Firefit Conference 2008Firefit Conference 2008‘Fit for Service, Fit for the Future’‘Fit for Service, Fit for the Future’

Physical Fitness in the Physical Fitness in the Fire ServiceFire Service

Kevin SykesKevin Sykes Professor of Occupational Health & FitnessProfessor of Occupational Health & Fitness

DirectorCentre for Exercise & Nutrition Science

University of Chester

You’ve got to be fit to handle this type of Job

You’ve got to be fit to handle this type of Job

Fitness for Firefighting• Aerobic Endurance – exercise for

prolonged periods at moderate/high intensity (e.g. running out numerous hoses)

• Strength – lifting & shifting heavy objects over short distances/time periods (e.g. lifting 1.35m ladder onto appliance)

• Local Muscle Endurance – lifting & shifting heavy objects over longer periods (e.g. carrying LPP to external water source)

• Flexibility – good range of joint movement (e.g. allowing work in cramped positions, crawling through small openings, etc)

• Agility & Balance – working in hostile,

ever-changing environments • Body Composition – excess fat can

influence job performance & is strongly linked to hypertension, heart disease and Type-2 diabetes. 1 stone excess fat adds 10% loading on body

Physiological Stresses of Operational Firefighting

• Hazardous environment - heat, humidity, smoke, noise, toxic, danger, etc.

• Fast response needed• Physically strenuous• Burdensome protective clothing • Breathing Apparatus• Carry & work with heavy tools• Fitness level• Body composition

2 firefighters – same job!

FitUnfit

You’ve got to be in good shape to handle this type of cardiovascular stress

Intense physical activity is a strong triggering factor for heart attack, especially among physically inactive and unfit individuals.

100%HRMax

85%HRMax

Firefighting is well known to be a dangerous occupation.

What is less well known is that the most frequent cause of death among firefighters is not burns, accidents or smoke inhalation. …..but is….

Heart Disease causes 45% of the deaths that occur while on duty (US study).

Heart Disease

Firefighters are x2 as likely to die from a heart attack in the line ofduty than police officers and x3 more likely than paramedics.

Emergency Duties and Deaths from Heart Diseaseamong Firefighters in the United States

(1994-2004)

Kales, Soteriades, Christophi & Christiani New England Journal of Medicine, 2007

Deaths from Heart Disease among US Firefighters (1994-2004)

Kales et al. (2007) New England J. Med

• Fire suppression is associated with the highest risk, up to 100 times as high as that for non-emergency duties.

• Good Aerobic Fitness is a key factor in ‘prevention’

• Firefighters may be required to work at maximal levels of exertion.• To someone not in good shape this presents serious risk. • Firefighters with low aerobic fitness have a 90% greater risk

of MI than those who are aerobically fit.

Peate et al (2002) J.Occ. & Environ. Med.

Exercise in the Prevention of Exercise in the Prevention of Heart DiseaseHeart Disease

• Regular exercise can reduce the incidence of heart disease by as much

as 50% !

Aerobic fitness

• Key measure of health-related fitness

Low level = risk of premature death & illness

High level = risk of premature death & illness

• VO2Max is criterion measure • In terms of health-related fitness -

mlsO2/kg/min more important than litres/min

Fit v UnfitRelative Health Risk

HeartDisease

Type 2Diabetes

ColonCancer

2.0

1.0

Fit – ‘Good’Unfit – ‘Below Average’ aerobic fitness category

1.5

StrokeBreast Cancer Osteoporosis

WHO (2003)

Health Benefits of Exercise• Reduce risk of heart disease & stroke • Improve blood pressure control • Reduce high cholesterol & improve blood lipid profile • Reduce body fat (particularly abdominal) • Enhance mental well-being • Reduce stress, anxiety & depression• Fortify the immune system - less prone to illness and disease• Sleep better • Increase bone density, helping prevent osteoporosis • Reduce risk of certain cancers (e.g. colon cancer)• Reduce risk of type-2 diabetes • Helps mobilise joints & alleviate osteoarthritis • Improve strength, flexibility & co-ordination• Reduce risk of falls • Improve & maintain healthy lung function• Give more energy & vitality• Improve fitness• Improved healthspan and lifespan BHF 2005

For general health:• 30 minutes per day (or

3x10mins)

• Moderate intensity physical activity

• 5 or more days per week

Department of Health 2004

67 Very, very light89 Very light1011 Fairly light

12 13 Somewhat hard14

15 Hard1617 Very hard1819 Very, very hard20 Maximal

LIGHT EXERCISESome health benefits but minimal fitness improvement

MODERATE EXERCISEHealth & fitness benefit- minimal risk

INTENSE EXERCISEFor those who want high fitness.Can cause heart attack in high riskindividuals.

