Tingelstad Hans Christian, Robitaille E, O'Leary T J, Laroche M-A, Larsen P, Reilly T
Personnel Support Programs, Directorate of Programs, Human Performance Research and Development, Canadian Forces Morale and Welfare Services, Ottawa, Ontario, Canada.
31 Canadian Forces Health Services Centre Detachment Meaford, Canadian Armed Forces Health Services Group, Ottawa, Ontario, Canada.
BMJ Mil Health. 2024 Nov 18. doi: 10.1136/military-2024-002747.
Musculoskeletal injuries (MSKI) are one of the biggest challenges for military services globally, contributing to substantial financial burdens and lost training and working days. Effective evidence-based intervention strategies are essential to reduce MSKI incidence, and research has shown the positive effect of both nutritional interventions and physical training (PT) interventions on reducing MSKI incidence. Levels of vitamin D metabolites have been associated with MSKI and bone stress fracture risk, while calcium and vitamin D supplementation has been shown to reduce the incidence of stress fractures during military training. Protein and carbohydrate supplementation during arduous military training (high volume, high intensity) has also been shown to reduce MSKI risk and the number of limited/missed duty days. PT has played a key role in soldier development to meet the occupational demands of serving in the armed forces. Paradoxically, while PT is fundamental to enhancing soldier readiness, PT can also be a major contributor to MSKI; emerging evidence suggests that the nature of the PT being performed is a risk factor for MSKI. However, strategies like reducing training load and implementing PT programmes using evidence-based training principles can reduce MSKI incidence among military service members by 33-62%, and reduce the financial burdens for military services. This review provides a summary of effective MSKI reduction interventions and provides strategies to enhance the success and adoption of such interventions.
肌肉骨骼损伤（MSKI）是全球军事服务面临的最大挑战之一，会造成巨大的经济负担以及训练和工作日的损失。有效的循证干预策略对于降低MSKI发病率至关重要，研究表明营养干预和体育训练（PT）干预在降低MSKI发病率方面均具有积极作用。维生素D代谢物水平与MSKI及骨应力性骨折风险相关，而补充钙和维生素D已被证明可降低军事训练期间应力性骨折的发生率。在艰苦的军事训练（高负荷、高强度）期间补充蛋白质和碳水化合物也已被证明可降低MSKI风险以及有限/缺勤天数。PT在士兵成长以满足军队服役职业需求方面发挥了关键作用。矛盾的是，虽然PT对于提高士兵的战备状态至关重要，但PT也可能是MSKI的主要促成因素；新出现的证据表明，所进行的PT的性质是MSKI的一个风险因素。然而，诸如降低训练负荷以及采用循证训练原则实施PT计划等策略，可将军事人员中的MSKI发病率降低33%至62%，并减轻军事服务的经济负担。本综述总结了有效的降低MSKI干预措施，并提供了提高此类干预措施的成功率和采用率的策略。
