Occupational PreparednessResearch and Practice

Brent A. Alvar, Ph.D., CSCS*D, RSCC*D, FNSCAProfessor ‐ Associate Dean of Research  

Rocky Mountain University of Health Professions

Bradley J. Warr, MAJ, SP , PhD, MPAS, PA-CUS Army

What is  Occupational Preparedness or Tactical Strength and Conditioning??

• Strength and Conditioning training for a differential “athlete”

• Military, Law Enforcement, Fire Fighters or other occupations that need specific fitness or conditioning for optimal job performance 

What is  Occupational Preparedness or Tactical Strength and Conditioning??

• Consideration is placed on the physical demands of the operational/occupational related activities

• Can proceed the way we would for the traditional athlete – however we have not typically done this in the past.  

• Although we are moving in the right direction… – Firefighter Military and Police testing and training

Thoughts on Athletics and Occupational Preparedness

• First athletes were truly soldiers and their competitions evolved into the first athletic events such as the Olympics

• Do have a history of conditioning – primarily aerobic in nature

• Is this truly the way our tactical athletes operate today??  

Military Fitness Testing

• Army– Push‐ups, Sit‐ups, 2 mile run

• Marine– Pull‐ups, Abdominal Crunch, 3 mile run, body comp

• Navy– Sit‐ups, Push‐ups, 1.5 mile run or 500m swim, body comp

• Air Force– Sit‐ups, Push‐ups, 1.5 mile run, body comp

Police Testing

• Arizona Public Service

FITNESS EVENT REQUIREMENT

1.5 mile run 16:00 (min:sec)

300 meter run 73.2 seconds

Push‐ups 24 reps

Agility run 21.8 seconds

Sit‐ups 28 reps

Marine Combat Fitness Test

• 880 Yard Run.Marines will run for 880 yards while wearing boots and camouflage uniform (pants and t‐shirt).

• Ammo Can Lifts.Marines will lift a 30 pound ammo can from the ground, over their heads as many times as they can in two minutes.

• Maneuver Under Fire.Marines must move through a 300 yard course, and perform designated tasks, in the time limit authorized. The tasks include:– Moving in a quick scurry for 10 yards, then a high craw for another 15 yards.– Drag a casualty for 10 yards, while zigzagging through several cones. Then lift 

the casualty and carry him/her at a run for 65 yards.– Carry two 30‐pound ammo cans for 75 yards, while zigzagging through a series 

of cones.– Toss a dummy grenade 22 1/2 yards and land it in a marked target circle.– Perform three push‐ups, pick up the two 30‐pound cans and sprint to the 

finish line.

Police Officers Physical Abilities Test(POPAT)

• 99‐YARD OBSTACLE COURSE Run a 99‐yard obstacle course consisting of several sharp turns, a number of curb height obstacles, and a 34‐inch high obstacle that must be vaulted.

• BODY DRAG    Lift and drag 165‐pound, lifelike dummy 32 feet.

• CHAIN‐LINK FENCE  Run five yards to a six‐foot, chain‐link fence, climb over fence, continue running another 25 yards.

• SOLID FENCE CLIMB  Run five yards to a six‐foot solid fence, climb over fence, continue running another 25 yards.

• 500‐YARD RUN   Run 500 yards (equivalent to one lap plus 60 yards of a standard running track). 

How to Begin Program Design

• Necessitates a thorough “Needs Analysis” where with your training prescriptions will be based upon– Job Analysis

• Movement Analysis• Physiological Analysis/Energy System Usage• Injury Analysis

– Assessment of the Individual• Training Status• Individual Testing and Evaluation• Goal Development

– Program Design• Specificity• Progressive Overload• Exercise Variation• Exercise Frequency, Duration, Intensity

Problem Statement

Very few research investigations have been conducted to identify suitable training strategies for promotion of firefighter police or military ‐specific physical fitness.

Firefighter Police and Military Readiness is a National Health/Safety Defense concern!

Firefighter Research

Study 1:  Physical Fitness and Job Performance in Firefighters

• Questions:  Is there a need to evaluate fitness in firefighters

• Is there a problem with their current fitness levels as a profession

• If so, what do we do to change the way we think about firefighters?  – Examples:

• Phoenix Fire Fitness Wellness Initiative• Mesa Community College Fire Academy• Fitness Testing with Chandler Fire

Background Information

• The physical stress that firefighters face exacerbates the risk of musculoskeletal injuries and cardiac complications. (any different for police?)

• A large number of job‐related deaths and injuries per year have led organizations such as the International Association of Firefighters and International Association of Fire Chiefs to consider and suggest physical training recommendations for fitness among firefighters

Epidemiological Data

• Muscle injuries (primarily strains and sprains) accounted for nearly half of firefighter injuries in 2002.