Fitness for Firefighting

• VO2Max has been consistently shown to be the best predictor of performance in simulated firefighting tasks (Heyman, 2002; Sykes, 2002)

What is VO2• VO2/min = oxygen uptake per minute• Often termed ‘Metabolic Rate’ • Measured in litres/min or mlsO2/kg/min

How is it Calculated?

• VO2/min = Minute Ventilation x O2% absorbed by bodye.g. Rest VO2/min = 10 x 3% = 0.3l/min

Typical values 0.3-0.5 l/min – males0.2-0.4 l/min - females

• Body Weight a key factor

• Rest VO2/min = 3.5 mlsO2/kg/min = 1MET

Approximate Energy Cost of Selected Activities

Activity mlsO2/kg/min MET

Rest 3.5 1

Dressing/undressing 7.0 2

Walking 3mph 10.5 3

Walking 4mph 14 4

Cycling 10mph 17.5 5

Jogging 5mph 26.0 7.5

Jogging 8min/mile 31 9

Running 7min/mile 42 12

Running 6min/mile 53 15

Bricklaying 25 7

Police Public Order 35 10

Fire Fighting 35 10

Y - 42 ?

Typical aerobic cost of fire fighting = 35mlsO2/kg/min

To be working at 80% of maximum, aerobic capacity needs to be at least 42mlsO2/kg/min

Proposed minimum aerobic fitness standard = 42mlsO2/kg/min

Firefit Steering Group (2007).

Aerobic Fitness & Firefighting

Metabolic Cost of Hose RunningRun out

Under-run

Make-up

Question: Run-out, under-run & make-up 23m lay flat delivery hose, 6 repeats ≤ 11 mins?

Method: 40 firefighters completed task: @ 11-min & @ 8-min pace Fm Phil Turner MSc

MSc Thesis 2007

Metabolic Cost of Hose Running

Results

N = 40

Mean ± SD

Height (cm) 178.92 ± 5.98

Weight (kg) 83.78 ± 9.29

Age (yrs) 37.75 ± 5.25

Predicted VO2max (mlsO2/kg/min) 48.46 ± 5.11

1 Repetition Bench Press (kg) 83.83 ± 19.74

Body Mass Index (BMI) 26 ± 2

Turner 2007

mlsO2/kg/min 11 min (paced) 8 min (paced)

Mean ± SD 34 ± 3 41 ± 4

CST

MSSRT

CHESTER TREADMILL WALK TEST

TREADMILL RAMP PROTOCOL WITH GAS ANALYSIS

Suggested Order for In-Service CR Fitness Testing

Gas Analyser Available No Gas Analyser Available

Multi-Stage Shuttle Run Test (Bleep Test)

• Recommended standard achieved at Level 8-6 (42mlsO2/kg/min)

• Stop Test when this Level is reached

A 12-minute progressive, treadmill walk test designed to identify individuals capable (or not) of reaching the proposed fitness standard of 42mlsO2/kg/min.

Chester Treadmill Walk Test6.2km/hr (3.75mph)

Sykes (2007)

VO2Max Testing

Health & Safety

• Complications associated with fitness testing are relatively low, however:

• Ability to maintain high level of safety depends on knowing when NOT to perform a fitness test (ACSM 2006)

• Pre-participation health screening – test administrator should ensure there are no medical contraindications to performing the test

• Higher risk with maximal fitness test• Need for knowledgeable, highly competent testers

Fitness Testing & Healthy Lifestyles advice Fitness Testing & Healthy Lifestyles advice must be conducted by must be conducted by knowledgeable, skilled and well-motivated advisersknowledgeable, skilled and well-motivated advisers

height

weight

Underweight Normal Range Overweight Obese <18 18 – 25 25.1-30 30+

Body Mass Index (BMI)

Jonah Lomu: BMI = 33 = OBESE!

