Changes in Firefighter Weight and Cardiovascular Disease Risk Factors over Five Years

Climbing the Ranks: A Study of Firefighter Health Disparities

The fire service command structure encompasses recruit, incumbent firefighter, and officer positions. The purpose of this study was to quantify the effect of rank (recruits, incumbent firefighters, and officers) on health and physical ability characteristics within the fire service. Retrospective data from thirty-seven recruits (age = 29 ± 5 yrs, BMI = 26.5 ± 2.3 kg/m2); eighty-two incumbent firefighters (age = 30 ± 7 yrs, BMI = 28.8 ± 4.3 kg/m2); and forty-one officers (age = 41 ± 6 yrs, BMI = 28.6 ± 4.3 kg/m2) from a single department were used. Participants completed body composition tests (i.e., body fat percentage [%BF] and body mass index [BMI]), an air consumption test (ACT), and cardiopulmonary exercise testing. The ACT consisted of 10 standardized tasks. Five separate one-way analyses of co-variance (ANCOVA) were calculated, accounting for age. Partial eta squared statistics were calculated and Bonferroni-corrected post-hoc analyses were employed. The results demonstrated a significant effect of rank on %BF (F = 9.61, p < 0.001, η2 = 0.10); BMI (F = 3.45, p = 0.02, η2 = 0.05); relative VO2MAX (F = 12.52, p < 0.001; η2 = 0.11); and HRMAX (F = 18.89, p < 0.001, η2 = 0.03), but not on ACT time (F = 0.71, p = 0.55, η2 = 0.01). These outcomes suggest there are variations in anthropometric and physiological metrics of health across firefighter ranks. Administrators should be aware how these markers of health may vary across firefighter ranks.

Evaluation of the relationship between occupational-specific task performance and measures of physical fitness, cardiovascular and musculoskeletal health in firefighters

INTRODUCTION

Firefighters are required to perform physically strenuous tasks such as hose drags, victim rescues, forcible entries and stair climbs to complete their public safety mission. Occupational-specific tasks are often used to evaluate the ability of firefighters to adequately/safely perform their duties. Depending on the regions, occupational-specific tasks include six to eight individual tasks, which emphasize distinct aspects of their physical fitness, while also requiring different levels of cardiovascular (CVH) and musculoskeletal health (MSH). Therefore, the aim of this study was to evaluate the relationship between specific occupational task performance and measures of physical fitness, cardiovascular and musculoskeletal health.

METHODS

Using a cross-sectional design, 282 full-time male and female firefighters were recruited. A researcher-generated questionnaire and physical measures were used to collect data on sociodemographic characteristics, CVH, MSH and weekly physical activity habits. Physical measures were used to collect data on physical fitness and occupational-specific task performance.

RESULTS

Absolute cardiorespiratory fitness (abV̇O2max), grip strength, leg strength, push-ups, sit-ups and lean body mass (all p < 0.001) had an inverse association with completion times on all occupational-specific tasks. Age was positively related to the performance of all tasks (all p < 0.05). Higher heart rate variability (HRV) was associated with better performance on all tasks (all p < 0.05). Bodyfat percentage (BF%) and diastolic blood pressure were positively associated with the step-up task (p < 0.05). Lower back musculoskeletal injury (LoBMSI), musculoskeletal discomfort (MSD), and lower limb MSD were associated with a decreased odds of passing the step-up. Upper body MSIs (UBMSI), LoBMSIs and Lower back MSD were associated with decreased odds of passing the rescue drag.

CONCLUSION

Firefighters that were taller, leaner, stronger and fitter with a more favourable CVH profile, higher HRV and less musculoskeletal discomfort performed best on all occupational-specific tasks.

