Firefighters spend their days and nights carrying out one of the most vital of all community services: saving lives and saving the homes in which we live. However, many of these professionals fail to realize the potential incendiary health problems simmering within their own bodies. In this article, we will delve into the appropriate fitness and nutrition guidelines for firefighters, in an effort to minimize their risk for heart disease and other professional hazards.
The Fire Within
As heroes who battle a relentless beast, firefighters choose to place their lives on the line each time they show up for a shift at the firehouse. Surprisingly, a significant number of on-duty firefighter deaths come in the form of heart disease, something no amount of protective gear can prevent. Cardiac arrest, the leading cause of death among firefighters aged 40 to 50, can arise due to a variety of job-related factors:
- poor dietary habits
- the presence of subclinical or clinical heart disease
- the stressful natureof the job itself, both emotional and physical
Researchers from the Centers for Disease Control determined that over the course of 10 years, 610 volunteer and 368 career firefighters died while on duty. Upon further analysis, the researchers looked specifically at the causes of death; they discovered that 50% of the deaths among the volunteer group and 39% among career firefighters were related to heart attacks. The median age of death was 47 for volunteers and 44 for career firefighters.
In 2008, in an effort to mitigate this risk, the International Association of Fire Fighters joined forces with the International Association of Fire Chiefs to create the Fire Service Joint Labor Management Wellness-Fitness Initiative (WFI). Upon recognizing the unique heart disease risks associated with firefighting duties, WFI set about creating fitness and wellness guidelines specific to the needs of this population.
Unique Duties Require Specialized Needs
One research study involved taking a task analysis of all common firefighting operations, followed by an in-depth physical/physiological characterization of those tasks which they deemed the most demanding in terms of energy output. The most common call for strength and/or endurance fell into the following three categories:
- lifting and carrying objects, often weighing up to 80 lbs.
- pulling objects up to 135 lbs.
- working with objects in front of the body weighing up to 125 lbs.
The most demanding firefighting operations required a mean VO2 of 41.5 ml/kg.min-1; 90% of these particularly arduous operations necessitated a mean VO2 of 23 ml/kg.min-1. These aerobic energy requirements corresponded to 85% and 50% VO2max, respectively.
Historically, firefighters have followed fitness guidelines developed for athletes, in an attempt to prevent on-the-job illness and injury. This included training both physically and mentally for peak performance. However, the reality of the physical demands placed upon a firefighter responding to a call do differ greatly from those for which an athlete trains. While an athlete knows the day, time and location of his scheduled competitive event, and has the luxury of pacing his in-season training over time, a firefighter never knows when his event will occur. This means he must approach his diet and training in a different manner.
Recognizing the unique and often highly specialized training needs of firefighters and other emergency service workers, the National Strength and Conditioning Association (NSCA) outlined a unique set of exercise guidelines for these populations in a program called NSCA — Tactical Strength and Conditioning. The NSCAclassifies firefighters, EMS workers, military personnel and police officers as “tactical athletes,” those who require a unique training approach in order to remain mentally and physically fit for unexpected bursts of extreme physical activity and mental stress. We can think of this as optimally training for peak condition at all times, unlike a competitive athlete who strives to deliver his best performance for a singular event.
Physical Conditions Add to the Stress
When firefighters respond to a call, they may find themselves operating under strenuous and physically demanding conditions. The protective gear, from helmets to boots and everything in between, plus their self-contained breathing apparatus, can weigh upwards of 75 lbs. Carrying all of this equipment along with heavy hoses, potentially up and down ladders and stairs, can significantly impair postural and functional balance. They also must contend with extremely stressful minute-to-minute conditions while potentially pulling/carrying frightened bodies out of harm’s way while battling the smoke and overpowering temperatures. Collectively, coupled with the mental stress this profession carries, all of these factors place a tremendous burden on an individual’s heart rate.
In 2008, the Orange County Fire Authority participated in a research study that revealed just how dramatically an initial firefighter alarm could elevate the heart rates of monitored firefighters –the average increase reached over 170 bpm. Additionally, they discovered a rate increase of more than 50 bpm over the resting heart rate while firefighters assembled themselves into their personal protective equipment; the average firehouse expects employees to get dressed and jump in the firetruck within 60 seconds of hearing the alarm.
Once on the scene and engaging in the various lifesaving and strenuous tasks, heart rates inch up once more, typically reaching 182 bpm. When we consider that a firefighter climbing stairs, armed with gear, equipment and potentially victims, for five straight minutes may reach 95% of maximum cardiac output, we begin to comprehend the arduous and stressful nature of this profession, and why the need to protect one’s heart health takes such precedence. Armed with this knowledge, fitness/health professionals can help lessen many of the negative effects of such a stressful profession by offering ways that firefighters can remain physically fit, adopt nutritious meal plans and develop appropriate coping skills to address mental drain.
