Authors alone are responsible for opinions expressed in the contribution and for its clearance through their federal health agency, if required.

ORIGINAL ARTICLES Authors alone are responsible for opinions expressed in the contribution and for its clearance through their federal health agency, if required. MILITARY MEDICINE, 180, 5:513, 2015 A Descriptive Study of the U.S. Marine Corps Fitness Tests (2000 2012) LCDR Jamie L. Bartlett, MSC USNR; Jennifer Phillips, MPH; Michael R. Galarneau, MS ABSTRACT This article describes the performance of active duty U.S. Marines on the Physical Fitness Test (PFT) and Combat Fitness Test (CFT) during calendar years 2000 through 2012. Our study sample included PFT composite scores (n = 543,185), PFT and CFT composite scores (n = 160,936), and PFT and CFT event scores (n = 135,926 and n = 201,953, respectively). In general, all Marines performed very well on each fitness test, with overall annual improvements. Interestingly, the majority of female Marines passed the minimum male standard on the CFT. Further studies will evaluate the relationship of fitness test performance and injury. INTRODUCTION It has been well established that a physically capable force is required to perform essential military tasks. 1 Each service branch determines the necessary physical fitness testing needed to maintain minimal levels of fitness and strength for its members respective duties. Operational tempo of the past decade has placed an unprecedented level of demand on U.S. warfighters. Currently, our warfighters deploy to some of the most physically demanding areas of the world. The recent demands continue to challenge service leaders trying to optimize warfighter readiness and minimize injury. Each of the armed services conducts some variation of an annual Physical Fitness Test (PFT). Each service PFT, which includes a distance run, timed sit-ups, and timed upper body event, follows a service-specific standard to assess the physical capabilities of the warfighter. The Marine Corps PFT is considered to have the most difficult physical standards by including the longest distance run (3 miles), a sit-up requirement, and a pull-up/flexed arm hang requirement. Although leaders Department of Medical Modeling, Simulation and Mission Support, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106. Approved for public release; distribution is unlimited. U.S. Government Work (17 USC 105). Not copyrighted in the United States. This research has been conducted in compliance with all applicable federal regulations governing the protection of human subjects in research (Protocol NHRC.2003.0025). The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the U.S. Government. doi: 10.7205/MILMED-D-14-00490 acknowledge that these tests are part of military service, the PFT is not a proven predictor of military success. Further, the specificity of performance-related fitness requirements varies depending on the individual s mission. The training requirements of an infantry scout with regular foot patrols across harsh terrain are notably different from that of a transport driver who regularly loads and unloads trucks. Consequently, warfighter training strategies must meet occupational task specificity as well as dynamic needs associated with theater. In 2008, the U.S. Marine Corps (USMC) implemented an annual Combat Fitness Test (CFT) in addition to the regular PFT. 2 The CFT is designed to standardize the assessment of common battlefield tasks. It includes three equally weighted events: Movement To Contact (MTC; 880-yard run in boots and camouflage uniform), Ammunition Lift (AL; 30-pound ammo can overhead lift for 2 minutes), and Maneuver Under Fire (MANUF; 300-yard combat obstacle course). The goal of this program is for Marines to train to the test, ultimately increasing their functional fitness. The USMC began official scoring the CFT in the fall of 2009. To the best of our knowledge, this is the first peer-reviewed examination of the USMC PFT/CFT relationship. The purpose of this article is to describe this relationship as well as the participants who completed the PFT from 2000 to 2012 and the newly implemented CFT from 2010 to 2012. METHODS We obtained the study sample from the USMC Manpower and Reserve Affairs Database. Data included performance on MILITARY MEDICINE, Vol. 180, May 2015 513