The Effect of Craniosacral Therapy on Blood Levels of Stress Hormones in Male Firefighter Cadets: A Randomized Clinical Trial

(1) Background: Fire department cadets preparing to become firefighters and paramedics experience high levels of stress when participating in incidents like traffic accidents and fires. Stress adversely affects health, and coping with it proves difficult. Unfortunately, there is no single method that reduces stress completely in humans. One non-invasive method for lowering stress hormone levels is craniosacral therapy. (2) Methods: Fifty-seven firefighting cadets aged 18-24 years (21.63 ± 1.41) participated in the study. They were randomly assigned to either a test group or a control group. Participants' blood levels of cortisol and CRH (corticotropin-releasing hormone) were assessed before and after the study. The study group underwent 5-week craniosacral therapy (1× per week). (3) Results: The Kruskal-Wallis test showed that the therapy group's results were statistically significant for CRH values (p-value = 0.00067) and for cortisol values (p-value ≤ 0.0001). Wilxocon and Dunn tests showed statistical significance for cortisol after CS therapy between the control and study groups (p = 0.0377), and for CRH between the control and study groups before (p = 0.00634) and after the study (p = 0.000887), and in the study group before and after the study (p = 0.0101). (4) Conclusions: The application of craniosacral therapy reduced stress hormone levels in male firefighter cadets. The results indicate that craniosacral therapy (five sessions, one per week) has an effect on the reduction of stress hormones.

The Prevalence of Metabolic Syndrome and Its Components in Firefighters: A Systematic Review and Meta-Analysis

Previous studies consistently report a high prevalence of cardiovascular disease (CVD) risk factors among firefighters. However, the clustering of CVD risk factors, defined as metabolic syndrome (MetSyn), has received little attention by comparison. Therefore, the aim of this study was to estimate the pooled prevalence of MetSyn among firefighters. Using combinations of free text for 'firefighter' and 'metabolic syndrome', databases were searched for eligible studies. Meta-analyses calculated weighted pooled prevalence estimates with 95% confidence intervals (CI) for MetSyn, its components and overweight/obesity. Univariate meta-regression was performed to explore sources of heterogeneity. Of 1440 articles screened, 25 studies were included in the final analysis. The pooled prevalence of MetSyn in 31,309 firefighters was 22.3% (95% CI: 17.7-27.0%). The prevalences of MetSyn components were hypertension: 39.1%; abdominal obesity: 37.9%; hypertriglyceridemia: 30.2%; dyslipidemia: 30.1%; and hyperglycemia: 21.1%. Overweight and obesity prevalence rates in firefighters were 44.1% and 35.6%, respectively. Meta-regression revealed that decreased risk of bias (RoB) score and increased body mass index (BMI) were positively associated with an increase in MetSyn prevalence. Since one in five firefighters may meet the criteria for MetSyn, novel interventions should be explored to both prevent MetSyn and reduce the onset of CVD risk factors.

Weight Status and Binge Drinking Among Male and Female Florida Firefighters

OBJECTIVE

The aim of the study is to examine the association between weight status and binge drinking among Florida firefighters.

METHODS

Health survey data collected between 2015 and 2019 among Florida firefighters participating in the Annual Cancer Survey were analyzed for weight class (healthy, overweight, obese) and binge-drinking behaviors. Binary logistic regression models were fit and stratified by sex while controlling for sociodemographic and health characteristics.

RESULTS

Among 4002 firefighter participants, 45.1% binge drink, 50.9% are overweight, and 31.3% are obese. Among male firefighters, being overweight (adjusted odds ratio = 1.34; 95% confidence interval = 1.10-1.64) or obese (1.29; 1.04-1.61) was significantly associated with binge drinking compared with healthy weight counterparts. In female firefighters, being obese (2.25; 1.21-4.22) was significantly associated with binge drinking but being overweight was not.

CONCLUSIONS

Being overweight or obese is selectively associated with binge drinking among male and female firefighters.

Utilizing multimodal high-intensity interval training for a firefighter training academy during the COVID-19 pandemic

BACKGROUND

Firefighters typically undergo a 16-24-week training academy during which they perform a variety of traditional exercise programs such as cardiovascular, resistance, and concurrent training. Because of limited facility access, some fire departments seek alternative exercise programs, such as multimodal high-intensity interval training (MM-HIIT), which essentially combines resistance and interval training.

OBJECTIVE

The primary purpose of this study was to assess the effect of MM-HIIT on body composition and physical fitness in firefighter recruits who completed a training academy during the coronavirus (COVID-19) pandemic. A secondary purpose was to compare the effects of MM-HIIT to previous training academies that implemented traditional exercise programs.

METHODS

Healthy and recreationally-trained recruits (n = 12) participated in 2-3 days/week of MM-HIIT for 12 weeks and had several components of body composition and physical fitness measured before and after the program. Because of COVID-19-related gym closures, all MM-HIIT sessions were performed outdoors at a fire station with minimal equipment. These data were retroactively compared to a control group (CG) that previously completed training academies with traditional exercise programs.

