One on One

The One-On-One Column provides scientifically

supported, practical information for personal trainers
who work with apparently healthy individuals or
medically-cleared special populations.

COLUMN EDITOR: Paul Sorace, MS, RCEP, CSCS*D

Health Concerns With the

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Fire Service and the

Benefits of a Health and
Wellness Program for
a Fire Department
John Hofman, CSCS, MS
Sacramento Fire Department, Sacremento, California

ABSTRACT
THE ONE-ON-ONE COLUMN WILL
PROVIDE EVIDENCE-BASED
STRENGTH AND CONDITIONING
GUIDELINES TO ENHANCE PER-
FORMANCE WHILE REDUCING IN-
JURIES ON THE FIRE GROUND, AND
DISCUSS MODIFICATIONS/SAFETY
PRECAUTIONS SPECIFIC TO THE
NEEDS OF THE FIREFIGHTER.
HEALTH AND WELLNESS
RECOMMENDATIONS FOR
FIREFIGHTERS
rofessional firefighters are gener-
flexibility, and a healthy body compo-
sition are important not only for occu-
pational requirements but also for the
safety of the firefighters, coworkers,
and the general public. It has been
observed by Davis et al. that fire-
fighters had higher levels of physical
fitness of healthy age-matched non-
firefighters. However, they observed
dramatic reduction in physical fitness
across the career span for a firefighter
(3). Cardiac risk factors can increase
with age and be compounded by occu-
pational stressors. As a result, many fire
departments are seeking to incorporate
a health and wellness program to pre-
firefighters, but many fire departments
are unable to afford to implement
them. According to the National Fire
Protection Agency (NFPA) (10), 41%
of California fire departments had no
program to maintain basic firefighter
health and wellness. Despite the
increase in education regarding fire-
fighter health and wellness, researchers
at Iowa State University discovered
that 86% of volunteer firefighters did
not know their blood lipid levels and
47% did not know their blood pres-
sure (24).
The International Association of Fire-
fighters and International Associations

P ally selected on the basis of their

excellent physical fitness, fire-
fighting experience, and likelihood of
success with professional training. Aer-
obic endurance training, fitness, mus-
cular strength, muscular endurance,
vent coronary risk factors as well as
other health risks associated with
firefighting.
A comprehensive health and wellness
program is an important and proactive
strategy to protect the overall health of
of Fire Chiefs-Wellness Fitness Initia-
tive (IAFF/IAFC-WFI) established
“The 10 Cities Initiative,” which uses
some of North America’s finest fire de-
partments to improve the health and
wellness of fire department personnel.