annual PFT and CFT components and resultant composite test scores. Local commands input event performance data and determine event score by referencing the appropriate table in the current Marine Corps Order. 2 The scores for each event are summed to generate composite PFT and CFT scores from 180 to 300 points (60 100 points per event). The current Marine Corps Order classifies each CFT score as a first class (>270), second class (225 269), third class (190 224), or failure (<190). Age and gender adjustments occur during scoring for each CFT component. For the PFT, performance on each component is given the same score, regardless of age, but adjusted by gender. Composite PFT scores are then classified by age groups (e.g., the youngest age group needs a minimum composite score of 225 for a first class classification, whereas the oldest age group only needs a minimum composite score of 150). We received event and composite score data for the PFT and CFT for calendar years 2010 through 2012. Only composite test scores for the PFT were available for years 2000 through 2009. The Institutional Review Board at the Naval Health Research Center, San Diego, California, approved this study. Data requests and analyses complied with all federal regulations regarding the protection of human subjects. Study Sample The initial study sample consisted of approximately 3 million active duty fitness records. We excluded records with a zero or null event or composite score (n = 30,367). It was unknown whether a null score was a result of medical waiver, event failure, or clerical error. Therefore, we included only participants who had complete records in all three events for that cycle s fitness test. When multiple records existed for an individual in the same testing cycle, we excluded the secondary record. Marines completed two fitness tests per calendar year. Before the implementation of the CFT in 2008, Marines completed two PFT cycles per calendar year. After CFT implementation, Marines have one PFT cycle (January through June) and one CFT cycle (July through December) per calendar year. From this sample, we identified demographic data through the Defense Manpower Data Center and Defense Enrollment Eligibility Reporting System databases. TABLE I. Descriptive Characteristics of Subjects, 2010 2012 2010 2011 2012 Characteristic (n = 638) (n = 10,434) c 2 (p) (n = 1,126) (n = 15,632) c 2 (p) (n = 9,485) (n = 127,241) c 2 (p) Age, Mean (Range) 24.2 24.6 0.5 (0.5) 24.8 (18 55) 25.6 (18 61) 16.98 25.7 26.9 (18 60) 266.2 Rank, No. 25.3 10.8 (0.1) 231.6 E1 E3 155 3,343 306 4,204 3,080 35,895 E4 E5 395 5,786 611 8,492 3,482 44,589 E6 E9 43 656 105 1,519 1,494 11,805 O1 O3 21 193 50 534 696 8,871 O4 O9 4 179 16 422 17 5,452 WO 2 42 8 83 88 1,643 Unknown 18 235 30 378 628 18,986 MOS, No. a 407.2 743.1 4,500.5 Ground Combat 49 4,054 85 5,685 790 38,015 Aviation 149 1,722 198 2,659 1,983 29,967 Administration/ 349 2,528 686 4,026 5,486 34,574 Supply Maintenance/ 73 1,919 129 2,859 997 20,482 Construction Other/Unknown 18 211 28 403 229 4,203 Race, % 42.9 78.9 543.7 White, 75.5 85.1 75 84.7 73.1 82.6 Non-Hispanic African- 16.3 9.4 17 9.6 17.1 10.8 American PFT, Mean 222.7 227.8 0 (1) 216.4 227.6 3.27 (0.07) 266.6 241.3 9.8 (0.002) CFT, Mean 272.5 274.7 5.8 (0.02) 272.7 277.6 14.3 (0.002) 280.7 284.5 42.2 CFT, Combat Fitness Test; MOS, Military Occupational Specialty; PFT, Physical Fitness Test. a Codes for each MOS category were Ground Combat (03, 05, 08, 18, 21, 23, 26, 58); Aviation (60 66, 68, 70, 72, 73, 75); Administration/Supply (01, 02, 04, 06, 27, 30, 31, 33, 34, 41, 43, 44, 46, 48, 55, 57, 59); and Maintenance/Construction (11, 13, 28, 35). 514 MILITARY MEDICINE, Vol. 180, May 2015

The final study sample included 543,185 Marines with a PFT composite score only (years 2000 2012); 160,936 with both PFT and CFT composite scores (years 2010 2012); and 135,926 and 201,593 with event scores for the PFT and CFT, respectively (years 2010 2012). Measures We collected demographic data that included birth date, rank, Military Occupational Specialty (MOS), gender, and race, using data from the Defense Manpower Data Center database. Birth date was used to calculate age at the time of each fitness record. We separated rank according to junior and senior levels within enlisted (E1 E3, E4 E5, E6 E9), officer (O1 O3, O4 O9), and warrant officer status. Common task elements were used to group MOS into ground combat, aviation, administration/supply, maintenance/construction, and other/unknown. Specific MOS codes for each category are listed in Table I. FIGURE 1. Median composite fitness test scores for the PFT (black markers, 2000 2012) and CFT (gray markers, 2010 2012) for female (circles) and male (squares) active duty Marines. Participants were scored based on the current standards for age and gender. Statistical Analysis All statistical analyses were performed using SAS software, version 9.3 (SAS Institute, Inc., Cary, North Carolina). Chi-square (c 2 ) tests were conducted to assess statistical significance of categorical variables by gender and year for the testing period 2010 2012. For continuous variables, we conducted 2-tailed t tests (p < 0.05) by gender and year of PFT/ CFT test. General linear modeling was performed to assess the statistical significance of median scores between genders and all years in the study period. Multivariate logistic regression was used to assess the statistical significance of gender differences in individual events of the CFT and obtain odds ratios (ORs) with 