CHANGING WORLDS The Impact of University Research

New Training Programmes at Work: Injury Reduction in the Armed Forces Dr James Bilzon Senior Lecturer in Human & Exercise Physiology Director of Studies in Sport & Exercise Medicine Department for Health University of Bath Bath Tel: +44 (0)

2. Epidemiological Research (Identify risk factors and generate hypotheses). 4. Programme Implementation (Introduce evidence-based policy/procedures). 5. Programme Monitoring (Long-term effectiveness of policy/procedures). 1. Surveillance Research (Quantify the size and nature of the problem). 3. Controlled Studies (Establish cause and effect, generate potential solutions). Research Strategy

The Problem…in % of trainees sustained a musculoskeletal injury (MSI) ~1000 per year Medically Discharged (MD) with severe MSI ~700 directly attributable to avoidable overuse MSI ~100 trainees per year hospitalised with Exertional Heat Illness (EHI)

Risk Factors Gender Females were up to 9 times more likely to be MD with MSI than males. Aerobic Fitness Least fit 20% of trainees were ~3 times more likely to be MD with MSI. Training Load Only 43% of ‘Paras’ completed training, with 14.4% MD due to MSI. Heat Stress In excess of 100 military trainees were admitted to hospital each year following an Exertional Heat Illness (EHI) in UK training.

Gender Streaming Richmond, Carter, Wilkinson, Horner, Rayson, Wright & Bilzon. (2010). Gender differences in the physical demands of British Army training. Ergonomics (submitted for review).

Soldier Preconditioning Course Bilzon, Colclough, and Lowe. (2008). Influence of Preconditioning on British Army Infantry Training Outcome. Med. Sci. Sports Exerc., 40: S238. Body Mass (kg) 2.4-km run time (mm:ss) Press-Ups (n) Sit-Ups (n) ADSC----11:30 (00:29)---- SPC start 75.2 (9.8)11:34 (00:42)32 (11)44 (12) SPC end 72.6 (9.3) † 10:47 (00:36) † 44 (12) † 53 (11) † The Medical Discharge rate due to overuse injury was 4.8% for SPC compared to 9.4% in non-SPC controls.

Physical Demands of Parachute Regiment Training Implemented revised physical selection standards Designed and implemented progressive training programme Introduced 4 th meal for trainees Increased pass rate from 43% to 58% Reduced MD due to overuse MSI from 14.4% to 5.1%

Exertional Heat Illness (EHI) During Military Training Bilzon, Richmond, Wilkinson, Timothy, Rayson and Folkes. (2005). Core body temperature responses of British Army officer cadets during initial training competitions. Med. Sci. Sports Exerc., 37: S402.

Impact Statements MD due to overuse MSI reduced 4-fold in female trainees since MD due to overuse MSI reduced 2.5-fold in male trainees since Parachute Regiment trainee pass rates have increased by 15% and MD due to MSI decreased 3-fold. Exertional Heat Illness (EHI) casualties almost completely eradicated at the Royal Military Academy Sandhurst.

Future Research Initiatives Pathophysiology of Exertional Heat Illness (EHI): influence of pre- exercise dietary fats and NSAIDs. Influence of lifestyle habits on physiological adaptations to military training. Operational fitness standards for the UK Fire & Rescue Services. Working in hypoxic environments.

CHANGING WORLDS The Impact of University Research