Context Over the past decade, the United States military has taken an interest in addressing soldiers’ spiritual fitness and readiness to help improve their mental health and resiliency. Similar efforts have not been applied within the Reserve Officers’ Training Corps (ROTC) population despite the mental health challenges these college students experience. Objective To examine spiritual readiness, spiritual fitness, and depressive symptoms in ROTC cadets. Design Cross-sectional study. Setting Web-based survey. Patients or Other Participants We recruited ROTC cadets from 1 large southeastern university (n = 91 of 315, 28.9% response rate). The ROTC cadets (age = 21 ± 3 years; men = 68, 74.7%; women = 22, 24.2%; missing = 1, 1.1%) were mainly classified as juniors (n = 30, 33.0%) and in Army ROTC (ROTC branch: Army = 69, Air Force = 20, Navy = 2). Main Outcome Measure(s) The survey contained 3 validated instruments used to assess spiritual fitness (the Spiritual Fitness Inventory [SFI]), spiritual readiness (Spiritual Wellbeing Scale [SWBS]), and mental health via depressive symptoms (Patient Health Questionnaire [PHQ-9]). Results were analyzed using descriptive statistics and nonparametric Mann-Whitney U tests to compare belief in God or gods with the dependent measures. A Pearson correlation was calculated to assess the relationship between the SWBS score and PHQ-9 data. Results In total, 85.7% (n = 78/91) of ROTC cadets stated that they believed in God or gods. Overall, the cadets were considered to have average spiritual fitness (mean = 75.04 ± 14.89) and moderate spiritual well-being (mean = 90.46 ± 18.09). The average PHQ-9 score was 4.22 ± 5.25. Individuals who believed in God or gods had higher spiritual readiness (believer = 94.44 ± 16.10, nonbeliever = 67.00 ± 9.35; P ≤ .01). No statistically significant differences were noted for symptoms of depression (believer = 3.38 ± 4.90, nonbeliever = 6.60 ± 6.90; P = .143) or spiritual fitness (believer = 76.12 ± 14.78, nonbeliever = 64.40 ± 12.68; P = .054) in ROTC cadets based on belief status. Conclusions Overall, the ROTC cadets had moderate to average spiritual fitness and readiness, with typical depressive symptoms scores. Spiritual readiness was different for those who believed in God or gods, and existential well-being was significantly correlated with depressive symptoms.

ABSTRACT Introduction Although bone formation has been observed in the distal tibia of trainees during Basic Combat Training (BCT), some animal studies have demonstrated greater mechanosensitivity in the juvenile compared to the mature skeleton. How age affects skeletal adaptations to military training is unknown. The purpose of this study was to determine if skeletal adaptations to US Army BCT differ by age. Methods We enrolled 2085 trainees (1303 males, 782 females). High-resolution peripheral quantitative computed tomography was used to assess total, cortical, and trabecular bone mineral density (BMD) and the microarchitecture of the distal tibia before and after 8 wk of BCT. Generalized linear models were used to compare mean percent change (95% confidence interval (CI)) in each bone parameter by age group (<20, 20–25, 26–29, and ≥30 yr) and to evaluate differences in bone parameter changes between age groups (effect estimates (95% CI)). Models were stratified by sex with multivariable adjustment. Results Male and female trainees in all age groups had increases in total BMD, trabecular BMD, and trabecular bone volume fraction from baseline ( P < 0.01 for all). Male and female trainees also had increases in trabecular thickness from baseline in all groups ( P < 0.05) except females ≥30 yr old. Female trainees 20–25 yr old had a significantly larger increase in trabecular thickness than those <20 yr old (effect estimate (95% CI), 0.33% (0.02%–0.64%); P < 0.05). Trabecular microarchitecture was largely not otherwise different between age groups for either sex. Male and female trainees <20 yr old had greater changes in cortical BMD compared to older age groups (males, P < 0.01; females, P < 0.05 for all). Conclusion Trainees <20 yr old experience the greatest improvements in cortical BMD at the distal tibia during US Army BCT, suggesting that adaptive bone formation in cortical bone may be attenuated with skeletal maturity. However, the mechanosensitivity of trabecular bone to exercise training remains intact regardless of age.

In active populations with medial tibial stress syndrome (MTSS), is extracorporeal shockwave therapy an effective treatment to reduce pain? A computerized search was conducted in October 2021. Inclusion criteria consisted of participants 18+ years old with diagnosed MTSS for 21+ days, where pain was in the posterior medial aspect of the tibia. Exclusion criteria involved patients with tibial fractures, compartment syndrome, and prior treatment of MTSS with extracorporeal shockwave therapy. Results were measured by the number of days athletes could complete the running protocol pain-free according to the Likert scale (p = .008), visual analog scale (p = .001), and Roles and Maudsley scale (RMS; p = .002). The third study showed no statistical significance in pain reduction or self-perception of change in symptoms on the Numerical Rating Scale (NRS; p = .05). Using the Strengthening the Reporting of Observational studies in Epidemiology scale, one study received a 17/22 since no biases were addressed, lack of participant status in each stage of the study, no numbers or analysis reported in each group, and no explanation of external validity or funding. The single-blind randomized controlled trial received a 10/11 using the Physiotherapy Evidence Database scale and one level of evidence. The double-blind sham randomized controlled trial received an 11/11 and one level of evidence (LOE). The research appraised would mostly agree the use of extracorporeal shockwave therapy could reduce pain in MTSS in active populations. The strength of recommendation is B.

The clinical question examined the use of the Shoulder Return to Sport after Injury (SI-RSI) scale to measure athletes' mental readiness after a shoulder injury to improve the return-to-play (RTP) decision-making process. In September 2023, a computerized search of PubMed for evidence was completed. Four articles met the inclusion and exclusion criteria. Outcomes included quantitative evidence of SI-RSI scores and if the athletes RTP. All four studies were evaluated using the Strengthening the Reporting of Observational Studies in Epidemiology Critical Appraisal Checklist. Points were removed for no explanation of statistical analysis, bias, funding, and loss of participants. Two of the included studies concluded that patients who RTP passed the SI-RSI benchmark 73.1% and 81.4% of the time. One study found that 74% of athletes that passed their determined benchmark returned to the same level of play after the injury. One study revealed that participants who RTP scored higher on the reinjury fear and risk subscale compared with those who did not (42.2 +/- 23 vs. 27.3 +/- 16, p = .02). The Strength of Recommendation Taxonomy checklist concluded a Level C recommendation because of the consistent Levels 2 and 3 evidence across all four studies. This recommendation accounts for the disease-oriented outcomes measured across all studies. This evidence suggests that the SI-RSI helps evaluate psychological readiness before RTP after a shoulder dislocation. Clinically, this may limit the recurrence of shoulder dislocations by requiring athletes to pass the SI-RSI benchmark.

Mindful Sports Performance Enhancement (MSPE) training is a relatively new concept, which focuses on helping athletes manage a variety of stressors experienced throughout a season, including performing well academically, staying fit, having a productive season in their sport, and maintaining a healthy social life. A need for a critical appraisal is needed to assess the effectiveness of the intervention. Two cohort studies and one randomized control trial were included in the study and assessed using STROBE and PEDro Scale. Key results show, all 3 studies identified participants experiencing benefits after MSPE with aspects of awareness, acceptance, and emotion regulation. Furthermore, student-athletes who attended either all the sessions or more sessions after the 6-week course showed greater satisfaction with mental and physical health. Overall, there is level "B" evidence to support effectiveness of MSPE for college athletes in reducing sport anxiety and improving their overall well-being.