• Overexertion was a primary causative factor for muscle injuries, many of which involved the back.

All Duties Combined - Nature of Civilian Firefighter Injuries 2002

Nature of Injury Number of Injuries

Percent of Injuries

Sprain, Strain, Muscular Pain 39,390 48.8Wound, Cut, Bleeding, Bruise 16,220 20.1Other 9,650 11.9Burns (Fire or Chemical) 3,855 4.8Thermal Stress 3,225 4Smoke or Gas Inhalation 2,575 3.2Dislocation, Fracture 2,340 2.9Other Respiratory Distress 1,360 1.7Burns and Smoke Inhalation 1,165 1.4Heart Attack or Stroke 1,020 1.3Total* 80,800 100*Totals may not add due to rounding.Source: National Fire Protection Association

Financial Burden

Severity LevelAverage Per Injury Cost

($2002)*

Estimated Firefighter Injuries Estimated Cost Estimated

Firefighter Injuries Estimated Cost

MAIS 1 $6,207 15,922 $98,821,000 20,965 $130,123,000MAIS 2 $64,793 24,202 $1,568,141,000 31,869 $2,064,868,000MAIS 3 $186,333 20,018 $3,730,098,000 26,359 $4,911,648,000MAIS 4 $352,384 1,075 $378,816,000 1,416 $498,810,000MAIS 5 $1,125,751 145 $163,540,000 191 $215,343,000

80,800 $5,942,867,000 80,800 $7,820,792,000

Average Cost/Injury $74,000 $97,000

Costs for Military Firefighters** $110 $8,091,000 110 $10,647,000

Total Cost** $5,950,957,000 $7,831,439,000* Comprehensive, but without property damage.** Costs are rounded, totals may not add.

Comprehensive Injury Costs by Maximum Abbreviated Injury Scale (MAIS) for Non-Fatal Injuries

Costs for Civilian Firefighters

NHTSA Estimate Including MAIS 0 Estimate Excluding MAIS 0

• Firefighter injuries result in both direct out‐of‐pocket costs related to the injury and indirect costs for preventing or mitigating injuries.

• An estimated $7.8 Billion is spent per year…

Study 1 ‐ Results

• Pearson product moment correlations were performed to identify the relationship between fitness components and job performance.

• Significant correlations (p<0.05) with job performance were identified for:– total fitness, bench press strength, hand grip strength, bent‐over row 

endurance, bench press endurance, shoulder, press endurance, bicep endurance , squat endurance, and 400‐m sprint time 

• It is apparent that firefighting taxes virtually all aspects of physical fitness. 

• Traditional firefighter exercise programs focusing mainly on cardiovascular fitness should be replaced with physical conditioning programs that address all components of fitness.

Study 2 Hypotheses

• H1: Firefighter recruits will benefit from an exercise prescription model adapted from concepts and principles which are accepted approaches of progressive training for athletic populations.

• H2: Firefighter recruits engaging in “Undulation Training” will experience superior results in physical fitness and firefighter‐specific testing modalities than those incorporating “Traditional Training”

Methods: Subjects

• Subjects Firefighter Recruits

– Randomly Assigned to: Stratified  by strength

• Undulation Training , or • Traditional Training 

• Age: 19‐24 years 

• Training Experience: High     training experience and     motivation

Methods: Testing• Body Mass: m = 85.4 kg

• Body Composition: • Bod Pod

– m = 87.4% Lean Mass            – (m = 73.8 kg lean mass)

• Anthropometry: – Chest Circumference: m = 56.3 cm– Biceps Circumference: m = 65.1 cm– Thigh Circumference: m = 70.5 cm

• Jumping Ability– Vertical Jump: m = 60.5 cm– Standing Broad Jump: m = 230.1 cm

• Muscular Strength– Barbell Back Squat: m = 128.4 kg– Barbell Bench Press: m = 101.7 kg

• Power & Movement Speed: Tendo Unit– 30% Squat Max: 

• Peak Power: m = 2661 W,• Ave Power: m = 1587 W• Peak Velocity: m = 2.15 m/s,• Ave Velocity: m = 1.28 m/s

– 60% Squat Max: • Peak Power: m = 2603 W, • Ave Power: m = 1431 W• Peak Velocity: m = 1.65 m/s, • Ave Velocity: m = 0.90 m/s

Methods: Testing

Performance Measures

• Firefighter Grinder: Each job performance task was performed as quickly as possible and timed for performance score. 