RESULTS

Subjects in the MM-HIIT group significantly improved several components of body composition and fitness, including fat mass, fat-free mass, body fat percentage, aerobic capacity, and muscular endurance. Moreover, there were no significant differences for any dependent variable when MM-HIIT was compared to the CG.

CONCLUSION

These results suggest that MM-HIIT may serve as an effective substitute for traditional concurrent training paradigms that are typically used for firefighter academies.

A Pilot Study on the Relationship between Cardiovascular Health, Musculoskeletal Health, Physical Fitness and Occupational Performance in Firefighters

Firefighters’ face life threatening situations and are frequently exposed to numerous physical, chemical, biological, ergonomic and psychosocial hazards. The purpose of this pilot study was to investigate the feasibility of conducting a large-scale study on cardiovascular and musculoskeletal health, physical fitness and occupational performance of firefighters. We conducted a cross-sectional pilot study by recruiting 36 firefighters. A researcher-generated questionnaire and physical measures were used to collect data on sociodemographic characteristics, cardiovascular and musculoskeletal health, physical fitness and occupational performance using a physical ability test (PAT). We documented a high equipment and intra-assessor reliability (r > 0.9). The potential logistic and/or administrative obstacles in the context of a larger study were discerned. Data were successfully retrieved using available equipment and survey instruments. Hypertension (30.6%) dyslipidaemia (33.3%), obesity (36.1%) and physical inactivity (66.7%) were the most prevalent cardiovascular disease risk factors. A significant difference between genders in total PAT completion time was also seen (p < 0.001). Cardiorespiratory fitness, lean body mass, grip strength and leg strength were significantly associated with occupational performance (p < 0.001). The pilot study supports the larger study feasibility and verified equipment and assessors’ reliability for research. Cardiovascular health, musculoskeletal health and physical fitness may be related to PAT performance.

Retrospective Longitudinal Evaluation of Male Firefighter's Body Composition and Cardiovascular Health

OBJECTIVE

Describe firefighter body composition and cardiovascular health as a function of age.

METHODS

217 male firefighters with 1922 distinct evaluations over 23-years were included in this retrospective analysis. The firefighters had their height, mass, six-site skin-fold, blood pressure, and resting heart rate measured annually. Linear mixed models were used to analyze the effect of age. Significance was set to P < 0.05.

RESULTS

With each 1-year increase in age, mass (0.42 kg, P < 0.001), body mass index (0.13 kg m-2, P < 0.001), body fat percentage (0.18%, P < 0.001), fat mass (0.25 kg, P < 0.001), and fat free mass (0.15 kg, P < 0.001) increased. Systolic blood pressure (-0.09 mm Hg, P = 0.263), diastolic blood pressure (0.05 mm Hg, P = 0.308), and resting heart rate (0.07 beats min-1, P = 0.291) did not change.

CONCLUSIONS

Interventions to maintain healthy body composition are critical to reduce sudden cardiovascular related death risk.

Evaluation of metabolic syndrome and sleep quality in shift workers

BACKGROUND

Shift workers have risks associated with metabolic syndrome and low sleep quality.

AIMS

This study aimed to examine metabolic syndrome and sleep quality in firefighters and mine workers working shifts and daytime hours.

METHODS

A comparative descriptive study was conducted in two institutions on firefighters and mine workers (n = 120) who were working shifts (n = 84) and working daytime hours (n = 36). The data were obtained using a questionnaire including socio-demographic information, anthropometric measurements and the Pittsburgh Sleep Quality Index.

RESULTS

When risk of metabolic syndrome was compared with sleep quality, it was found that according to International Diabetes Federation criteria, 11% of those diagnosed with metabolic syndrome among shift-working firefighters and 5% of those diagnosed with metabolic syndrome among shift-working miners had low sleep quality. It was found that according to the National Cholesterol Education Program-Adult Treatment Panel III criteria, 9% of those diagnosed with metabolic syndrome among shift firefighters and 2% of those diagnosed with metabolic syndrome among shift miners had low sleep quality.

CONCLUSIONS

Preventive measures should be taken to reduce the risk of metabolic syndrome in shift workers.

Carotid intima-media and epicardial adipose tissue thickness in adult patients with epilepsy taking anti-seizure medication and its long-term significance

OBJECTIVES

We investigated epicardial adipose tissue thickness (EATT), carotid intima-media thickness (CIMT), and lipid profile in adult patients with epilepsy (PWE) taking anti-seizure medication(s) (ASM) and compared with those of the healthy population. We also investigated whether duration of follow-up and number of ASM(s) (mono- vs. polytherapy) affect these risk factors.

METHODS

Twenty PWE older than 18 years of age were recruited at the outpatient epilepsy clinic and compared to twenty controls. Patients who were 18 years old and younger, those with cardiovascular risk factors, and patients with follow-up duration less than 2 years were excluded from the study.

RESULTS

Epicardial adipose tissue thickness and CIMT were thicker compared to controls. While patients' low-density lipoprotein (LDL) levels were higher than controls, and high-density lipoprotein (HDL) levels were lower, the levels were in normal ranges. Those patients with duration of follow-up more than five years had thicker EATT. The 5-year LDL was in normal ranges while HDL was abnormally low. Number of ASM(s) was not associated with increased risks of atherosclerosis. Increased CIMT in patients taking ASM(s) was independent of their lipid profile.

CONCLUSION

Anti-seizure medications contribute to accelerated atherosclerosis in people with epilepsy. Chronic use of ASMs may increase this chance. It is appropriate to use ASM(s) with lower chances of atherosclerosis in people with epilepsy and encourage them to change their lifestyle in order to modify cardiovascular risk factors. Meantime, it is reasonable to assess the risk of atherosclerosis periodically in these patients by noninvasive methods including lipid profile, CIMT, and EATT.

A Cross-Sectional Examination of 10-Year Atherosclerotic Cardiovascular Disease Risk Among US Firefighters by Age and Weight Status

Examine atherosclerotic cardiovascular disease (ASCVD) risk scores by age and weight status in career firefighters.

Low testosterone and cardiometabolic risks in a real-world study of US male firefighters

Low serum total testosterone (TT) is associated with increased cardiovascular risk and metabolic derangements, with fatty liver (FL) emerging as an additional cardiometabolic threat. We investigated the associations between TT and cardiometabolic (CM) health in 298 US male firefighters. Cross-sectional data from occupational health examination were analyzed. TT was categorized as low (< 264 ng/dL), borderline (264–399 ng/dL), and reference (400–916 ng/dL). Conventional CM risk factors were compared among TT categories, and between firefighters with and without FL. 81% of firefighters were obese/overweight; almost 40% had FL. In the low-TT group, only 3.1% had normal BMI, while 78.1% had FL. The low-TT group had a worse CM profile, independently of age and BMI, and a fourfold higher adjusted odds of having FL. FL was associated with lower TT, regardless of age, BMI and HbA1c. Having a FL, HbA1c ≥ 5.7% or triglycerides ≥ 150 mg/dL increased the odds for low-TT by 4.1, 2.7 and 6.6 times, respectively. These real-world data reveal strong associations between low-TT and CM risk factors and support a call for action towards screening for low-TT and FL, regardless of age, BMI or dysmetabolic conditions in firefighters. Recognizing cardiometabolic risks in firefighters provides an opportunity to lessen cardiovascular diseases burden.

Cardiovascular Disease Risk Factors by BMI and Age in United States Firefighters

OBJECTIVE

This study examined cardiovascular disease risk factors by BMI category in firefighters, the association of BMI and age with risk factor prevalence, and the prevalence of risk factors by BMI category within age groups.

METHODS

Cardiovascular measures from the medical evaluations of 4,453 firefighters, performed between 2015 and 2018 at four occupational health clinics in the United States (South-West Cohort, Mid-Atlantic Cohort, South-East Cohort, and Mid-West Cohort), were analyzed cross-sectionally by BMI and age categories.

RESULTS

Among female firefighters with normal weight, 25% had high blood pressure, 8% had low high-density lipoprotein cholesterol, and 0% had high glucose, whereas the prevalence in female firefighters with obesity was 57%, 45%, and 11%, respectively. Among male firefighters, there were independent and significant associations of BMI and age for the prevalence of high blood pressure, high cholesterol, high triglycerides, and high glucose. Higher BMI category was associated with a higher prevalence of high blood pressure, high triglycerides, and low high-density lipoprotein cholesterol within all age groups and with a higher prevalence of high glucose and high cholesterol within ages 40 to 49 and 50 to 59 years.