All fat is not equal

Increased risk of Type 2 diabetes, dyslipidaemia, high blood Increased risk of Type 2 diabetes, dyslipidaemia, high blood pressure, heart disease, stroke, liver disease, respiratory pressure, heart disease, stroke, liver disease, respiratory problems, gout, cancer, osteoarthritisproblems, gout, cancer, osteoarthritis

Ideal Increased Risk Greater Risk<37ins 37-40ins 40+ ins<94cms 97-101cms 102+ cms

<32ins 32-35ins 35+ ins<80cms 80-87cms >88+ cms

Males

Females

Underweight Normal Range Overweight Obese <18 18 – 25 25.1-30 30+

Body Mass Index (BMI)

Importance of maintaining a good body weight for firefighter fitness

• Excess body fat or additional weight carried adds extra strain on CVR systems – approx 10% loading for every 1 stone.

• PPE/BA weighs approx 3 stones! • Major impact on ‘operational’ physical fitness

Weight Control StrategyWeight Control Strategy

Healthy Eating3-5x /week of LSD

Exercise (30mins, brisk)

Resistance exercise

10% reduction in weight can convey significant health benefits

90% of successful long-term slimmers take regular exercise

Physical Fitness in the Fire Physical Fitness in the Fire ServiceService

• Recognition of importance

• Support at all levels

• Structured approach

• Multidimensional

• Multisectoral

• Firefit

Firefit Conference 2008Firefit Conference 2008‘Fit for Service, Fit for the Future’‘Fit for Service, Fit for the Future’

Physical Fitness in the Fire Physical Fitness in the Fire ServiceService

Kevin SykesKevin Sykes Professor of Occupational Health & FitnessProfessor of Occupational Health & Fitness

DirectorCentre for Exercise & Nutrition Science

University of Chester

Firefit Conference 2008Firefit Conference 2008‘Fit for Service, Fit for the Future’‘Fit for Service, Fit for the Future’

Physiology of Ageing- and possible effects on firefighters

Kevin SykesKevin Sykes Professor of Occupational Health & FitnessProfessor of Occupational Health & Fitness

DirectorCentre for Exercise & Nutrition Science

University of Chester

“So, Mr Jones, how old are you?”

“32?”

If you didn’t know how old you are…….. ….how old would you think you are ?

Many of us are health-conscious

But many still take their health for granted….. … until they lose it!

Prevention is better than cure

We can now expect to live 10 years longer than in the 1950s

1950-2005

Increase in Life Expectancy

20

05

Females live 5yrslonger thanmales

UK Life Expectancy

• Females: Average 82yrsHighest 86yrs Kensington, Chelsea, E.Dorset

Lowest 70yrs Glasgow

• 75% of females will be alive after the age of 75• 50% of males will be alive after the age of 75

• Males: Average 77yrsHighest 81yrs Kensington, Chelsea, E.DorsetLowest 65yrs Glasgow

6

37% CVD

28% Cancer

36% CVD

24% Cancer

Lifespan v ‘Healthspan’

Men Women

Expected Lifespan: 77yrs 82yrs

Expected ‘Healthspan’: 67yrs 72yrs

ADD Life to years… not years to life

Life after 30 !!

Aerobic Fitness & Ageing• Decrease in cardiac function: e.g. HR = 220-Age Cardiac Output Stroke Volume• Decrease in Circulatory capacity: e.g. Increase in peripheral resistance Less blood flow to active muscle• Decrease in muscle O2 uptake: e.g. Reduced a-vO2 diff Reduction in mitochondria & oxidative

enzymes• Reduced Respiratory function (FVC, FEV, RV, MaxVe-1)

VO2Max decreases by 10% per decade after 25-30yrs

HOWEVER……Fit 60yr old fitter than sedentary 20-30yr olds!

