The Commander's Wellness Program: Assessing the Association Between Health Measures and Physical Fitness Assessment Scores, Fitness Assessment Exemptions, and Duration of Limited Duty.

Introduction: Air Force Medical Service health promotions staff have identified a set of evidenced-based interventions targeting tobacco use, sleep habits, obesity/healthy weight, and physical activity that could be integrated, packaged, and deployed as a Commander's Wellness Program. The premise of the program is that improvements in the aforementioned aspects of the health of unit members will directly benefit commanders in terms of members' fitness assessment scores and the duration of periods of limited duty. The purpose of this study is to validate the Commander's Wellness Program assumption that body mass index (BMI), physical activity habits, tobacco use, sleep, and nutritional habits are associated with physical fitness assessment scores, fitness assessment exemptions, and aggregate days of limited duty in the population of active duty U.S. Air Force personnel.

Methods: This study used a cross-sectional analysis of active duty U.S. Air Force personnel with an Air Force Web-based Health Assessment and fitness assessment data during fiscal year 2013. Predictor variables included age, BMI, gender, physical activity level (moderate physical activity, vigorous activity, and muscle activity), tobacco use, sleep, and dietary habits (consumption of a variety of foods, daily servings of fruits and vegetables, consumption of high-fiber foods, and consumption of high-fat foods). Nonparametric methods were used for the exploratory analysis and parametric methods were used for model building and statistical inference.

Results: The study population comprised 221,239 participants. Increasing BMI and tobacco use were negatively associated with the outcome of composite fitness score. Increasing BMI and tobacco use and decreasing sleep were associated with an increased likelihood for the outcome of fitness assessment exemption status. Increasing BMI and tobacco use and decreasing composite fitness score and sleep were associated with an increased likelihood for the outcome of limited duty status, whereas increasing BMI and decreasing sleep were associated with the outcome of increased aggregate days of limited duty. The observed associations were in the expected direction and the effect sizes were modest. Physical activity habits and nutritional habits were not observed to be associated with any of the outcome measures.

Conclusions: The Commander's Wellness Program should be scoped to those interventions targeting BMI, composite fitness score, sleep, and tobacco use. Although neither self-reported physical activity nor nutritional habits were associated with the outcomes, it is still worthwhile to include related interventions in the Commander's Wellness Program because of the finding in other studies of a consistent association between the overall number of health risks and productivity outcomes.