Purpose This study aimed to determine the association between sickle cell trait (SCT) as a binary variable and hemoglobin S percentage as a stratified categorical variable with aerobic and anaerobic fitness. Methods This retrospective cohort study included all recruits who entered U.S. Air Force basic training between January 2009 and December 2014. Fitness parameters among recruits with and without SCT were compared using a standardized fitness assessment of a 1.5-mile timed run, 1 minute of push-ups, and 1 minute of sit-ups. Performance was further compared by stratifying those with SCT by their hemoglobin S percentage (20-29.99%; 30-39.99%; and ≥40%). Results Of all recruits (N=210,461) who entered training during the surveillance period, 2,161 (1.0%) had SCT. After adjusting for age, sex, race, body mass index, and ambient temperature while conducting the fitness assessment, recruits with SCT were slower on their initial run than their peers without SCT by a mean (standard error) of 9.4 (2.6) seconds (p
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