• Tasks included a hose pull, stair climb while carrying a high‐rise hose pack, simulated victim drag, and equipment hoist. 

• These tasks were judged to be representative of tasks performed at the fire scene by fire department administrators and previous researchers

Performance Testing

Periodization• Important theory for past 30 years• Planned variation in the intensity and the volume of a workout– Linear and Nonlinear periodized protocols

• Linear ‐ (classic) Progressive increase in intensity for small variations in each 2 ‐ 4 week microcycle– Starts with higher volume and lower intensity

• Nonlinear ‐ allows for variation of intensity and volume within each week 

• Why is this important for Occupational Preparedness Training???

Epidemiology: Injuries

• Overexertion and stress is the primary causative factor for muscle injuries, many of which involved the back.

• Incidence of work‐related injury in the fire service has been estimated to be nearly 4X that for private industry*

*International Association of Firefighters, 1999

Current Findings and New Recommendations

• Progressive resistance training modalities may provide a suitable training stimulus to promote performance enhancement in firefighter‐specific job tasks. 

• Firefighters engaging in chronic “Undulation Training” may experience superior emergency preparedness than those incorporating “Traditional Training”

Training: Undulation vs. Traditional

Training Duration: 12 Total Weeks (9 weeks training, 3 weeks testing)

• Undulation Training: 3 x per week– Weekly fluctuation in training designed to preferentially elicit adaptation in 

each muscular fitness component: • Strength, Power/Speed, Endurance/Hypertrophy

• Traditional Training: 3 x per week– Mean training prescription is equated 

• Volume, intensity, rest, movements

– Incorporating a “Linear Periodization” Model • Separate mesocycles to preferentially elicit adaptation in each muscular fitness component: Strength, Power/Speed, Endurance/Hypertrophy

“Traditional” Training• Individual mesocycles to 

preferentially elicit adaptation in Endurance & Hypertrophy, Strength, Power, Speed 

• Typically intended   to accommodate a “PEAK”

NSCA, 2000

Undulation vs Traditional Training

Undulation (UT) or Mixed Methods Training• Daily fluctuations in training designed to preferentially elicit adaptation in each muscular fitness component: – (1) Absolute & Relative Strength Capacity 

– (2) Muscular Peak Power & RFD

– (3) Local Muscular Endurance & Hypertrophy

Support For UT or “Mixed Methods” Training• Mixed‐methods resistance training programs are particularly 

advantageous due to an ability to simultaneously elicit – Hypertrophy – Endurance – Strength – Muscular Power Adaptations– Improved functionality among diverse populations  

• Newton and colleagues determined that young and older men exhibit similar improvements in multiple fitness parameters with appropriate mixed‐methods periodized resistance‐training programming *

Newton et al, 2002

Traditional Training

Weeks 1- 3 Weeks 4 - 6 Weeks 7 - 9

Upper Body Endurance/Hypertrophy Strength Power/Speed

Lower Body Endurance/Hypertrophy Strength Power/Speed

Endurance/Hypertrophy: High Volume, Low Intensity, Short Rest Breaks

Strength: Low Volume, High Intensity, Long Rest Breaks

Power/Speed: Moderate Volume, Low-Moderate Intensity, High Speed, Long Rest Breaks

• This program is characterized as a Traditional Linear Periodization Model. 

• There was a gradual increase in training intensity and requisite decrease in training volume, over the course of 9‐weeks of training. 

• The final 3‐weeks of training were characterized as a Power/Speed mesocycle, because all movements were completed with very high speed and reduced load.

Undulation Training Model

Monday Wednesday Friday

Upper Body Endurance/Hypertrophy Strength Power/Speed

Lower Body Strength Power/Speed Endurance/Hypertrophy

Endurance/Hypertrophy: High Volume, Low Intensity, Short Rest Breaks

Strength: Low Volume, High Intensity, Long Rest Breaks

Power/Speed: Moderate Volume, Low-Moderate Intensity, High Speed, Long Rest Breaks

Weeks 1 - 9

• This program is characterized as an Undulation Periodized Model. 

• There were weekly fluctuation in training designed to preferentially elicit adaptation in each muscular fitness component: Strength, Power/Speed, Endurance/Hypertrophy

Training Variables Explained

Results

0

5

10

15

20

25

30

Perc

ent I

mpr

ovem

ent

Upper Body MuscularStrength

Lower Body MuscularStrength

Peak Power Output Vertical Jump Grinder Performance

Training Control (TCo)

Undulation Training (UT)

*

Results• Both groups experienced increases in performance measures

• UT group experience significantly greater improvements in Grinder Performance

• Also Effect size calculations show favorable changes (>.50) for UT in:– Thigh circumference, vertical jump 1RM Squat, Grinder performance and Peak Power Output

• Suggesting a greater stimulus for multidimensional muscular fitness development  with UT and greater transfer to performance

Transfer of Training to Sport/Occupational Performance

• Transfer represents the amount of improvement in performance due to the conditioning program– How much does “off‐the‐field” training help the athlete?

