The Aging Firefighter – Health and Fitness Considerations Throughout a Career – FirefighterNation: Fire Rescue

(Photo: O2X)

By Alex Redshaw (CSCS)

via O2X

Firefighting presents a unique set of stressors that affect mental and physical performance and compound throughout a career. Given the risks, firefighters display elevated rates of occupational injuries, cardiovascular disease, cancers, and sleep disorders compared to the general population. To mitigate significant risks to health and well-being, it is essential for departments to invest in systems that identify risk factors and provide effective interventions that support members throughout their careers.

Firefighters change throughout their careers, whether it be due to the job itself or factors outside the department. Initially, probationary firefighters undergo a period of adaptation and skill acquisition as they acclimate to the demands of the job and the shift work schedule. Subsequently, mid-career firefighters navigate promotional opportunities and heightened responsibilities while those approaching retirement contemplate their financial security and physical health. Throughout these stages, firefighters should continue prioritizing their health, underscoring the need for sustained attention to personal well-being amidst evolving professional demands.

Research indicates that physical performance declines to pre-recruit levels within the first year of a firefighter’s probationary period (Cornell et al., 2017). Factors contributing to this decline include sleep disruptions, poor nutrition and fitness behaviors, stress of a new job, and exposure to traumatic events. Unfortunately, this trend persists throughout a firefighter’s career, with fitness, movement quality, body composition, and cardiovascular health continuing to deteriorate with age (Walker, 2014; Redshaw, 2023; Bode, 2021). Given the profound impact of shift work on the circadian rhythm and overall health, maintaining optimal physical and mental well-being remains imperative.

Cardiovascular Risk

Despite spending only a fraction of their careers fighting fires, firefighters face a disproportionate risk of sudden cardiac events, accounting for the majority of line-of-duty deaths (Smith, 2019). In addition, for every fatal cardiac event, there are another 17 non-fatal line-of-duty cardiac events annually (Smith, 2013). While firefighting itself does not directly cause cardiac events, the strenuous nature of the profession exacerbates underlying cardiovascular risks, including hypertension, obesity, diabetes, and reduced cardiorespiratory fitness.

Firefighting requires a high level of cardiorespiratory fitness (≥44 mL/kg/min) to perform common firefighting tasks safely and efficiently. Therefore, the National Fire Protection Association has suggested 42 mL/kg/min as the minimum cardiorespiratory fitness required for safe firefighting performance (Durand, 2011). However, these physical standards are often not enforced, with many departments accepting a higher level of risk.

Age also represents a significant factor in the incidence of fatal cardiac events among firefighters, particularly between 54 and 64 years old (Bode, 2021). Often, healthcare providers are hesitant to provide medical treatment for cardiovascular risk factors until the age of 45 years, when age becomes a risk factor. However, early interventions and the promotion of preventive measures are essential to mitigate these risks, highlighting the need for comprehensive wellness programs tailored to firefighters of all ages.

Injury Risk

Lower levels of muscular strength, endurance, and flexibility, coupled with reduced cardiorespiratory fitness, correlate with higher rates of injuries among firefighters (Cady, 1979; Poplin, 2014). Dunstan and colleagues (2021) identified increased musculoskeletal injury expenditure and lost workdays among older firefighters. There also appeared to be a significant increase in cost per claim in those 60-70 years compared to other age groups. Interestingly, while cost per claim seems to increase chronologically with age, those 50-59 were the only group to be overrepresented in terms of number of claims, total direct costs, and total lost workdays (Dunstan, 2021). The elevated injury risk during aging may be attributed to several factors, including the inherent age-related deterioration of physical function.

A recent study found that full-time firefighter movement quality, comprised of balance, coordination, strength, and symmetry of movement, deteriorated linearly with age, with a rapid reduction at age 50 (Redshaw, 2023). Obesity, low levels of physical fitness, and recent injury history also negatively impacted firefighter movement quality. The inherent loss of movement quality during aging may be attributed to the increased rate of muscle mass, size, and quality deterioration that begins around 40 years of age before increasing again around 60 (Volpi, 2010). Fortunately, older people have been found to respond positively to exercise interventions, in which both aerobic and resistance training should be included in exercise interventions to mitigate age-related declines in movement quality and reduce injury risks (Redshaw, 2023).

Action Plan

The best time to start making changes is now! Getting on top of your health early in your career will help with the early identification of many health issues and also help assist with slowing down the rate of physical deterioration. If you’re already over 50, don’t worry; by starting today, you can reduce your risk tomorrow.

Fortunately, there are many evidence-based approaches to reducing the risk of cardiovascular disease, injury, and other non-communicable diseases such as cancer and metabolic syndrome.

Fitness: It is recommended that people achieve more than 300 minutes of moderate physical activity per week to improve cardiorespiratory fitness and reduce the likelihood of cardiovascular disease, obesity, cholesterol, diabetes, and hypertension. During consultations with firefighters, I typically recommend 30-45 minutes of purposeful physical activity each day, including a more strenuous session in which they work at greater than 80% of their age-predicted maximum heart rate (Zone 4/5) once to twice per week (i.e., HIIT).

Tailored resistance training programs, as little as eight weeks, can effectively improve movement quality and reduce injury risk (Bennett, 2019; Stanek, 2017). Resistance programs for firefighters over 50 should target functional movement patterns that promote balance, coordination, strength, and symmetry to restore some of the age-related deterioration of physical fitness. Fire department programs should emphasize unilateral lower body strength, motor control, and force absorption to reduce the associated injury risks.

Nutrition: While there is no consensus on what is the optimal diet, it is generally recommended that limiting the intake of highly processed foods, alcohol, sodium (<2,300mg), trans fats (<5g), saturated fats (<10% daily energy consumption) will help reduce risk of cardiovascular disease (Yu, 2018). Also recommended is for firefighters to prioritize protein consumption, especially if they train regularly, aim to lose weight, or are over 50 years old. Further, protein intake should be around 30% of daily calories and consumed evenly throughout the day, with the guidelines of 1.2-2.0g/kg depending on their activity level.

Sleep: Sleep is significantly impacted through years of shift work, with nearly 40% of firefighters positive for at least one sleep disorder (Barger, 2015). Firefighters who screen positive for sleep disorders are also more likely to have cardiovascular disease (240%), diabetes (190%), depression (310%), and anxiety (380%). To minimize the effects of poor sleep, “banking sleep” on off days by accumulating an extra two hours per night than you would usually achieve is an excellent strategy to both prepare for the next shift and repair the physiological effects from the previous shift (Rupp, 2009).

Conclusion

Safeguarding the health and fitness of firefighters requires a multifaceted approach encompassing preventive measures, lifestyle interventions, and comprehensive department wellness programs. By prioritizing health throughout their careers and embracing evidence-based strategies, firefighters can mitigate occupational risks, enhance resilience, and enjoy fulfilling and healthy lives. Firefighters owe it to themselves and their communities to prioritize their well-being and serve as role models for healthy living amidst the challenges of their profession.