• Low aerobic fitness is more important precursor ofall-cause mortality than any of the other risk factors

Aerobic Fitness, Ageing & Longevity

* Least fit x2 as likely to die prematurely from all causes* Reduced lifespan and healthspan

Aerobic Fitness, Ageing & Longevity

Strength & Ageing• Max muscle strength is achieved

between 25-35yrs• Strength decreases around 10% per

decade after 25-30• Primary cause ‘sarcopenia’: 50% reduction in Motor Units 25-

80yrs Loss of muscle mass Loss of Total muscle fibres Reduced muscle X-section Loss of Fast twitch fibres Reduced CNS responses

However, large individual variations – some stronger at 60 than many at 30.

Strength & Ageing

Resistance training can markedly improve strength in both males and females at all ages

Improvements in strength of 50-70yr olds males following resistance training.Many 60yr olds were stronger than 30yr olds

Ageing & Flexibility

• Decrease in passive and active range of movement

• Shortened muscles• Weaker ligaments, tendons, joint capsule• Increased likelihood of injury• Decrease in kinaesthetic awareness

Ageing & Body Composition

• Gradual gain in body weight from 20-70yrs• Decrease in muscle• Increase in fat (subcutaneous, depot, intramuscular &

essential)• Decrease in bone mass (e.g. mineral density)

Hazardous Waste

A cluster of CV risk factors- insulin resistance- hyperinsulinaemia- impaired glucose tolerance or diabetes- raised triglycerides- raised LDLs- decreased HDLs

“Diabesity”

Hazardous Waist

Advancing age – spreading waistline - reduced fitness –

Metabolic Syndrome

Normal

When insulin is bound to the insulin receptor of the cell, glucose can be transported into the cell and be used.

Type 2 Diabetes

• Insulin receptors not functioning

• Insulin cannot bind• Glucose cannot be

transported into the cells

Around 90% of all diabetics are Type 2

Benefits of Exercise for Diabetes

• Improve insulin sensitivity

• Improve glycaemic control

Possible Effects of Ageing on Firefighters

Typical aerobic cost of fire fighting = 35mlsO2/kg/min

To be working at 80-85% of maximum, aerobic capacity needs to be at least 42mlsO2/kg/min

Proposed minimum aerobic fitness standard = 42mlsO2/kg/min

Firefit Steering Group (2007).

Norms for Aerobic Capacity (mlsONorms for Aerobic Capacity (mlsO22/kg/min)/kg/min)Males Age Group

Fitness Rating 15-19 20-29 30-39 40-49 50+

Excellent 60+ 55+ 50+ 46+ 44+

Good 48-59 44-54 39-49 37-45 35-43

Average 39-47 35-43 32-38 30-36 27-34

Below Average 30-38 28-34 22-31 24-29 22-26

Poor <30 <28 <26 <24 <22

Females Age GroupFitness Rating 15-19 20-29 30-39 40-49 50+

Excellent 55+ 50+ 46+ 43+ 41+

Good 44-54 39-49 35-45 34-42 33-40

Average 36-43 32-38 29-34 27-33 26-32

Below Average 29-35 27-31 24-28 22-26 20-25

Poor <29 <27 <24 <22 <20

Sykes 1996

Intense physical activity is a strong triggering factor for heart attack, especially among physically inactive, older and unfit individuals.

100%HRMax

85%HRMax

Heat Stress Tolerance & Ageing

• Reduced thermal tolerance

• Reduced sweat production – less heat lost by evaporation

• More susceptible to fatal heat injuries

Ageing & Balance• Good balance important for operational firefighters -• Working on roofs, smoky places, slippery surfaces while

wearing PPE & BA• Wearing PPE & BA affects functional balance in older

compared to younger firefighters (BA was more a sig. factor).

• Postural balance (with eyes closed) was more negatively affected among the older subjects than the younger ones.

Punakallio et al (2003)  

Dynamic (Functional) & Static (Postural Sway) Balance- general decrease with ageing

Ageing & Firefighters

• Age is a poor predictor of job performance among firefighters

• Physical fitness and mental abilities showed the strongest relationship with job performance

• These vary greatly across individuals regardless of age

Pynes (1996)

Ageing and Firefighter Fitness

• Aerobic Endurance • Strength

• Local Muscle Endurance Flexibility

• Agility & Balance• Body Composition • Metabolic Fitness - Insulin

sensitivity, glucose tolerance, normal BP, heart-healthy blood lipid profiles & fat-burn capability

Trainability & Age

• