Reducing Injury and Medical Discharge Rates

Introduction

In August 2017, national news headlines about Army recruitment standards caused a stir and led to many emotionally charged discussions across the country. These headlines included ‘“Political Correctness Gone Mad”: Australian Army Told Not to Recruit MEN as Part of a Gender War to Push to Have More Women Soldiers',^[1] ‘“PC Gone Mad”: Army, Air Force, Navy Bans Men in Bid to Boost Women’^[2] and ‘Australian Army Reportedly Shuns Male Recruits in Favour of Women’.^[3]

At that time, I was nearing completion of the Army’s Subject One for Corporal course – a promotion course for Army’s Private soldiers. At the end of her congratulatory address to my cohort, the course’s Commanding Officer (CO) opened the floor for questions and feedback. The speed at which some of my colleagues’ hands were raised spurred laughter from most of the audience. Seconds later, however, the mood was more sombre.

The CO invited one of the soldiers with a raised hand to speak. In reply, the soldier said something to the effect of, ‘Ma’am, for the last 10 minutes or so you’ve reiterated that you hold us all to the same standard. But you don’t.’ Responding to the CO’s request for clarification, the soldier added, ‘If you hold us all to the same standard, then why do males and females have different fitness standards?’ At this point, the Regimental Sergeant Major (RSM) addressed the soldier’s remarks with words to the effect of, ‘It’s not true that we hold you to different fitness standards because males and females have different physiologies. So the standards we hold you to are, in fact, the same when we take into account these differences.’ Although at the time I did not fully internalise what the RSM was saying, I intuitively agreed with him. However, I could also see the logic of my colleague’s perspective.

At that moment, I found myself struggling with a dilemma. On the one hand, I agreed with my colleague’s observation that the sexes are held to different fitness standards. This fact is evidenced by the Army’s Basic Fitness Assessment (BFA), which imposes fewer repetitions of push-ups and sit-ups on female members, and provides them more time to complete the run/walk component of the test. On the other hand, I agreed with the RSM’s explanation that men and women possess different physiologies and may therefore be held to the same fitness standards when these differences are accounted for.

At the start of 2018, I began making a series of enquiries of junior non-commissioned officers (JNCOs), senior non-commissioned officers (SNCOs), junior officers (JOs) and senior officers (SOs)^[4] about the purposes of the BFA and the Physical Employment Standard Assessment (PESA). My intent was to better understand and reconcile the points made by my course colleague and the RSM. To my surprise, there was very little consistency in the answers I received. When asked about the purpose of the BFA, some would say it is a minimum standard of physical fitness for ongoing employment in the Army. Others would say it is a minimum standard of physical fitness that ensures personnel employed by the Army are maintaining an acceptable level of overall physical health. Some explained that it was a strategy employed by the government to increase the number of female intakes into the Army.

When I enquired about the purpose of the PESA, some said it provides the best indication as to whether someone is able to meet the physical fitness demands of their job, while others argued that it was introduced to make it more difficult for females to enter into Combat Corps, as a counter to the BFA. Some respondents opposed the PESA because they believed that it greatly overestimated Army’s job-specific physical fitness requirements.

It seemed that, in an effort to reduce my uncertainty, I had inadvertently magnified it.

In the absence of clarity among my fellow serving members, I sought answers in Defence policy and in any literature I could find on the subject. The purpose of this paper is to share my research findings and the conclusions I reached. My aim is to support better-informed conversations around this topic that can lead to positive outcomes for the Army and Australian Defence Force (ADF) as a whole.

Initial Findings

Since the BFA is a component of the Army Individual Readiness Notice (AIRN), understanding the purpose of the AIRN would be a reasonable place to start the research. Yet after reading the initial five paragraphs in the AIRN policy, I found it extremely difficult to overlook a number of conflicting statements. To understand the nature of this inconsistency, it is useful to consider the following three statements:^[5]

[The] Army Individual Readiness Notice (AIRN) policy has been developed to ensure Army personnel maintain themselves at a base level of preparedness IOT [in order to] carry out lead up training for deployment on operations at short notice.

…

AIRN assists pre-deployment training during force preparation by providing a common start point and addresses Army’s duty-of-care commitment by prescribing the baseline individual readiness standard to be achieved by Army personnel.

…

The purpose of AIRN is to maintain a baseline level of IR [Individual Readiness] within Army to ensure that Army personnel are capable of being deployed on operations at short notice.

 

The first statement implies that the AIRN is, in itself, an inadequate standard for deployment on operations at short notice. In contrast, the third statement implies that the AIRN is an adequate standard to be deployed on operations at short notice—the exact opposite of the first statement. According to the Australian National Audit Office, however, the AIRN provides ‘a baseline of individual readiness … for members entering pre-deployment training’.^[6]

So is this ‘baseline’ actually adequate for deployments on short notice? In my view, the answer depends on the type of operation under consideration. To understand how I reached this conclusion, it is instructive to examine the PESA in some further detail.

The PESA is intended to ‘provide assurance [that] personnel have the physical capacity to safely perform the range of physically demanding tasks associated with their employment in Army’.^[7] The PESA consists of four levels and entails several activities, including route march with a load, fire and movement bounds, jerry can carry and weighted box lift, all conducted in uniform and boots, with the addition of webbing, rifle and body armour. The assessment level is based on the role in which soldiers are employed, and is age and gender neutral. Of note, Army asserts that ‘extensive scientific research has been conducted to ensure PESA reflects a spectrum of physically demanding trade tasks’,^[8] and ‘the PESA elements are based on the essential tasks required to be performed by all members of the Army and are gender and age neutral’. The PESA, however, is not an AIRN requirement and is not necessarily a prerequisite for deployment on non-warlike or peacetime operations. It is, however, a standard demanded of members designated for warlike operations. A reasonable conclusion from this distinction is that the AIRN is regarded as imposing adequate fitness standards for non-warlike and peacetime operations, but not for warlike operations.

Given the extensive level of research that was conducted to produce the PESA, along with the PESA’s purpose, there is an argument to be made for the PESA to replace the BFA as the AIRN requirement. There are two justifications for this view. First, regardless of the environment within which they are operating, military personnel must continue to possess ‘the physical capacity to safely perform the range of physically demanding tasks associated with their employment in Army’, regardless of their gender or age. The second reason is far more technical in nature and its explanation provides good foundation for discussing the significant challenges posed by Army’s efforts to generate appropriate physical employment standards for its serving members. To this end, the following section summarises the relevant technical considerations.

Gender and Relative versus Absolute Fitness

Whereas the term ‘relative strength’ is used to describe ‘the total amount of force that can be produced in a movement relative to one’s body weight’, the term ‘absolute strength’ describes the ‘maximal amount of force that one can produce in a single movement’. Both forms of strength are related because—given that the individual’s body weight does not increase—an increase in absolute strength should be reflected in an increase in relative strength.^[9] Studies conducted on healthy males and females reported that, when compared to their male counterparts, on average females have approximately two-thirds of the muscle mass, 6–12 per cent higher body fat, 12.5 per cent less blood volume per kg of body mass, 12 per cent lower haemoglobin concentration and 10–20 per cent lower maximal oxygen uptake (VO2 max) per kg of body mass.^[10]

For the purpose of this paper, the terms ‘relative fitness’ and ‘absolute fitness’ are used to refer to the combination of the cardiovascular and strength components of physical fitness in males and females. Thus, ‘relative fitness’ refers to an individual’s total cardiovascular and force outputs relative to their maximal cardiovascular capacity and body mass, respectively. On the other hand, ‘absolute fitness’ refers to an individual’s maximal cardiovascular and force outputs at any movement and at any point in time. In this regard, females can be said to possess lower absolute fitness while simultaneously needing to apply a higher level of relative fitness to complete the same physical task as their male counterparts.

Applying the distinction between relative fitness and absolute fitness, the BFA can be viewed as a measure of relative fitness, while the PESA is a measure of absolute fitness. This is because the BFA standards vary in relation to the individual’s gender and age while the PESA is gender and age neutral. In other words, the BFA measures the individual’s relative fitness while the PESA assesses their absolute fitness. In the next section, the implications of this distinction are discussed with reference to the principles of physical training.

Principles of Physical Training

When participating in exercise, or sport training, there are seven basic principles that athletes and coaches must keep in mind. These are:^[11]

1. Specificity—a person’s physical adaptations are specific to the type of training stress. Athletes should therefore train movement patterns and intensities to improve their performance at distinct, key components of specific tasks.
2. Individualisation—the adaptation capacity of individuals to physical training varies according to physiological, psychological, environmental and genetic factors. Consequently, a training program should account for variables such as age, current fitness level, lifestyle habits and training history.
3. Overload—exposing the tissues to higher levels of training stimuli at regular intervals induces training adaptations within athletes. Nonetheless, excessive overload combined with inadequate rest may cause adverse effects such as overtraining and injury.
4. Progression—for continued training adaptation, a systematic and gradual increase in training overload is necessary. However, the rate of progress must be considered because rapid progress may lead to injury while slow progress will delay goal attainment.
5. Periodisation—refers to the systematic planning of varying training loads and incorporating adequate rest and recovery to meet short- and long-term training goals. Hence, it provides a structure for controlling the stress and recovery required to induce training adaptations while reducing the risk of excessive overtraining.
6. Rest and recovery—this is a frequently neglected training principle, although it is arguably one of the most important to consider and incorporate. Inadequate rest and recovery exposes athletes to overtraining and overuse injuries. The age of athletes, type of training and environmental conditions are some of the factors that should be considered during the recovery process after a training session.
7. Reversibility—on discontinuation of training a specific activity or as a result of inadequate training, the body will adapt to these conditions through loss of performance in that activity.

Although soldiers who pass their BFA will need to participate in lead-up training before undertaking their PESA, none of the skills tested in the BFA are tested in the PESA. In effect, the BFA operates as the start point of physical fitness, providing a flexible gender- and age-dependent start point of physical fitness. By contrast, the PESA is ‘a fixed end point of fitness for military service’.^[12] Of concern, the transition from the BFA standards (the start point) to the PESA standards (the end point) does not adhere to any of the physical training principles. Also, given females have lower BFA standards than their male counterparts—as viewed from an absolute fitness perspective—but are required to meet the same PESA standards for their corps and to do so within the same training period, it is apparent females will need to train at higher intensities if they are to undertake the same training frequency. Although this observation can also be made for males over 25 years of age when compared to their younger colleagues, the disparity especially affects females because they require longer times to recover from injuries than their male counterparts,^[13] while simultaneously being more susceptible to stress fracture injuries.^[14]

The challenge of balancing relative and absolute fitness requirements in a military context is acknowledged in the relevant research literature. For example, the research team responsible for the introduction of the Pre-Enlistment Fitness Assessment (PFA) has observed:^[15]

Although there is no question regarding a fixed end point of fitness for military service, if the time to achieve that end point is fixed and there are different start points, the net result will be a major difference in both the absolute and the relative amounts of effort and improvement needed.

… The current system of variable start points and a fixed end point is a recipe for injury, particularly given the low levels of initial fitness in females.

AIRN as Preparation for Pre-deployment Training

As outlined previously, a key rationale for the AIRN is that it aids in the preparation of military members for pre-deployment training. Specifically, the relevant Army Standing Instructions provide that it ‘assists pre-deployment training during force preparation by providing a common start point’. This being the case, the AIRN ‘addresses Army’s duty-of-care commitment by prescribing the baseline individual readiness standard to be achieved by Army personnel’. The problem is that this statement does not withstand closer scrutiny.

To assert that the AIRN provides a common start point implies that all members of Army who are AIRN compliant—regardless of gender or age—possess the same (a common) level of physical fitness. This statement can only be true if viewed through the lens of relative fitness.

