Physical activity in postdeployment Operation Iraqi Freedom/Operation Enduring Freedom veterans using Department of Veterans Affairs services.

INTRODUCTION Despite the high degree of physical fitness required for Active Duty servicemembers of the U.S. Armed Forces and when compared with nonveterans of all ages, the veteran population has a greater prevalence of being overweight [1] and obese [1-2]. Furthermore, veterans receiving healthcare services from the Department of Veterans Affairs (VA) have a greater prevalence of obesity than the general public [3-4] as well as veterans not using VA services [2,4]. In comparison with the general public and veterans not using the VA, veterans using VA services have also been shown to self-report poorer health [4-6]; are more likely to be physically inactive [2]; and are more likely to carry one or more chronic diagnoses such as hypertension, hypercholesteremia, and diabetes [2,4,6-7]. Moreover, U.S. veterans who have spent time in theater often experience mental illnesses, pain syndromes, and musculoskeletal complaints [8-12]. These represent independent risk factors for sedentary behavior and obesity and are associated with increased morbidity and mortality [13-20]. Recently returned Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) veterans represent a unique population served by the VA. Having recently been engaged in a physically demanding environment, these veterans, many with physical and/or mental sequelae from their tour of duty, face an abrupt transition to civilian life [11,21-28]. In light of the growing body of evidence demonstrating the benefits of physical activity, including decreasing both obesity-associated morbidity and mortality [29-30] and disability from chronic musculoskeletal pain [31], OIF/OEF veterans using the VA are an ideal population for interventions centered around increasing physical activity. Of the postdeployment OIF/OEF veterans using the VA, this study identified their perception of physical activity and the types of physical activity engaged in during Active Duty and postdeployment. By further understanding postdeployment veterans' perceptions of physical activity as well as physical activities they engage in postdeployment, the VA may be able to develop targeted interventions to manage optimal weight and prevent overweight and obesity, along with its sequelae, in this population. METHODS We conducted a cross-sectional survey of postdeployment OIF/OEF veterans who were registered with the VA Ann Arbor Healthcare System, Ann Arbor, Michigan, from October 2001 through July 2007. The survey was open for a period of 3 months (June-August 2008). The Computerized Patient Record System, the electronic medical record system used by the VA, was used for recruitment to create a database of 3,352 OIF/OEF veterans and servicemembers. The vast majority of these identified veterans were separated from the military. Those veterans who were deceased, had an unclear period of military service or unclear registration date with the VA, or had an incomplete address were excluded from the database (n = 1,089). Invitations to participate in the online survey were sent to the remaining 2,263 OIF/OEF veterans through the U.S. mail. Of those mailed, 214 were returned as undeliverable, resulting in 2,049 delivered invitations. These invitations included a link to the online survey as well as a unique 6-digit personal identification number (PIN) that was required to access the survey. The online survey was conducted through SurveyMonkey (http://www.surveymonkey.com/; Palo Alto, California), a for-profit Web site that allows users to design and manage online surveys as well as compile survey responses. After following the survey link, participants were presented with information regarding the survey and an informed consent statement. Participants were required to agree to the informed consent statement to proceed. After consenting, participants were asked to provide their PIN. This PIN was used to screen for uninvited survey respondents and identify any possible duplicate respondents. …