74 VOLUME 37 | NUMBER 4 | AUGUST 2015 Copyright Ó National Strength and Conditioning Association
According to Kuehl et al. (9), the 10
departments within the WFI program
saved $1,336,535 per year compared
with fire departments that did not
implement a health and wellness pro-
gram. The WFI is based on the premise
that the program is nonpunitive and
confidential. For any program to suc-
ceed, it is recommended they adopt
these same conditions.
A comprehensive health and wellness
program should include the following
components:
 Regular fitness screenings and tiered
medical assessments
 Aerobic output
 Anaerobic output
 Resistance training
 Flexibility, mobility, and stability
 Hydration
 Nutrition
 Rehabilitation
 Data collection
REGULAR WELLNESS
SCREENINGS AND MEDICAL
ASSESSMENTS
Regular wellness screenings and
medical assessments are an impor-
tant foundation for a successful com-
prehensive health and wellness
program. The fire service developed
2 resources to aid in recommenda-
tions: NFPA 1583: Standard on
Health-Related Fitness Programs for
Firefighters (12) and NFPA 1582—
Comprehensive Occupational Medi-
cal Program for Fire Departments
(13). These resources are to provide
the minimum requirements of the
development, implementations, and
managements for a health-related fit-
ness program. It is not created to
establish physical performance crite-
ria and must be nonpunitive. The
purpose of these assessments is to
perform health screening, not pri-
mary care.
NFPA 1582 recommends an annual
medical examination for firefighters
older than 40 years, at least every 2
years for those aged between 30 and
39 years, and at least every 3 years for
those aged 29 years and younger (11).
Examinations should be standardized
for all members. The overall tiered
medical program provides a more
cost-effective strategy for depart-
ments to maintain a program and help
identify and render assistance to
members who need intervention.
Table 1 describes the most common
health risks associated with in the fire
service.
PHYSICAL FITNESS ASSESSMENT
Age and poor posture are 2 contrib-
uting factors to musculoskeletal inju-
ries. One-third of all firefighter
injuries occur between the age of 30
and 39 years (14). This is significant in
the prevention of injuries because
during this time period most fire-
fighters begin to lose their flexibility,
experience a reduction in aerobic
capacity, and gain weight.
Identify the firefighter’s needs first by
incorporating a comprehensive assess-
ment. An older more-experienced fire-
fighter who is overweight and has
a bad back may not be inclined to do
hard intervals. So, apply appropriate
levels of exercise and correct progres-
sions in regards to movement.
AEROBIC OUTPUT
Many recruits entering the fire acad-
emy do not have sufficient aerobic
capacity levels to fight fires. It is only
after they enter the academy and
receive the proper physical training
that they meet the necessary physical
requirements (18). Generally, most
training focuses on aerobic exercise
and muscular endurance, but this
does not provide the best evaluation
of the overall demands of firefight-
ing (16).
According to the Illinois Fire Service
Institute (4), 3 hours of prolonged fire-
fighting stiffens arteries and impairs
heart function in young healthy male
firefighters. One recent study per-
formed at the Institute of Health Sci-
ence and Applied Physiology (19)
showed that aerobic endurance after
weightlifting seemed to reduce the
arterial stiffness. Therefore, it may
be recommended to incorporate
Strength and Conditioning Journal | www.nsca-scj.com
aerobic training after resistance train-
ing sessions.
To determine aerobic capacity, many
fire departments incorporate some
type of aerobic assessment. Based on
the recommendations of the IAFF/
IAFC Wellness Fitness Initiative, a fire-
fighter should have a peak V̇ O2 of no
less than 42 mL$kg21$min21 to meet
the physical demands of the job. Those
who have a peak V̇ O2 of 33.5
mL$kg21$min21 or less have been
determined to be at risk because they
can only perform specific firefighter
tasks for a few minutes (21).
ANAEROBIC OUTPUT
High levels of anaerobic power have
been significantly correlated to job-
specific tasks (16). Hose operation,
structure ventilation, stair climbing,
and rescue operations all require
a high amount of anaerobic output.
Assessment of anaerobic performance
can provide exercise professionals
with valuable information about the
firefighter’s fitness status as well as
allowing them to monitor improve-
ment throughout their training.
Therefore, it is very important that
both an aerobic and anaerobic train-
ing program be part of the firefighter’s
exercise prescription.
RESISTANCE TRAINING
Although some fire departments have
implemented various forms of muscu-
loskeletal conditioning activities like
high-intensity training, and multipla-
nar metabolic conditioning, one-third
of all injuries in the fire service were
a result of physical exercise activities
(14). Firefighter’s applications of
strength and endurance were lifting ob-
jects (up to 80 pounds), pulling objects
(up to 135 pounds), and work with
objects at or beyond arms’ reach in
front of the body (up to 125 pounds)
(6). It is vital for a firefighter to have
a sufficient amount of strength
throughout their career to help reduce
musculoskeletal injuries.
GRIP STRENGTH
Most firefighter activities require
a high level of grip strength. Lack of
75
One on One

Table 1
Health risks associated within the fire service

Health concern Screening Health risk Recommendation

Obesity Body fat %/BMI Firefighters are often classified as obese or Body composition goals would be to work
overweight due to many factors with the person to affect health changes,
associated with the job (i.e., poor identify any reasons for obesity, address
nutrition, sleep disruptions, limited the underlying health issues, provide any
physical activity) (2,10). BMI was an assistance with a dietician and fitness
independent predictor of absenteeism trainer, and monitor their progress
due to injury (10,22)
Hypertension Blood pressure Hypertension is still the leading risk factor Exercise reduces the risk of having high
for heart disease and stroke (3). Elevated blood pressure by 50%, and if you already
blood pressures have both acute and have hypertension, regular physical
chronic health concerns, which usually fitness activity can take about 10 mm Hg
improve with exercise and diet (4) off your systolic and diastolic pressure (5)
Lung function FEV1/FVC% Lung function and obstructive airway Subjects’ lung disease statuses may vary.
diseases are strongly and independently Individualized assessments should
associated with increased risk of heart evaluate each firefighter’s abilities to
failure (15) perform functions safely without further
impacting on the disease. If possible,
consult with the individual’s
pulmonologist
Aerobic METS Firefighters with a low aerobic capacity Male firefighters in the lowest fitness
capacity increase their chances of having category (METS #10) had a nearly
a myocardial infarction (3) 10-fold higher prevalence of metabolic
syndrome compared with colleagues
in the highest fitness category
(METS .14) (1)
Diabetes Glycated High blood sugar or diabetes mellitus is Carbohydrate restriction improves glycemic
hemoglobin a major risk for coronary heart disease control, insulin levels, triglycerides, and
(HbA1c) and stroke HDL levels even in the absence of weight
loss (1,8,23)
Inflammation CRP The New England Journal of Medicine Low risk of developing cardiovascular
concluded that CRP outperforms LDL disease if your hs-CRP level is lower than
cholesterol as a predictor of 1.0 mg/L
cardiovascular risk and is a better
predictor of cardiovascular events (heart
attacks, strokes, bypass surgery, or
angioplasty) than other inflammatory
markers (17)
Average risk of developing cardiovascular
disease if your levels are between 1.0 and
3.0 mg/L
High risk for cardiovascular disease if your
hs-CRP level is higher than 3.0 mg/L
HbA1c is a laboratory test that shows the average level of blood sugar (glucose) over the previous 3 months. It is used in the diagnosis and
monitoring of diabetes and prediabetes (insulin resistance). Highly sensitive CRP or hs-CRP seems to be correlated to heart disease risk. The body
produces CRP during the general process of inflammation. Therefore, hs-CRP is a “marker” for inflammation, meaning its presence indicates an
increased state of inflammation in the body.