Preparing for Critical Balance
Another study, the results of which appeared in the Journal Aviation, Space and Environmental Medicine, investigated how the burden of fire-protective equipment (FPE) affected the functional/postural balance capabilities of both younger and older firefighters.
The subjects, 2 groups of professional firefighters classified by age (33-38 and 43-56 yr.), walked on a force platform to assess postural balance with and without the burden of FPE, and likewise on a wooden plank with and without FPE to determine if the extra load threw off their functional balance abilities.
The researchers determined that while wearing fire-protective gear, both postural and functional balance suffered, as well as the speed with which the firefighters could move, another key consideration in this profession. Taking their study a step further, attempting postural balance with eyes closed proved much more of a challenge for older firefighters than their younger co-workers.
This introduces the idea of bringing functional training into the realm of firefighting fitness and preparedness. By incorporating balance training into these exercise protocols, firefighters could see a diminished risk of injuries due to functional/postural imbalances.
Hazardous Duty and Ensuing Death Toll
An on-duty fatality gets recorded when a firefighter dies while physically at work or within 24 hours of his last shift. As referenced above, a firefighter may find himself working non-stop at 90-95% of his maximum heart rate while responding to a call. As a result, the demands on a firefighter’s cardiovascular system during physical work far exceed what even professionally trained athletes experience while engaging in intense exercise. If a firefighter lives on a daily basis with even subclinical vascular disease, the stress and pressure exerted within the arteries can break open both stable and unstable plaque, potentially triggering a heart attack or stroke.
Unforgiving Circumstances
Nutrition goals for firefighters include following heart-healthy eating behaviors both at work and at home, as well as striving to achieve/maintain a healthy weight. Many individuals whose weight places them in the overweight category can live for years without undo complications from clinical risk factors such as elevated triglyceride levels, high A1C and uncontrolled blood pressure. However, less latitude exists for unhealthy levels given the circumstances in which firefighters find themselves on a regular basis. Excess body fat increases the heart’s workload, and also amplifies heat stress by preventing efficient heat dissipation during exercise. In addition, obesity increases the caloric expenditure required to perform firefighting tasks such as climbing ladders and stairs, and as such may elevate the risk of injury while performing these tasks.
Promoting Wellness
The Fire Service Joint Labor Management WFI promotes a heart-healthy diet, weight control, regular fitness training, and abstention from smoking. Their recommendation suggests that all fire departments, both volunteer and career, set forth a comprehensive wellness program that includes medical and fitness exams, behavioral (mental) health interventions, fitness training, and injury/medical rehabilitation. Unfortunately, since participation in this initiative remains voluntary, almost 70% of fire departments within the United States lack such critical programs.
By mandating such exams and interventions when necessary, physicians working together with firehouse Battalion Chiefs can address individual modifiable risk factors, and can pave the way for catching any preexisting or emergent heart conditions before a life-threatening situation ensues. If firefighters understand their health status and disease risk more fully, they may find the motivation within themselves to adopt a healthier lifestyle and engage in a training program aimed at preventing both cardiovascular disease and cardiac death.
Firefighters may need to learn that their wellness needs differ greatly from those of the general population, before they adopt a willingness to make lifestyle changes. Their very job description assumes that they agree to physically and mentally perform at their peak level, each and every time that alarm rings. For personal trainers seeking to create a niche business, working with EMT’s, firefighters, paramedics and police officers could open up a very successful and satisfying arena. Consider hosting a Wellness Fair for emergency personnel in your neighborhood, to raise awareness of the unique needs of these professionals. You can forge alliances with hospitals and registered dietitians, thereby offering a complete wellness package. Developing training protocols for the needs of this demographic might help push trainers out of their gym/fitness center comfort zone; and serving the public professionals who keep us safe can prove extremely rewarding.
Unlike a prize sought by professional athletes, such as winning the NCAA tournament trophy or the NHL’s Stanley Cup, firefighters see the ultimate trophy as returning home alive and healthy. Let’s help them make that a reality!
References
https://www.todaysdietitian.com/newarchives/020810p44.shtml
https://pubmed.ncbi.nlm.nih.gov/1325260/
https://pubmed.ncbi.nlm.nih.gov/14620471/
https://pubmed.ncbi.nlm.nih.gov/3701477/
