What are the Predictors of Wellness Behaviours in US Army Physicians?

Research Paper Title

Predictors of Wellness Behaviors in U.S. Army Physicians.


In 2013, the U.S. Army Surgeon General implemented the Performance Triad (P3), an educational initiative to improve health-related behaviours of soldiers throughout the U.S. Army. The components of P3 are Sleep, Activity, and Nutrition with tenet behaviours for each component. This study reports the results of the 2015 U.S. Army Medical Corps survey regarding physician knowledge and adherence to the tenet behaviours of P3.


In 2015, an anonymous survey was sent to all active duty U.S. Army physicians to assess demographic information, work hours, and knowledge of and adherence to P3. The survey assessed the tenets of P3 with questions about the following topics:

  • Obtaining 8 h of sleep per day;
  • Performing at least 2 d of resistance training and 1 day of agility training per week;
  • Re-fueling 30-60 min after exercise;
  • Incorporating at least 150 min of moderate and 75 min of vigorous aerobic exercise per week;
  • Going caffeine free 6 h before bedtime;
  • Eating at least 8 servings of fruits and vegetables per day; and
  • Getting 15,000 steps per day.

For each question, there were four response options which ranged from “Always” to “Never.” A positive response to the questionnaire was defined as answering frequently or always. The responses were analysed by comparison of several physician categories utilising descriptive statistics and multi-variable analysis.


Surveys were completed by 1,003 of approximately 4,500 U.S. Army physicians. 79.1% of the respondents were male. Staff physicians made up 834 (83.6%) of the respondents compared with 164 (16.4%) physicians in training. Overall 25% of respondents were adherent to the sleep tenet, 45% to the exercise tenet, and 38% to the nutrition tenet. Reported work hours were significantly higher in physicians in training compared with staff physicians (p < 0.001).

About 28.4% of staff reported a positive response to obtaining at least 8 h of sleep per night, compared with 12.7% of residents/fellows. In multi-variable analyses:

  • Better sleep was associated with being a staff physician [odds ratio 2.4 (95% confidence interval 1.40-4.13)], working fewer hours per week [1.75 (1.37-2.25)], and belief in supervisor adherence to P3 [2.04 (1.59-2.56)].
  • Increased exercise was associated with male gender [2.09 (1.45-3.02)], being a staff physician [1.63 (1.09-2.43)], and belief in supervisor adherence to P3 [1.43 (1.18-1.75)].
  • Positive response to the nutrition tenet was associated with belief in supervisor adherence to P3 [1.23 (1.01-1.49)].


Overall, US Army physicians are most adherent to the exercise tenet and least adherent to the sleep tenet of P3; this is consistent with the military culture. Work hours seem to affect wellness behaviours. Specifically, physicians who work fewer hours are more likely to report obtaining 8 hours of sleep per day and exercise on a regular basis.

Importantly, belief in supervisor adherence to P3 was associated with better adherence to P3, suggesting that physician leadership has a positive effect on wellness behaviours. This suggests a role for similar wellness programmes in civilian healthcare institutions.

Future research should also include changes in health system policies to motivate physician wellness behaviours.


Hsu, D.P., Hansen, S.L., Roberts, T.A., Murray, C.K. & Mysliwiec, V. (2018) Predictors of Wellness Behaviors in U.S. Army Physicians. Military Medicine. 183(11-12), pp.e641-e648. doi: 10.1093/milmed/usy059.


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