• Amount of improvement in physical fitness compared to the amount of improvement in sport performance and in this case occupational specific performance

Specificity as a Principle of Training

• An abundance of evidence exists to support this principle

• Current attention should be focused on developing further knowledge about transfer of training– How can we measure transfer? – Can we differentiate between programs?  – Can we apply scientific findings to practice?

Measuring Transfer

• Zatsiorksy proposed the following equations:

Transfer = Result gain in non‐trained exerciseResult gain in trained exercise

• Zatsiorsky, VM (1995). Science and practice of strength training.  Human Kinetics: Champaign, pp. 9‐11.

Result Gain =         Gain in performanceStandard deviation of performance

Transfer

• Example– Pretest Squat

• 200 ± 10 lbs 

– Posttest Squat• 250 lbs

– Pretest VJ• 20±3 inches

– Posttest VJ• 25 inches

• Result gain squat– (250‐200)/10 = 5.0

• Result gain VJ– (25‐20)/3 = 1.67

• Transfer of training– 1.67/5.0 = 0.34

Preliminary Findings…

TRANSFER        LT UTBP / Halyard Raise 1.70             2.75BP / Rope Pull 2.87             5.57BP / Sledgehammer 2.15             3.19BP / Ceiling Prop 2.21 2.91BP / Total Time 2.18 3.92

SQ / Hose Drag 0.16 0.15SQ / Stair Climb 0.27              0.77SQ / Total Time 1.12              3.44Dodd et ak: Unpublished

Preliminary Findings…

Dodd et al: Unpublished

BENCH PRESSSQUAT

Conclusions

• Approach occupational training the way you would approach training for athletes

• Conduct a thorough need/movement/injury analysis for proper exercise prescription

• Inherent necessity for occupational specificity of training

Conclusions

• Undulation training appears to be an appropriate approach to continuous training for firefighters (other occupations?)

• Regular intervals of testing and training should be implemented for all tactical athletes.

• Need for additional research on health related benefits of and occupational necessity resistance training for firefighters and other occupations (police & military)

Effects of combat on physical fitness in Arizona National Guard

Soldiers

Bradley J. WarrMAJ, SP

PhD, MPAS, PA-C, CSCSUS Army

Why do we care?

Pre and post deployment health assessments are currently conducted – however

Very few studies have looked at the impacts of combat on physical fitness levels

No studies have explored a possible relationship between fitness and utilization of medical resources

Previous Research

• Sharpe et. al, 2008 – mild decreases in fitness for active duty male soldiers deployed to Afghanistan– VO2 Max– Body Composition– Upper extremity power

Previous Research

• Lester et. al, 2010 – decreases and increases in fitness in active duty soldiers deployed to Iraq– Decreased 2 mile run performance (13%)– Body Composition – increased fat mass (9%)– Power Increase – bench throw (9%)– Strength Increase – upper (7%), lower (8%)

Health During Deployment

• 25% reporting a decline in health(Medical Surveillance Monthly Report, May 2010)

• 54-77% - Diarrhea• 69% - Upper respiratory Infections• 35% - Non-combat injuries

(Sanders et al, 2005)

Objectives

Aim 1: Determine the effects of long term (6-15 mo) combat deployments on physical fitness levels (strength, flexibility, power, muscular endurance, body composition and, VO2 max)

Aim 2: Determine the effectiveness of using pre-deployment fitness levels as an indicator for non-combat related injury or illness during deployment

Inclusion/Exclusion Criteria

• Inclusion– Active duty guardsmen– All races– All genders– Completed medical

screening prior to deployment

• Exclusion– Males >45 years old– Females >55 years old– Severe physical

limitations– Uncontrolled chronic

disease– Deploying less than 6

months or greater than 15 month

Participation Requirements

• Testing prior to and at the conclusion of deployment

• No specific training requirements while deployed

• Authorize the review of deployment medical records

Methods

• Conduct pre and post-deployment data collection

• Inventory all components of medical records– Hard copies– Self report surveys– Electronic medical records

• Conduct Analysis

Components of testing• Flexibility

– Trunk extension– Sit and reach– Shoulder Elevation

• Strength– 1 RM bench– 1 RM squat

• Power– Wingate cycle test– Standing Broad Jump

• Muscular endurance– Push-up– Sit-up

• Aerobic fitness– VO2 peak

• Body composition– Bodpod– BIA

Why did we use these tests?