CONCLUSIONS

An increasing prevalence of risk factors with older age and higher BMI suggests that preventive strategies should be initiated in younger firefighters and aggressively promoted or mandated throughout firefighters' careers.

Differences in 5-year weight change between younger and older US firefighters

BACKGROUND

Research consistently finds that, on average, firefighters gain weight over time and some data indicate that younger firefighters are more likely to gain weight than older firefighters. The purpose of this study was to estimate the 5-year weight change among younger and older US firefighters.

METHODS

Data from two occupational medical exams separated by 5 years (2009-2016) were examined from a cohort of US career firefighters in Virginia (males, n = 589; females, n = 67). The cohort was grouped into two age categories (< 45 years and ≥ 45 years). Weight change subgroups were Loss (decrease of > 3% body weight), Stable (within ±3% body weight) and Gain (increase of > 3% body weight). Multinomial logistic regression models and linear regression models were conducted to examine differences in the probability of being in a particular weight change category, weight change overall and by weight change category between younger and older firefighters.

RESULTS

At baseline, 25 and 35% of younger (< 45 years) and older (≥ 45 years) were obese, respectively. Younger firefighters gained significantly (P < 0.05) more weight (3.0 ± 0.2 kg) than older firefighters (0.8 ± 0.5 kg). Younger firefighters were more likely to gain weight (53% versus 39%) and less likely (10% versus 20%) to lose weight as compared to older firefighters. Smaller weight gains were associated with age and BMI with the smallest increases observed in overweight and obese firefighters ≥45 years of age.

CONCLUSIONS

Health care providers should be attentive to weight gain, even among young non-obese firefighters, and counsel firefighters to avoid the additive risks of being older and heavier. In addition, weight loss/management programs should be promoted in the fire service to encourage healthy body weight and to prevent unhealthy weight gain among both young and old firefighters alike.

Exploring the impact of the COVID-19 pandemic on the mental health of first responders

The present investigation evaluated the preliminary impact of COVID-19 exposure on first responder mental health. Data were collected between June and August 2020. The sample was comprised of 189 first responders (M_age = 47.58, SD = 10.93; 21% female), recruited nationally, who completed an online survey. Results indicated that COVID-19-exposed first responders were more likely to be emergency medical services [EMS] personnel (vs. non-EMS) in career (vs. volunteer) roles. COVID-19-exposed first responders reported higher alcohol use severity; no other between-group differences were noted. COVID-19-related worry and medical vulnerability were incrementally associated with more severe symptoms of anxiety and depression; only COVID-19-related worry was associated with alcohol use severity. Among the subset of first responders (n = 122) who reported COVID-19 exposure, COVID-19-related worry was significantly associated with PTSD symptom severity. Covariates included gender, trauma load, years as a first responder, and COVID-19 exposure. Clinical and policy implications as well as future directions will be discussed.

Firefighters Are More Physically Active On-Duty Compared to Off-Duty

Physical inactivity, coupled with increasing obesity levels, in firefighters plays a key role in aggregated cardiovascular events. The purpose of this study was to investigate device-measured physical activity (PA) for firefighters while on- and off-duty to have a clearer understanding of their overall PA level. Methods: Twenty-nine career firefighters participated in this non-experimental, within-subjects study by wearing an accelerometer to assess PA intensities and step-count. Obesity was classified using body mass index (BMI). Dependent t-tests were used to examine mean differences in PA intensities when on- and off-duty. Pearson product-moment correlations were used to assess the association between PA intensities when on and off-duty. Results: According to the World Health Organization BMI categorizations, 20 firefighters were overweight, 9 were obese, and, thus, none were normal weight. Only light PA (LPA) was statistically significant (p = 0.026) for on- and off-duty days with a small-to-medium effect size (d = 0.47), meaning that on average, firefighters performed more minutes of LPA when on-duty compared to off. There was a significant difference between on- (9060.2 ± 2636.4) and off-duty (7495.3 ± 2835.8) daily step counts (p = 0.011). Conclusion: As the results demonstrate, there is a dire need for increased PA levels in firefighters while on- and off-duty.