Sports Med. 2026 Feb 12. doi: 10.1007/s40279-026-02399-3. Online ahead of print.
ABSTRACT
PURPOSE: Holistic Health and Fitness (H2F) is the United States Army’s largest force modernization initiative aimed at preserving combat power by optimizing soldier readiness across five domains: physical, mental, nutritional, sleep, and spiritual. At the core of this effort are H2F Performance Teams (HPTs): embedded, interdisciplinary subject matter experts, composed of strength and conditioning coaches, athletic trainers, physical and occupational therapists, registered dietitians, and mental readiness professionals. These teams operate within brigades to deliver proactive, preventive, and performance-enhancing interventions that reduce injury risk, accelerate rehabilitation, improve fitness and cognitive performance, and sustain deployability. This evaluation quantified the return on investment (ROI) of embedded HPTs across 56 matched active-duty brigades (28 HPT-resourced, 28 controls), encompassing over 1,000,000 soldiers from fiscal year (FY) 2019 through FY2023.
METHODS: A quasi-experimental, presence-based difference-in-differences framework estimated multiyear treatment effects for musculoskeletal injury (MSKI) referrals and profiles, behavioral health (BH) and substance abuse (SA) profiles, Army Combat Fitness Test (ACFT) pass/failure rates, Army Body Composition Program (BCP) noncompliance, and Rifle Marksmanship Qualification (RMQ). Outcome deltas were monetized using validated cost-per-case benchmarks from military/government reports and peer-reviewed studies. A 10,000-draw Monte Carlo simulation, incorporating triangular distributions and a ρ = 0.15 Gaussian copula, modeled fiscal uncertainty, interdomain dependency, and force-wide extrapolation.
RESULTS: Despite significantly worse baseline odds pre-resourcing, HPT brigades reversed all major readiness disadvantages by FY2023. MSKI referral odds declined 61% (odds ratio [OR] 1.16 → 0.45), SA profile odds dropped 79% (OR 1.92 → 0.41), and BH > 90-day profile odds fell 44% (OR 1.51 → 0.84). ACFT failure odds decreased 22% (OR 1.05 → 0.82), RMQ expert qualification odds increased 33% (OR 1.21 → 1.60), BCP failure odds decreased 12%, and RMQ failure odds declined 28%. Annually, per brigade, these effects translated to 1363 adverse events avoided and 37,484 duty days restored. Using domain-specific cost estimates, a 10,000-draw Monte Carlo simulation estimated mean annual cost avoidance of $14.06 M per brigade (95% CI $12.25-16.19 million), with 99.05% of draws exceeding a 4:1 ROI. Duty day restoration and expert RMQ gains added $10.38 million (95% CI $8.15-13.00 million) in readiness value. Combined, annual total economic value reached $24.44 million per brigade (ROI = 8.15:1; 95% CI 7.17-9.27), with force-wide extrapolation yielding $5.28 billion in annual total Army returns. Every $1 invested in HPTs returns $8.15 in value ($4.69 in cost avoidances and $3.46 in readiness improvements).
CONCLUSIONS: Embedded HPTs produce robust, statistically significant, multidomain improvements in readiness, performance, and cost efficiency. These estimates exclude long-horizon returns such as retention, disability deferral, or downstream system savings-suggesting total ROI is significantly underestimated. This study indicates HPTs are core readiness infrastructure. Their full-scale implementation is a strategic imperative for modernizing force sustainment and preserving the Army’s most critical asset: the soldier.
PMID:41678032 | DOI:10.1007/s40279-026-02399-3