BMI 5 body mass index; CRP 5 C-reactive protein; FEV1/FVC% 5 the percentage of the vital capacity, which is expired in the first second of
maximal expiration; LDL/HDL 5 low-density lipoprotein/high-density lipoprotein; METS 5 metabolic equivalent of task.

76 VOLUME 37 | NUMBER 4 | AUGUST 2015

 Table 2
Recommended physical fitness assessments associated with the fire service

Description Recommendation Assessment

Aerobic output Aerobic output will measure the degree The IAFF/IAFC Wellness Fitness Initiative Gerkin treadmill
to which a firefighter can efficiently recommend a firefighter should have protocol
move oxygen through their body and a peak V̇O2 of no less than 42
the extent to which they can mL$kg21$min21 to meet the physical
effectively use that oxygen. This will demands of the job
determine, in large part, how fast or
long they can respond to a medical
emergency or situation
It is recommended that fire recruits have FDNY stepmill test*
a peak V̇O2 max of 45 mL$kg21$min21
on entry into an academy (20)
1.5-mile run
Anaerobic output High levels of anaerobic power have High-intensity intermittent training 300-m run
been significantly correlated to job- may improve both anaerobic and
specific tasks (15). Hose operation, aerobic energy systems significantly,
structure ventilation, stair climbing, probably through imposing different
and rescue operations all require intensities (19)
a high amount of anaerobic output
20-M shuttle test
Resistance training Firefighter’s applications of strength and 85% of RM Push up with
endurance were lifting and carrying metronome
objects (up to 80 pounds), pulling (80 bpm)
objects (up to 135 pounds), and
working with objects in front of the
body (up to 125 pounds) (5)
4–6 repetitions to enhance power and Pull up
strength
Push to pull ratio 1:2 Grip strength
Unilateral movements
Core stability Job-specific tasks require balance, Lumbar and abdominal stability Front plank
strength and power, while performing
complex motor patterns. (i.e., twisting,
bending stepping, etc). A stable core,
as well as a strong foundation of
muscular balance, is essential in
preventing many of the injuries
associated with firefighting
 Stir the pot Side plank: left
 Shoulder taps Side plank: right
 Bird dogs
Ability to resist rotation
 Chops—downward diagonal plane
movements with a pillar core
 Lifts—upward diagonal plane
movements with a pillar core

(continued)

Strength and Conditioning Journal | www.nsca-scj.com 77

One on One
Flexibility, mobility, Weakness or lack of sufficient
and stability coordination in core musculature can
lead to less efficient movements,
compensatory movement patterns,
strain, overuse, and injury
RM 5 repetition maximum.
*International Association of Firefighters/International Association Fire Chief—Wellness Fitness Initiative.
grip strength can make tasks like
opening fire hydrants, pulling hoses
of various weights and water pres-
sures, and carrying tools during mul-
tiple “call-outs” throughout a shift
very difficult or impossible. Exercise
professionals should include activities
for improving grip strength within
resistance training workouts.
Research has suggested grip strength
could be a possible predictor of current
health status, physical performance as
well as a measure of recovery from phys-
ical stress. Grip strength has been shown
to be related to differences in endocrine
function and hormone release (e.g., cor-
tisol, endorphins) after a night of sleep
deprivation (7). This could have impor-
tant implications for firefighters as they
have a high likelihood of incurring poor
sleeping habits, thereby lacking proper
recovery.
MUSCULAR STRENGTH AND
ENDURANCE
Performing common firefighting tasks,
such as forced entry, throwing ladders,
and pulling hose, requires multiplanar
force generation and multisegmental
stability. Tasks are often on 1 leg and
in positions requiring high levels
of trunk flexion, extension, and rota-
tion. Unilateral lower-body strength
78 VOLUME 37 | NUMBER 4 | AUGUST 2015
Table 2
(continued )
Twists—side to side movements with
a pillar core
Hip and thoracic mobility
 Elbow to instep stretch
 Side lying external rotation
exercises (such as split squats, lunges,
lateral squats, lateral step-ups, and
crossover step-ups) can help simulate
some firefighting strength demands
and potentially reduce the likelihood
of injuries. Table 2 describes the rec-
ommended physical fitness assess-
ments associated with the fire service.
SUMMARY
Developing a comprehensive health
and wellness program focusing on
improving aerobic endurance, muscu-
lar strength, muscular endurance, flex-
ibility, as well implementation of
comprehensive health screening pro-
grams can help reduce firefighter-
related health and injury risks and
enhance their job performance.
Conflicts of Interest and Source of Funding:
The author reports no conflicts of interest
and no source of funding.
John Hofman is the strength and con-
ditioning coach for the Sacramento Fire
Department.
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