This report examines the relationship between the Army Combat Fitness Test (ACFT), the U.S. Army's physical fitness test of record, and injuries among active component soldiers. The authors used available data to gain initial insights on the relationship between test administration, individual test events, and injury risk. The report provides policy options that the Army can consider to assess soldiers at risk and reduce preventable injuries.

The Army Combat Fitness Test (ACFT) and the Health of the Active Component

Understanding the Link Between the ACFT and Personnel Health and Injuries

Daniel Hicks, Carra S. Sims, Mary Avriette, Max Steiner, Sarah Baker

ResearchPublished Mar 10, 2025

The Army Combat Fitness Test (ACFT) became the U.S. Army's physical fitness test of record in October 2022. The test is substantially different from the previous test and consists of six events intended to measure a more expansive set of capabilities: muscular strength and endurance, power, speed, agility, aerobic endurance, balance, flexibility, coordination, and reaction time. One of the Army's stated goals for the test was to reduce preventable injuries. More than half of soldiers experienced a new injury in 2021, so success in reducing the risk of injury could have a significant impact on both medical costs and lost workdays. Because the ACFT has been administered for a relatively short period, there are limited data available to assess the relationship between the ACFT and soldier health and injuries. Nevertheless, this research effort used available data to gain initial insights into this relationship. This study was part of RAND's independent assessment of the ACFT, focusing specifically on injury risk.

To the extent that broader, more-holistic training is motivated by the more-expansive physical requirements of the ACFT, the literature suggests that the ACFT could in the long term lead to an overall reduction in injury rates. Many of the authors' recommendations focus on potential ACFT policy actions that the Army could take to help reduce preventable injuries and assess and monitor soldiers at risk.

Key Findings

The timing of ACFT administration is strongly associated with injury risk

  • The data showed an increase in overuse injuries prior to the test date but no change in the rate of acute trauma injuries leading up to the test.

Acute trauma and overuse injuries are a risk the day of the test

  • A brief spike in injuries occurred on the date of the test and for several days following the test date, which are likely injuries associated with the ACFT itself.

Risk of injury from the test appears to decline with experience

  • There was a decline in injury incidence associated with a soldier gaining experience with the ACFT.

The ACFT does not present a substantially greater injury risk than the Army Physical Fitness Test (APFT)

  • The pattern of observed injury for the ACFT was similar to or lower than that of the APFT.

Injury risks for male and female soldiers differ by body region

  • For both overuse and acute trauma injuries, women are significantly more likely to suffer lower-extremity injuries than their male counterparts, whereas men are more likely to suffer upper-extremity injuries.

Overall and event-specific ACFT performance is predictive of future injury risk

  • Soldiers who failed the ACFT were about 20 percent more likely to suffer an injury in the 180-day window following the ACFT.
  • Better performance on the ACFT is associated with reduced risk of injury in the 180-day window following the ACFT.
  • Cardiorespiratory activities exhibited some of the strongest positive associations between performance and reduced injury risk.

Recommendations

  • Include additional relevant determinants of injury risk in surveillance and monitoring systems.
  • Enhance existing or establish new procedures to collect cause-of-injury data.
  • Incorporate physical fitness assessments into injury surveillance.
  • Monitor ACFT performance throughout the performance range; do not focus only on those who do not pass.
  • Continue to monitor injury risk and track trends.
  • Continue to systematically collect data on desired outcomes from investments such as Holistic Health and Fitness.

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Hicks, Daniel, Carra S. Sims, Mary Avriette, Max Steiner, and Sarah Baker, The Army Combat Fitness Test (ACFT) and the Health of the Active Component: Understanding the Link Between the ACFT and Personnel Health and Injuries. Santa Monica, CA: RAND Corporation, 2025. https://www.rand.org/pubs/research_reports/RRA2005-1.html.
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The research described in this report was sponsored by the Office of the Assistant Secretary of the Army for Manpower and Reserve Affairs and conducted by the Personnel, Training, and Health Program within the RAND Arroyo Center.

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