The Prevalence of Low-Level Exertional Rhabdomyolysis and Muscle Damage During Military Field Training Exercises

Abstract

Exertional rhabdomyolysis (ER) is a condition characterized by skeletal muscle breakdown due to strenuous physical exertion. ER has a higher prevalence in populations undergoing rigorous training, such as military personnel. ER incidence rates in military settings are up to 20 times that of civilian populations. Despite this prevalence, many ER cases remain undiagnosed or underreported particularly among Reserve Officer Training Corps (ROTC) cadets. This research aims to explore physiological and psychological changes occurring during a two-to-three-day ROTC field training exercise (FTX), focusing on biomarkers such as creatine kinase and myoglobin, energy availability, hydration status, and training adaptations. The findings contribute to a deeper understanding of ER risk factors and recovery mechanisms in ROTC members. The first portion of this project examined the effects of an ROTC FTX on cadet nutrition and energy balance. The results demonstrated that cadets often fail to consume sufficient nutrition to maintain energy balance, leading to short-term low energy availability. This suggests that strategic fueling strategies, improved ration compositions, and enhanced nutrition education are necessary to sustain both training performance and long-term health. The second portion of this project explored the effects of an ROTC FTX on physical and psychological strain, measured through pain pressure threshold, mood, energy, and restfulness. The results demonstrated that cadets experienced a significant decline in mood, energy, and restfulness early in the FTX, particularly among Marines. Pain Pressure Thresholds (PPT) values correlated with fatigue and muscular strain, with novice cadets experiencing greater physiological stress. This suggests that recovery strategies should be tailored to branch-specific needs, experience level, and conditioning. The third portion of this research evaluated the effects of a ROTC FTX on hydration markers, electrolyte balance, and metabolic biomarkers. The results demonstrated significant changes in hydration status and metabolic markers, though blood markers of renal function remained stable. This suggests that monitoring hydration and metabolic responses is crucial in training environments. The final portion of this project brought together the three prior sections to evaluate the effects of an ROTC FTX on systemic stress, metabolic shifts, and muscular adaptations. The results demonstrated that cadets exhibited physiological changes in hydration status, metabolic markers, and pain tolerance. Higher body fat percentages and older age were correlated with greater metabolic fluctuations, and fitness levels appeared to buffer metabolic perturbations. These findings suggest that physiological responses to military training are transient, with adaptations primarily reflecting immediate physical demands rather than long-term alterations. Collectively, this body of research provides insight into the physiological and psychological adaptations experienced by ROTC cadets during a FTX. The findings suggest that cadets generally adapt well to training demands, and that nutrition, hydration, recovery strategies, and individual variability play key roles in optimizing performance and minimizing risks.