95% confidence intervals (95% CIs). RESULTS Descriptive characteristics of the final study sample for 2010 2012 are presented in Table I (n = 164,556). Most of the samples were male (93.2%) and held a rank between E2 and E5 (58.5%). Not surprisingly, only a small percentage of females filled ground combat elements (8.2%), whereas a large percentage filled administrative/supply (58.0%) and aviation (19.1%) billets. Figure 1 shows the steady improvement in median composite PFT scores for both females and males since 2000. Further, all Marines had higher composite scores on the CFT. Female and male Marines similarly obtained first class PFT (76.9% and 80.2%, respectively) and CFT composite scores (83.8% and 86.3%, respectively). Overall, 68.3% of female and 73.5% of male Marines achieved a first class score on both fitness tests. Table II shows average event performance for females and males on each PFT and CFT task; on average, males outperformed females in every event. Male Marines were more likely than females to perform 75 or more sit-ups (OR = 5.37; 95% CI: 4.95 5.83). On the 3-mile TABLE II. Average Performance on PFT and CFT Events, by Gender Mean (SD) Event Female (n = 8,231) Male (n = 120,403) PFT Flexed-Arm Hang(s) 63 (11.82) N/A Pull-Ups (Count) N/A 15 (4.60) Sit-Ups (Count) 94 (11.63) 98 (6.09) 3-Mile Run (Minutes) 26:07 (2:51) 23:01 (2:37) CFT MTC (Minutes) 3:45 (0:28) 3:08 (0:22) AL (Count) 60 (13.22) 94 (12.61) MANUF (Minutes) 3:22 (0:32) 2:33 (0:24) Under Fire; MTC, Movement to Contact; PFT, Physical Fitness Test. run, males were more likely than females to finish in a time of 22:10 or less (OR = 7.55; 95% CI: 7.00 8.13). Next, we applied the more difficult male scoring standard to female performance on each of the CFT events. The majority of females in each age group could pass the current male CFT scoring standard (Table III). In Table IV, we further categorized each of the CFT events into tertiary (high, TABLE III. Percentage of Females Who Met Male CFT Component Minimum Requirements, by Fitness Testing Age Group Age, Years MTC AL MANUF 17 26 85.5% 96.9% 89.5% 27 39 94.8% 96.6% 99.9% 40 45 99.2% 96.1% 99.6% 46+ 97.6% 93.3% 100.0% Under Fire; MTC, Movement to Contact. MILITARY MEDICINE, Vol. 180, May 2015 515

TABLE IV. Percentage of Participants Who Performed in Target Range on CFT Components Females (n = 8,231) Males (n = 120,403) MTC <3:00 Minutes 3.8% 45.1% 3 4:00 Minutes 70.0% 53.9% >4:00 Minutes 26.2% 1.0% AL >75 Repetitions 8.3% 93.9% 50 75 Repetitions 74.7% 5.8% <50 Repetitions 17.0% 0.3% MANUF <3:00 Minutes 23.1% 86.6% 3 4:00 Minutes 66.6% 13.1% >4:00 Minutes 10.3% 0.4% Under Fire; MTC, Movement to Contact. medium, and low) performance groups. With the exception of the MTC event, the majority (93.9% for AL and 86.6% for MANUF) of males performed each event in the highest performance group. The majority of females (approximately 70% for all events) performed in the medium group. DISCUSSION Here, we have described the performance of active duty Marines who participated in required fitness testing in 2000 2012. The majority of Marines were young, enlisted men in occupational specialties such as infantry, artillery, or aviation. Despite the strenuous involvement in global operations during this time, Marines continually performed well on both the PFT and CFT. All services recognize value in maintaining minimal levels of fitness in their members to reduce long-term health care costs. The relationship between physical training and injury in the military has been well documented. 3 6 Implemented in its current form since 1997, the USMC PFT is a classic military measure of physical capacity. Marines perform well on this test, steadily improving since 2000. This is likely a result of the increased focus on Force fitness in recent years. Although improvements in Marines fitness likely improve overall health, the relationship with injury during combat deployments remains unknown. Commanders acknowledge the difference between fitness test performance and realistic operational readiness. Traditional fitness tests are often negatively biased against participant body size, 7,8 whereas increased body size (not fatness) is positively associated with load carriage performance. 