Further, studies have demonstrated that sit-ups and push-ups—which are key components of the BFA—are poor predictors of job-related task performance within Army. In particular, sit-ups have no relationship with occupationally relevant tasks.^[16] Furthermore, since females (on average) possess a lower absolute fitness than their male counterparts, and absolute fitness is a better predictor of an individual’s capacity to safely perform the physical demands of their job, then the BFA automatically disadvantages females by exposing them to a higher risk of injury while performing their physical job tasks.

Figure 1 is intended to provide a visual representation of the interaction between the BFA and PESA in terms of absolute fitness per age bracket and sex.

In reality, the PESA is a more appropriate standard by which to assess soldiers’ physical capacity to meet the physical demands of their various duties.^[18] This assertion is supported by an Australian study of fully qualified soldiers in units from the following selected corps:

• Royal Australian Infantry Corps
• Royal Australian Artillery Corps
• Royal Australian Engineers
• Royal Australian Armoured Corps
• Royal Australian Corps of Signals.

This study found that 34 per cent of all participants reported sustaining at least one injury as a result of a load carriage activity during their military career and that females have a 21 per cent higher risk of injury than males.^[19] It is particularly notable that females of equivalent physical fitness have the same risk of injury as their male counterparts.[20] In this regard, most of the factors linked to susceptibility to physical injuries in males and females can be credited to their physical conditioning and not to their gender.

The proposition that the PESA offers a more suitable fitness standard than the BFA is not uniformly accepted. As noted earlier in this paper, many individuals dislike the PESA because they believe that it greatly overestimates the job-specific physical fitness requirements; and this concern warrants closer scrutiny. The most accurate way to determine whether the PESA provides a realistic standard that accurately correlates with a soldier’s physical fitness requirements for their professional duties in Army can best be determined by comparing the injury rates of soldiers on operational deployments with the injury rates of soldiers post completing the PESA. Regrettably, I was unable to locate any study that directly investigated this matter. Nevertheless, the answer may be derived via other methods.

To address this issue, I considered the number of first-time self-reported injuries by Australian soldiers within the first 12 months of their posting in an operational unit. The results showed that 20 first-time occurrences of load carriage injury were reported by participants during their first 12 months in an operational unit, and the total number of individuals who participated in the study was 338. Based on these figures, it can be concluded that an average of 5.92 percent of fully qualified Australian soldiers newly posted into operational units are injured every 12 months as a result of load carriage activities.

Because there are no Australian studies of deployment injuries, I examined US research on injury rates conducted on deployed American soldiers. A study of soldiers deployed to Afghanistan in 2012 found that 45 percent of US soldiers reported at least one injury during their 12-month deployment period. Of these injuries, lifting/carrying was the most frequently reported cause of the injury (9.8 percent), immediately followed by dismounted patrolling (9.6 percent) and physical training (8 percent).^[21] It is notable that the average weight of equipment worn by the American soldiers involved in the study fell in the range of 21.3 ± 13.6 kg and that it was worn for an average of 6.7 ± 4.9 hrs, while the average weight carried by those in the Australian study was heavier at 29.5 kg. By comparing the percentage of injuries in newly posted Australian soldiers into operational units during their first 12 months (5.92 percent) with the percentage of injuries in US soldiers deployed to Afghanistan during their 12-month rotation due to dismounted patrolling (4.32 percent of the 593 participants) , it is reasonable to conclude that a fully qualified Australian soldier is approximately 30 percent more likely to sustain an injury while participating in load carriage activities during peacetime as an American soldier conducting patrols on foot in a war zone.

