Environmental Medicine and Sciences Division, Institute of Naval Medicine, Crescent Road, Alverstoke, Hampshire PO12 2DL, UK.
Regional Medical Centre, RAF Halton, Aylesbury, Bucks HP22 5PG, UK.
Mil Med. 2020 Feb 13;185(1-2):170-177. doi: 10.1093/milmed/usy177.
Musculoskeletal injuries are common during military and other occupational physical training programs. Employers have a duty of care to reduce employees' injury risk, where females tend to be at greater risk than males. However, quantification of principle co-factors influencing the sex-injury association, and their relative importance, remain poorly defined. Injury risk co-factors were investigated during Royal Air Force (RAF) recruit training to inform the strategic prioritization of mitigation strategies.
A cohort of 1,193 (males n = 990 (83%); females n = 203 (17%)) recruits, undertaking Phase-1 military training, were prospectively monitored for injury occurrence. The primary independent variable was sex, and potential confounders (fitness, smoking, anthropometric measures, education attainment) were assessed pre-training. Generalized linear models were used to assess associations between sex and injury.
In total, 31% of recruits (28% males; 49% females) presented at least one injury during training. Females had a two-fold greater unadjusted risk of injury during training than males (RR = 1.77; 95% CI 1.49-2.10). After anthropometric, lifestyle and education measures were included in the model, the excess risk decreased by 34%, but the associations continued to be statistically significant. In contrast, when aerobic fitness was adjusted, an inverse association was identified; the injury risk was 40% lower in females compared with males (RR = 0.59; 95% CI: 0.42-0.83).
Physical fitness was the most important confounder with respect to differences in males' and females' injury risk, rather than sex alone. Mitigation to reduce this risk should, therefore, focus upon physical training, complemented by healthy lifestyle interventions.
肌肉骨骼损伤在军事和其他职业体能训练计划中很常见。雇主有责任降低员工的受伤风险，而女性受伤的风险往往高于男性。然而，对于影响性别-损伤关联的主要共同因素及其相对重要性的量化，仍定义不明确。本研究旨在通过调查英国皇家空军（RAF）新兵训练中的损伤风险因素，为制定减轻策略的战略重点提供信息。
一项前瞻性队列研究纳入了 1193 名（男性 n = 990[83%]；女性 n = 203[17%]）正在接受第一阶段军事训练的新兵，监测他们的损伤发生情况。主要的独立变量是性别，在训练前评估了潜在的混杂因素（体能、吸烟、人体测量学指标、教育程度）。使用广义线性模型评估性别与损伤之间的关联。
在训练期间，共有 31%的新兵（男性 28%；女性 49%）至少发生了一次损伤。与男性相比，女性在训练期间受伤的未调整风险增加了两倍（RR = 1.77；95%CI 1.49-2.10）。在将人体测量学、生活方式和教育指标纳入模型后，超额风险降低了 34%，但关联仍然具有统计学意义。相比之下，当调整有氧健身时，发现了一个相反的关联；与男性相比，女性的损伤风险降低了 40%（RR = 0.59；95%CI：0.42-0.83）。
就男性和女性受伤风险的差异而言，体能是最重要的混杂因素，而不仅仅是性别。因此，为了降低这种风险，应重点进行体能训练，并辅以健康的生活方式干预。
