ABERDEEN PROVING GROUND, Md. – One of the top challenges facing Army leaders today is maintaining a fit and ready force. In 2017, active-duty Soldier musculoskeletal, or MSK, injuries and related conditions led to 2 million medical encounters and roughly 10 million limited duty days. This works out to an average of 37 limited duty days per injury.This is where the Army’s Performance Triad program of sleep, activity and nutrition can play a crucial role in helping leaders improve their Soldier’s health.“The Army's P3 program gave me a solid baseline on the importance of getting enough sleep, healthy eating and fitness on overall Soldier well-being,” said Lt. Col. Aaron C. Teller, commander of the 79th Explosive Ordnance Disposal Battalion (EOD), Fort Riley, Kansas.Teller and his command sergeant major, Sgt. Maj. Brett Fisher, both participated in the P3 pilot program while stationed at Joint Base Lewis-McChord, Washington.“The initial program helped me focus on getting seven or more hours of sleep in a 24-hour period along with eating more fruits and vegetables,” said Fisher.The P3 program encourages Soldiers to incorporate sleep, activity and nutrition targets into their daily and weekly routines. The Army Public Health Center recently released updated P3 targets for the Army’s Soldier Athletes:Get seven or more hours of sleep per 24-hour periodTake short tactical naps when possibleSupplement unit PT with individual exercise for a total of more than 300 minutes of aerobic activity and three strength sessions each weekMix the types and intensity of exercises to keep muscles challengedInclude recovery days after hard workoutsEat at least eight servings of fruits and vegetables a dayRe-fuel 30-60 minutes after strenuous exerciseDrink plenty of water every day“Many Soldiers and Families are very busy and it takes creative strategies and planning to reach all of these targets,” said Joanna Reagan, registered dietitian at the Army Public Health Center. “Most Soldiers can balance the activity portion, however reaching the targets for sleep and nutrition are more difficult to achieve on a regular basis.”Teller and his leadership team are all working on the targets with their Soldiers.“Lt. Col. Teller and Command Sergeant MFisher have been big advocates for self-improvement, including their personal involvement in the battalion Army 10-miler team and routinely joining unit PRT events,” said Maj. Blake Zenteno, 79th EOD executive officer. “I have made these programs part of my leader counseling to ensure battalion leaders encourage these practices down to the Soldier level.”Reagan says leader investment is critical to prioritizing, and improving the health readiness of Soldiers and units.“Leaders can drive and accelerate culture change and provide resources to master the fundamentals of Personal Readiness,” said Reagan. “I also talk about how critical it is for leaders to talk to Soldiers about these goals along with supporting resources on the installations such as the Army Wellness Centers, registered dietitians, and R2 Performance Centers.”For example, the AWCs provide state-of-the-art health and fitness assessments through a standardized model implemented at 35 Army installations here and overseas.“With detailed monitoring and evaluating, we are able to track improvements in individual Soldier readiness outcomes,” said Joanna Ward-Brown, APHC’s project officer for Army Wellness Center Operations. “AWCs are also able to stratify musculoskeletal risk using a Soldier's BMI and two-mile run time in order to provide actionable data to unit leaders and individual Soldiers on how to decrease their risk of injury.”The most popular services at the AWCs are body composition assessment, metabolic testing and fitness testing, said Ward-Brown. The AWCs conduct body composition assessment via the BodPod, which is the gold standard of body composition measurement and uses air displacement technology in order to calculate an individual's body fat percentage. Metabolic testing measures an individual's resting metabolic rate, or RMR, using FitMate technology. This pinpoints the precise number of calories burnt during rest, which is crucial when trying to lose weight or build lean mass. The fitness testing performed at the AWCs involves sub-maximal VO2 testing, which measures cardiorespiratory fitness, strength assessments and a flexibility assessment to give a baseline of an individual's overall fitness level and track improvement over time.During her P3 presentations, Reagan asks unit members to all stand, and then she reads the P3 Soldier Athlete targets and has Soldiers sit down if they are currently missing a target. Not surprisingly, there usually aren’t a lot of Soldiers standing at the end of the list.“I was surprised that anyone could meet all of the targets at once -- everyone in the military should have a challenging time with the whole program,” said Fisher. “It is in the nature of our jobs to lack a lot of the things that are required to meet the objectives. I am trying a Holistic approach now and doing well at meeting most if not all of the requirements.”Zenteno, who was one of the few 79th EOD Soldiers left standing during Reagan’s presentation, recognizes the importance of self-care.“There is so much emphasis on ‘taking care of the team’ and leaving no Soldier behind, but when Soldiers/Leaders don’t take care of themselves, they go down and negatively affect the team,” said Zenteno. “Additionally, quality of life is important for us all, life can be hard enough without adding illness and fatigue to it all.”Teller says it’s important for leaders to model the right activities.“We're working very hard to ensure fitness equipment is available at all times for Soldiers to utilize on their schedule,” said Teller. “Sleep and nutrition are the tough ones, especially for our Soldiers in the barracks. Formal and informal discussions are needed regularly to shape sleep and nutrition behavior in addition to modeling a healthy lifestyle.”Teller recognizes the challenges of the P3 Soldier Athlete goals, and has modified his unit’s training schedule to help them meet the targets.“Tactical naps are challenging with my schedule, but I've started calendaring additional physical fitness during the duty day with Soldiers to ensure I'm supplementing unit PT for running team practice, weight training and other targeted activities,” said Teller. “I'm definitely not getting the eight servings of fruits and vegetables everyday but I'm working on it.”Reagan often works with the local installation registered dietitians, and Army Wellness Center health educators to raise awareness about the P3 goals and offer creative strategies to reach these targets.“Soldiers can reach the target for eight servings of fruits and vegetables with some adjustments in planning,” said Reagan. “Try new menus at breakfast with adding more veggies, new side dishes with extra veggies, including cut-up fruit as a dessert at dinner are easy tips. I also talk about establishing regular sleep patterns with healthy sleep tips.”Reagan also encourages leaders to incorporate the additional Holistic Health and Fitness goals of spiritual and mental fitness into their targets.Teller plans to incorporate sound holistic health and nutrition fundamentals into unit training and professional development plans.“I am excited to see where this program goes,” said Fisher. “I will definitely take advantage of several of the P3 events that are offered, and reach out to the Fort Riley Army Wellness Center this week to get more information and start working with the staff ASAP.”Ward-Brown says AWCs, like the one at Fort Riley, have been following a multi-channel communication strategy to enhance continuity of care and expand utilization/reach to clients while recommended COVID-19 physical and social distancing guidelines were in place during these past months.“As clients return to AWCs, the program is continuing to add virtual health coaching, health education, and social media as integral parts of program execution,” said Ward-Brown. “Together with face-to-face assessments and follow-on virtual health coaching, we anticipate to see even better Soldier performance outcomes and improved readiness in FY21.”Reagan says small changes can make a big difference.“Changing habits takes time but it helps if leadership, colleagues and family make changes together,” said Reagan. “Personalizing P3 strategies can be made through Army Wellness Centers and installation registered dietitians to optimize sleep, activity and nutrition.”Check out the Performance Triad Challenge webpage for more ideas.For print products, magnets or other resources, check out the P3 download center.The Army Public Health Center focuses on promoting healthy people, communities, animals and workplaces through the prevention of disease, injury and disability of Soldiers, military retirees, their families, veterans, Army civilian employees, and animals through population-based monitoring, investigations, and technical consultations.