Based on these studies, it is fair to say that load bearing is a function of deployment and, therefore, the absolute fitness requirement of the PESA represents the reality of military service better than the relative standards of the BFA. Nonetheless, there is scope for improvement in the PESA assessment standards. While deployed Australian combat units do carry heavy loads when in Marching Order (an average of 47.7 kg),^[22] the American study found that 53 per cent of all patrols are conducted on foot. This suggests that the PESA route-marching component may indeed be overestimating the required physical demands of soldiers and is therefore exposing them to an unnecessarily higher risk of injury. This is because the maximum tactical rate of movement is 2,000 m/h while the PESA route-marching component is conducted at a rate of 5,500 m/h, a rate that even exceeds the maximum non-tactical rate of movement of 5,000 m/h.^[23]

Further, an individual’s physical fitness requirements in the workplace will vary depending on their specialty, their qualifications and the nature of the task being performed (e.g. administrative versus patrolling tasks), as well as the context in which the task is being performed (e.g. secure location versus forward operating base).^[24] While there is no consensus among researchers regarding the relationship between military rank and physical injury, there is broad agreement that age and gender are correlated with susceptibility to physical injury. There is also agreement that a correlation exists between age and rank, whereby higher ranks are held by older individuals.^[25]

The disparity in the correlation between military rank and physical injury is, in my opinion, due to the different variables considered in each study. Although a number of studies may be conducted on deployed personnel, if some of these studies consider age, gender, rank and nature of prime task (administrative versus tactical tasks) as input variables for predicting physical injury, while others consider the deployment environment (secure location versus forward operating base) as an additional variable, then the results would be expected to differ. That is, SOs and SNCOs largely involved in administrative tasks are significantly less likely to engage in physically arduous activities when operating from a secure location than they would be if operating from a forward operating base. Therefore, the variables considered by the studies play a significant role in determining whether a correlation exists between rank and physical injury. Nonetheless, for the purposes of this paper it is assumed that a general relationship between age and rank does exist, which is an observable reality from common daily experience within both the military and civilian workforces. Accepting this proposition, the PESA standard is inevitably far more onerous for SOs and SNCOs than it is for JOs and JNCOs. This is because SOs and SNCOs need to train at tremendously higher intensities to reach the same PESA standard than their significantly younger counterparts. Therefore, given the propensity for SOs and SNCOs to fulfil non-tactical functions, imposing the PESA standard unnecessarily exposes them to high risk of injury.

Final Thoughts and Recommendations

As demonstrated by this paper, the BFA has little to no correlation with performance in job-related tasks and the PESA arguably overestimates the physical requirements associated with employment in Army. In addition, the interaction between the BFA’s relative fitness and the PESA’s absolute fitness standards operates to the detriment of the entire Army population, and its female members in particular.

Despite the tension between relative and absolute physical fitness standards, it is nevertheless logical to assert that the PESA represents a more suitable baseline physical standard than the AIRN’s BFA. That is because only the PESA ‘provide[s] assurance personnel have the physical capacity to safely perform the range of physically demanding tasks associated with their employment in Army’. This conclusion is only valid, however, so long as Army maintains a system of physical fitness assessments that is internally inconsistent. While the current PESA is evidently more relevant to the employment requirements of Army, it is nevertheless true that the BFA has been evaluated and found adequate to support deployments on non-warlike and peacetime operations. These contradictions point firmly to the need for reform. This is especially true since experience at the JO and JNCO levels points to the variations in the physical fitness assessments as common friction points between Army personnel that inadvertently lead to unwanted tensions within the workplace—as demonstrated at the beginning of this paper.

A solution, however, is within reach. Based on my analysis, I make the following recommendations for consideration by Army:

• Conduct a study to determine the impact of the PESA on the physical wellbeing of Army personnel by analysing the number of injuries that occur during the lead-up training as well as post the conduct of the PESA.
• Maintain the current BFA elements and standards for SNCOs and SOs.
• Amend the BFA elements and standards for JNCOs and JOs to better align and correlate with the current PESA elements and standards—see Appendix 1.
• Amend the PFA elements and standards for new entrants to provide a more reliable prediction of their ability to successfully and safely graduate from their initial military training by better aligning them with these of the current PESA—see Appendix 1.

Conclusion

There is no doubt that employment in the Australian Army necessitates the imposition of physical fitness standards to assist with the selection of personnel for their potential involvement in physically arduous activities. Such assessments, however, must be instantaneously relevant, backed up with sound scientific evidence and complementary in nature. Deviation from these principles has, to date, proven to increase the risk of physical injury among Army personnel and, by extension, to be detrimental to ADF capability.

