potential national security implications but may be available from the public affairs office pending a formal request, documented need to know requirement, verification of data security practices and authorizations, completion of a data sharing agreement, and formal review. All requests to initiate this process should be directed to U.S. Army Training and Doctrine Command Center for Initial Military Training Public Affairs Office at usarmy.jble.tradoc.mbx.cimt-pao@army.mil.","order":2,"name":"Ethics","label":"Availability of data and material","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Data were pulled from U.S. Army and Department of Defense data systems. Written informed consent was not required as the data were official historical records and \u00a746.102(l) legislation specifies authorized operational activities in support of homeland security, defense, or other national security missions do not constitute research and are thus not subject to 45 CFR 46. Department of the Army Execution Order 149-19 established Holistic Health and Fitness (H2F) as an operational activity in support of national defense and directs the analysis and reporting of these ROI metrics.","order":3,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"A.G.T.\n 1,2,5\u20138\n , M.S.\n 5\u20138\n , A.E.M.\n 4,6,7\n , C.L.S.\n 5,7,8\n , and K.A.B.\n 3,4,6,7\n .\n 1\n Manuscript ideation;\n 2\n publication process management;\n 3\n program generation;\n 4\n program fielding;\n 5\n data analysis;\n 6\n literature review;\n 7\n manuscript drafting and editing;\n 8\n figure and table design.","order":4,"name":"Ethics","label":"Authors\u2019 contributions","group":{"name":"EthicsHeading","label":"Declarations"}}]}}