• Feasibility

• Familiarity

• Transportability

Flexibility• Sit-and-reach• Shoulder elevation• Trunk extension

Strength - 1 Repetition Max

• Bench• NSCA/ACSM

protocol

• Squat• NSCA/ACSM

protocol

Lower Extremity Power• Wingate Test• Alternate measure:

– Standing Broad Jump

Muscular Endurance• Army Physical Fitness

Test – Push-ups– Sit-ups

VO2 Max - Cardiorespiratory• Modified Bransford and Howley Protocol –

commonly referred to as Daniel’s

Body Composition• Bodpod by Life

Measurement– Air displacement

plethysmography • Alternate measure:

– Tanita, bioelectrical impedance

Medical Visit Categorization• Total number of visits• Upper Extremity• Lower Extremity• Spine• Gastrointestinal• Respiratory• Physical Therapy• Behavioral Health

Lessons Learned• Soldier training is more important than your

research• Don’t overestimate the sample populations

training experience, e.g. 1RM Bench• Remain flexible and accomodating• Be persistent

Resulting Publications• Warr, B.J., Alvar, B., Dodd, D., Heumann, K., Mitros, M., Keating, C.,

Swan, P. (2011) How Do They Compare?:An Assessment of Pre-deployment Fitness in the Arizona National Guard. Journal of Strength and Conditioning Research. 25 (11): 2955–2962.

• Warr, B.J., Heumann, K.J., Dodd, D.J., Swan, P.D., Alvar, B.A. (2012) Injuries, Changes in Fitness, and Medical Demands in Deployed National Guard Soldiers. Military Medicine. 177(10):1136-1142.

• Warr, B.J., Alvar, B.A., Spiering, B.A., Scofield, D.E. (2012) Influence of Training Frequency on Fitness Levels and Perceived Health Status in Deployed National Guard Soldiers. Journal of Strength and Conditioning Research., 27(2), 315-322.

Pre-deployment Data

Warr, B.J., Alvar, B., Dodd, D., Heumann, K., Mitros, M., Keating, C., Swan, P. (2011) How Do They Compare?:An Assessment of Pre-deployment Fitness in the Arizona National Guard. Journal of Strength and Conditioning Research. 25 (11): 2955–2962

Pre-deployment Data• AZNG Soldiers heavier and stronger in

absolute terms• When relative strength computed

• 1RM bench – 1.03 vs. 1.03 kg lifted/kg body weight

• 1RM squat – 1.33 vs. 1.30 kg lifted/kg body weight

• Similar cardiorespiratory fitness between components

Warr, B.J., Alvar, B., Dodd, D., Heumann, K., Mitros, M., Keating, C., Swan, P. (2011) How Do They Compare?:An Assessment of Pre-deployment Fitness in the Arizona National Guard. Journal of Strength and Conditioning Research. 25 (11): 2955–2962

Pre versus Post-Deployment Data

Warr, B.J., Heumann, K.J., Dodd, D.J., Swan, P.D., Alvar, B.A. (2012) Injuries, Changes in Fitness, and Medical Demands in Deployed National Guard Soldiers. Military Medicine. 177(10):1136-1142.

Aerobic Capacity vs. Utilizaton of Medical Resources

Warr, B.J., Heumann, K.J., Dodd, D.J., Swan, P.D., Alvar, B.A. (2012) Injuries, Changes in Fitness, and Medical Demands in Deployed National Guard Soldiers. Military Medicine. 177(10):1136-1142.

Training Frequency vs Fitness

Warr, B.J., Alvar, B.A., Spiering, B.A., Scofield, D.E. (2012) Influence of Training Frequency on Fitness Levels and Perceived Health Status in Deployed National Guard Soldiers. Journal of Strength and Conditioning Research. 27(2), 315-322

Frequency vs Perceived Health

Warr, B.J., Alvar, B.A., Spiering, B.A., Scofield, D.E. (2012) Influence of Training Frequency on Fitness Levels and Perceived Health Status in Deployed National Guard Soldiers. Journal of Strength and Conditioning Research. 27(2), 315-322 .

What to make of current results?• Increased strength

– Not focusing enough time conducting resistance training prior to deployment?

– More time for training while deployed?– Soldiers prefer this over aerobic training?

• Decreased aerobic capacity– Too much emphasis running prior to deployment?– Not enough time spent maintaining cardio while

deployed?

What to make of current results?

• Improved body composition– Is this related to increased resistance

training?– Improved diet while deployed?

Questions?