9 By introducing the CFT requirement, the USMC wanted to increase fitness and performance during combat-like tasks. We noticed that PFT scores improved during the study period (while standards have remained the same) and notably increased after implementation of the CFT. In this analysis, we could not account for other aspects of the Marine experience, which could improve PFT performance such as learning, maturity, increased responsibility, and increased education. However, it does appear that the overall fitness of the USMC is improving with the new programs in place. We intend to further explore the relationship of fitness test performance and potential injury since the implementation of the CFT. As we noted, the majority of female Marines passed the current male testing standard. Separating the standards on the basis of gender reduces the legitimacy of female performance on a fitness test. The recent end to the combat exclusion policy for women has challenged the Armed Services to evaluate their current physical testing standards. Because the front lines of recent engagements are murky at best, all Marines in combat, regardless of gender, should be held to the same minimum physical standard. Although it will likely take time for females in all service branches to adapt to more challenging standards, our data show that female Marines can meet the same minimum standard expected of their male peers. A common adage in business says, What gets measured and rewarded gets done. Because fitness test performance is weighed into enlisted promotion evaluations, 10 Marines are motivated to perform well on these tests. On-base programs, such as Semper Fit, 11 were put in place along with the CFT to educate Marines about training and operational readiness. Nevertheless, squads and individuals often train on their own time. CrossFit, High Intensity Tactical Training, and other similar workouts have become popular in Marine Corps communities. 12 With the ongoing conflicts and recent policy changes, USMC leaders will need to continue to evaluate the effectiveness of the CFT, particularly regarding genderneutral and MOS-specific standards. Overall, the USMC has adapted to meet additional testing requirements and appears to embrace the functional training philosophy. CONCLUSIONS Although we have more than a decade of comprehensive data for all Marines who took each available fitness test, it remains unclear whether the new USMC training and testing programs improve overall military capabilities. Active duty Marines consistently perform well above the minimum required physical standards. Interestingly, the vast majority of female Marines passed the current male requirements for the CFT. Although the traditional PFT might not reflect a true training benefit, Marines place a high value on first class test performance. We intend to further study the relationship between high physical capabilities (as measured via standardized fitness testing), injury prevention, and the demand on military medical resources during and after deployment. ACKNOWLEDGMENTS The authors would like to specifically thank Peggy Han, Kaeley Shannon and Jaime Horton for their assistance with this manuscript. This work was supported by BUMED Wounded, Ill, and Injured W263, Work Unit No. 60332. 516 MILITARY MEDICINE, Vol. 180, May 2015

REFERENCES 1. Jonas W, O Conner F, Deuster P, Peck J, Shake C, Frost SS: Why total force fitness? Mil Med 2010; 175(8): 6 13. 2. Office of the Commandant of the Marine Corps: Marine Corps Physical Fitness Program. Marine Corps Order 6100.13 W/CH 1. Washington, DC, Department of Defense, 2008. Available at http://www.marines.mil/portals/59/publications/mco%206100.13%20w_ch%201.pdf; accessed May 6, 2014. 3. Knapik J, Ang P, Reynolds K, Jones B: Physical fitness, age, and injury incidence in infantry soldiers. J Occup Med 1993; 35: 598 603. 4. Jones BH, Cowan DN, Tomlinson JP, Robinson JR, Polly DW, Frykman PN: Epidemiology of injuries associated with physical training among young men in the army. Med Sci Sports Exerc 1993; 25: 197 203. 5. Jones BH, Knapik JJ: Physical training and exercise-related injuries. Surveillance, research and injury prevention in military populations. Sports Med 1999; 27: 111 25. 6. Reynolds KL, Heckel HA, Witt CE, et al: Cigarette smoking, physical fitness, and injuries in infantry soldiers. Am J Prev Med 1994; 10: 145 50. 7. Bilzon JL, Allsopp AJ, Tipton MJ: Assessment of physical fitness for occupations encompassing load-carriage tasks. Occup Med (Lond) 2001; 51: 357 61. 8. Crowder TA, Ferrara AL, Levinbook MD: Creation of a criterion-referenced Military Optimal Performance Challenge. Mil Med 2013; 178: 1085 101. 9. Vanderburgh PM: Occupational relevance and body mass bias in military physical fitness tests. Med Sci Sports Exerc 2008; 40: 1538 45. 10. Office of the Commandant of the Marine Corps: Marine Corps Promotion Manual, Volume 2, Enlisted Promotions. Marine Corps Order P1400.32D Ch 2. Washington, DC, Department of Defense, 2012. Available at http:// www.marines.mil/portals/59/publications/mco%20p1400_32d%20ch2 %20PT%201.pdf; accessed May 6, 2014. 11. Office of the Commandant of the Marine Corps: Semper Fit Fitness and Health Promotion Policy. Marine Corps Order 1700.29. Washington, DC, Department of Defense, 2013. Available at http://www.marines. mil/portals/59/mco%201700_29.pdf; accessed May 6, 2014. 12. Mitchell B: CrossFit workout craze sweeps the Corps. Marine Corps Times, June 22, 2008. Available at http://www.marinecorpstimes.com/ article/20080622/news/806220313/crossfit-workout-craze-sweeps-corps; accessed May 6, 2014. MILITARY MEDICINE, Vol. 180, May 2015 517