Performance Triad and Health of the Force

2018 Health of the Force Executive Summary

Soldier health is the foundation of our Army's ability to deploy, fight, and win against any adversary. Health of the Force is an evidence-based portrait of the health and well-be­ing of U.S. Army Active Component Soldiers. It communi­cates information leaders can use to understand and improve Soldier health, medical readiness, and health promotion measures. A collaborative effort of the Armed Forces Health Sur­veillance Branch, U.S. Army Public Health Center, and the Army Resiliency Directorate, Health of the Force combines surveillance metrics and program spotlights from medical, wellness, and environmental domains. The report illustrates salient health issues through infographics, charts, and installation profiles for 40 Army installations. An expanded environmental health section describes how the condition of the environment informs Soldiers' ability to work, train, and deploy. Educational spotlights highlight emerging threats to health readiness and promote programs that have positively influenced health status within the Army.

During 2017, the Army demonstrated reduced rates of injury, smoking, and chronic disease compared to previous years. Overall, 56% of Soldiers had a new injury and injury rates were higher among women and older Soldiers. Of injuries, 71% were musculoskeletal "overuse" injuries. The 2018 Health of the Force reported that 15% of Soldiers had a diagnosis of one or more behavioral health conditions, 12% had a sleep disorder, and 17% were obese.Approximately 23% of Soldiers reported using tobacco products, less than the national average of 25%, when adjusted to the Army sex and age demographics. Finally, there has been a 34% rise in reported chlamydia infections over the past 5 years, most notably among women. This year, the print edition is accompanied by Health of the Force Online (login required), a digital interface that allows users to drill down and examine Army-wide, Command- and installa­tion-level health metrics. Together, these Health of the Force tools can spark the dialogue and inquiry that will drive cul­tural and programmatic changes to achieve Force dominance.

SLEEP

The CDC and the National Sleep Foundation (NSF) both recommend adults attain 7 or more hours of sleep per night (CDC, 2017c; NSF, 2018). In 2017, most AC Soldiers reported getting 6 or more hours of sleep per night on both duty and non-duty nights.

Table 1. Estimated Hours of Sleep by Duty Status, AC Soldiers, 2017

Most Soldiers reported sleeping 6 to 7 hours per night, regardless of duty status. However, nearly 1 in 3 reported getting less than 6 hours of sleep on weeknights/duty nights. Soldiers also reported getting more sleep on weekend/non-duty nights compared to weeknights/duty nights.

Table 2. Percent Meeting Weeknight/Duty Night Sleep Target by Sex and Age, AC Soldiers, 2017

Regardless of sex or age, approximately 1 in 3 AC Soldiers attained the target amount of 7 or more hours of sleep on weeknights/duty nights.

Table 3. Percent Meeting Weekend/Non-Duty Night Sleep Target by Sex and Age, AC Soldiers, 2017

Nearly 3 out of 4 AC Soldiers met the sleep target on weekends/non-duty nights. The trend of increased hours of sleep on non-duty nights was similar across sex and age groups.

ACTIVITY

The CDC recommends two activity targets (CDC, 2018e): engaging in 2 or more days of resistance training per week, and adequate aerobic activity.

Adequate aerobic activity can be attained in three ways:

• 150 minutes a week of moderate-intensity aerobic activity, or
• 75 minutes a week of vigorous-intensity aerobic activity, or
• An equivalent combination of moderate- and vigorous-intensity aerobic activity.

Table 4. Percent Meeting Resistance Training Target by Sex and Age, AC Soldiers, 2017

More than 4 out of 5 Soldiers engaged in resistance training on 2 or more days per week. Target attainment varied by sex and age groups, with 85% of men under age 35 reporting adequate resistance training while 65% of women over age 45 met the target.

Table 5. Percent Meeting Aerobic Activity Target by Sex and Age, AC Soldiers, 2017

Approximately 90% of Soldiers attained adequate aerobic activity in 2017. Women met the target less frequently than their male counterparts across all age categories.

Figure 1. Aerobic Activity Target

NUTRITION

Nutrition targets are based on U.S. Department of Agriculture MyPlate recommendations (USDA, 2018). The GAT, which defines a serving slightly differently than the MyPlate recommendations, asks Soldiers to report the approximate servings of fruits and vegetables they consume each week. Nutrition targets are defined as eating two or more servings of fruits and two or more servings of vegetables per day. On average, Soldiers reported consuming more servings of vegetables than fruits.

Table 6. Estimated Fruit and Vegetable Consumption per Week, AC Soldiers, 2017

Most Soldiers reported fruit consumption ranging from a few servings per week to a few servings per day. Vegetable consumption was higher; more Soldiers reported consuming multiple servings per day.

Table 7. Percent Meeting Fruit Consumption Target by Sex and Age, AC Soldiers, 2017

More than 1 in 3 Soldiers reported eating 2 or more servings of fruits per day. A higher proportion of women met the fruit target than men across all age categories.

Table 8. Percent Meeting Vegetable Consumption Target by Sex and Age, AC Soldiers, 2017

Nearly half of Soldiers reported meeting the target of eating 2 or more servings of vegetables per day. Similar to the reported fruit consumption, a higher proportion of women met the vegetable target than men.

Summary

Army leadership can prioritize weekday sleep for all Soldiers and emphasize focused intervention for increasing resistance training among female Soldiers. Male Soldiers would benefit from consuming additional fruits and vegetables. Combined, these tactics will enable Soldiers to achieve optimal performance and readiness goals.

Percent Meeting SAN Targets, AC Soldiers, 2017:

Sleep on weeknights/duty nights: 
38% attained 7 or more hours of sleep on weeknights/duty nights.

Sleep on weekends/non-duty nights: 
72% attained 7 or more hours of sleep on weekends/non-duty nights.

Resistance training:
83% engaged in resistance training 2 or more days per week.

Aerobic activity:
90% achieved adequate moderate and/or vigorous aerobic activity targets.

Fruit servings per day: 
37% ate 2 or more servings of fruits per day.

Vegetable servings per day:
45% ate 2 or more servings of vegetables per day.

Performance Triad Measures by Installation

Table 9. U.S.-based Installations

Table 10. Installations Outside the U.S.