{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T15:33:48Z","timestamp":1777390428352,"version":"3.51.4"},"reference-count":21,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2016,11,25]],"date-time":"2016-11-25T00:00:00Z","timestamp":1480032000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Sports Med"],"published-print":{"date-parts":[[2017,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Musculoskeletal injuries are prevalent among military trainees and certain occupations. Fitness and body mass index (BMI) have been associated with musculoskeletal conditions, including stress fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Hypothesis:<\/jats:title>\n                    <jats:p>The incidence of, and excess health care utilization for, stress fracture and non\u2013stress fracture overuse musculoskeletal injuries during the first 6 months of service is higher among unfit female recruits. Those who exceeded body fat limits are at a greater risk of incident stress fractures, injuries, or health care utilization compared with weight-qualified recruits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Cohort study; Level of evidence, 3.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>All applicants to the United States Army were required to take a preaccession fitness test during the study period (February 2005\u2013September 2006). The test included a 5-minute step test scored as pass or fail. BMI was recorded at application. There were 2 distinct comparisons made in this study: (1) between weight-qualified physically fit and unfit women and (2) between weight-qualified physically fit women and those who exceeded body fat limits. We compared the incidence of, and excess health care utilization for, musculoskeletal injuries, including stress fractures and physical therapy visits, during the first 183 days of military service.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Among the weight-qualified women, unfit participants had a higher non\u2013stress fracture injury incidence and related excess health care utilization rate compared with fit women, with rate ratios of 1.32 (95% CI, 1.14-1.53) and 1.18 (95% CI, 1.10-1.27), respectively. Among fit women, compared with the weight-qualified participants, those exceeding body fat limits had higher rate ratios for non\u2013stress fracture injury incidence and related excess health care utilization of 1.27 (95% CI, 1.07-1.50) and 1.20 (95% CI, 1.11-1.31), respectively. Weight-qualified women who were unfit had a higher incidence of stress fractures and related excess health care utilization compared with fit women, with rate ratios of 1.62 (95% CI, 1.19-2.21) and 1.22 (95% CI, 1.10-1.36), respectively. Among fit women exceeding body fat limits, the stress fracture incidence and related excess health care utilization rate ratios were 0.79 (95% CI, 0.49-1.28) and 1.44 (95% CI, 1.20-1.72), respectively, compared with those who were weight qualified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The results indicate a significantly increased risk of musculoskeletal injuries, including stress fractures, among unfit recruits and an increased risk of non\u2013stress fracture musculoskeletal injuries among recruits who exceeded body fat limits. Once injured, female recruits who were weight qualified but unfit and those who were fit but exceeded body fat limits had increased health care utilization. These findings may have implications for military accession and training policies as downsizing of military services will make it more important than ever to optimize the health and performance of individual service members.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0363546516675862","type":"journal-article","created":{"date-parts":[[2016,11,23]],"date-time":"2016-11-23T22:40:28Z","timestamp":1479940828000},"page":"311-316","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":32,"title":["Excess Stress Fractures, Musculoskeletal Injuries, and Health Care Utilization Among Unfit and Overweight Female Army Trainees"],"prefix":"10.1177","volume":"45","author":[{"given":"Margot R.","family":"Krauss","sequence":"first","affiliation":[{"name":"ManTech International Corporation, Fairfax, Virginia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nadia U.","family":"Garvin","sequence":"additional","affiliation":[{"name":"ManTech International Corporation, Fairfax, Virginia, USA"},{"name":"Walter Reed Army Institute of Research, Silver Spring, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael R.","family":"Boivin","sequence":"additional","affiliation":[{"name":"Walter Reed Army Institute of Research, Silver Spring, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David N.","family":"Cowan","sequence":"additional","affiliation":[{"name":"ManTech International Corporation, Fairfax, Virginia, USA"},{"name":"Walter Reed Army Institute of Research, Silver Spring, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2016,11,25]]},"reference":[{"key":"bibr1-0363546516675862","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ijo.0803715"},{"key":"bibr2-0363546516675862","doi-asserted-by":"publisher","DOI":"10.3233\/WOR-2012-1355"},{"key":"bibr3-0363546516675862","doi-asserted-by":"publisher","DOI":"10.1016\/S0749-3797(99)00173-7"},{"key":"bibr4-0363546516675862","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2014.08.008"},{"key":"bibr5-0363546516675862","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2012.02.014"},{"key":"bibr6-0363546516675862","doi-asserted-by":"publisher","DOI":"10.1093\/occmed\/kqr028"},{"key":"bibr7-0363546516675862","unstructured":"Department of the Army. Army Regulation 600-9: The Army Weight Control Program. November 27, 2006. Available at: http:\/\/www.amsara.amedd.army.mil\/Documents\/AMSARA_AR\/AMSARA%20AR%202013_final.pdfhttp:\/\/www.wood.army.mil\/sapper\/student_frames\/AR%20600_9.pdf. Accessed April 29, 2016."},{"key":"bibr8-0363546516675862","unstructured":"Department of the Army. Prevention and Control of Musculoskeletal Injuries Associated With Physical Training. Technical Bulletin Medical 592 (TB MED 592). May 1, 2011. Available at: http:\/\/www.usariem.army.mil\/assets\/docs\/publications\/guidance\/tbmed592_musculoskeletal_injuries.pdf. Accessed May 29, 2015."},{"key":"bibr9-0363546516675862","doi-asserted-by":"publisher","DOI":"10.1007\/s00421-008-0717-7"},{"key":"bibr10-0363546516675862","doi-asserted-by":"publisher","DOI":"10.1177\/036354659302100512"},{"key":"bibr11-0363546516675862","doi-asserted-by":"publisher","DOI":"10.1249\/00005768-199302000-00006"},{"key":"bibr12-0363546516675862","doi-asserted-by":"publisher","DOI":"10.1097\/00043764-199306000-00017"},{"key":"bibr13-0363546516675862","doi-asserted-by":"publisher","DOI":"10.1097\/00005768-200106000-00014"},{"key":"bibr14-0363546516675862","doi-asserted-by":"publisher","DOI":"10.2165\/00007256-200636070-00005"},{"key":"bibr15-0363546516675862","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0b013e3181893164"},{"key":"bibr16-0363546516675862","doi-asserted-by":"publisher","DOI":"10.7205\/MILMED.173.6.555"},{"key":"bibr17-0363546516675862","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0000000000000329"},{"key":"bibr18-0363546516675862","doi-asserted-by":"publisher","DOI":"10.1111\/obr.12067"},{"key":"bibr19-0363546516675862","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2009.10.004"},{"key":"bibr20-0363546516675862","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2474-14-238"},{"key":"bibr21-0363546516675862","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-789X.2006.00251.x"}],"container-title":["The American Journal of Sports Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0363546516675862","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/0363546516675862","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0363546516675862","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T09:50:25Z","timestamp":1777369825000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/0363546516675862"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,11,25]]},"references-count":21,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2017,2]]}},"alternative-id":["10.1177\/0363546516675862"],"URL":"https:\/\/doi.org\/10.1177\/0363546516675862","relation":{},"ISSN":["0363-5465","1552-3365"],"issn-type":[{"value":"0363-5465","type":"print"},{"value":"1552-3365","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,11,25]]}}}