The research findings of this paper highlight a need for Army’s current continuum of physical fitness assessments to be re-evaluated in light of known physical training principles; correlation between physical conditioning, gender and susceptibility to injury; and statistics on physical injury in non-warlike and warlike environments.

Because physical fitness is one of the many inputs to Army capability, it is very difficult to predict the full implications of the recommendations made here. Nevertheless, it is evident that Army’s physical fitness requirements need regular revision and updating to remain relevant, contemporary and able to support our military men and women in the range of roles they are expected to fulfil on behalf of the nation.

About the Author

Flying Officer Micheal Abdel-messih enlisted in the Australian Regular Army in 2014 as a Parachute Rigger. On completion of his employment training in 2015 he was posted to Joint Logistics Unit (East) and in 2017 he completed the Subject One for Corporal – Army. Flying Officer Abdel-messih posted to ADFA in 2019, where he completed his Bachelor of Mechanical Engineering (Honours) as an Army Officer Cadet and transferred to the RAAF as an Armament Engineer in 2022.

In his personal time, Flying Officer Abdel-messih enjoys reading, exercising, camping and 3D printing.

Acknowledgements

I would like to thank Colonel Brad Kilpatrick, CAPT Tristan Hedger, Warrant Officer Class 2 Jon Davey, Lieutenant Ellen Rosengreen and Miss Amanda Carron for their support and constructive feedback that helped elevate the quality of the ideas delivered in this paper.

Appendix 1

Proposed amendments to the current suite of physical fitness assessments employed by the Australian Army

Fitness Assessment	Age	Gender	All Corps	Combat Corps	Infantry Corps	Remarks
Pre-enlistment Fitness Assessment	All	All	Tier-1 All Corps PESA (ACPESA)	Tier-1 Combat Corps PESA (CCPESA)	Tier-1 Infantry Corps PESA (ICPESA)	Varies between individuals based only on their choice of corps
Basic Fitness Assessment	Intermittently applicable – rank dependent	Intermittently applicable – rank dependent	Tier-2 ACPESA for NCOs and JOs	Tier-2 CCPESA for NCOs and JOs	Tier-2 ICPESA for NCOs and JOs	Current BFA elements and standards are only applicable to SNCOs and SOs
Physical Employment Standard Assessment	Intermittently applicable – rank dependent	Intermittently applicable – rank dependent	Tier-2 ACPESA for NCOs and JOs	Tier-2 CCPESA for NCOs and JOs	Tier-2 ICPESA for NCOs and JOs	Not applicable to SNCOs and SOs

 

PESA Tiers

Tier	All Corps PESA	Combat Corps PESA	Infantry Corps PESA
Tier-1	The equivalent of an output that is a third of the current ACPESA output i.e. 1.7 km route march with a 7.5 kg load in 17–18.5 minutes, etc.	The equivalent of an output that is a third of the current CCPESA output i.e. 3.4 km route march with a 11.5– 13.5 kg load in 33.5–37 minutes, etc.	The equivalent of an output that is a third of the current ICPESA output i.e. 5 km route march with a 13.5–15 kg load in 50–55 minutes, etc.
Tier-2	The equivalent of an output that is two-thirds of the current ACPESA output i.e. 3.4 km route march with a 15 kg load in 34–37 minutes, etc.	The equivalent of an output that is two- thirds of the current CCPESA output i.e. 6.8 km route march with a 23–27 kg load in 67–74 minutes, etc.	The equivalent of an output that is two- thirds of the current ICPESA output i.e. 10 km route march with a 27–30 kg load in 100–110 minutes, etc.
Tier-3	The current ACPESA standards i.e. 5 km route march with a 23 kg load in 50–55 minutes, etc.	The current CCPESA standards i.e. 10 km route march with a 35–40 kg load in 100–110 minutes, etc.	The current ICPESA standards i.e. 15 km route march with a 40–45 kg load in 150–165 minutes, etc.

Endnotes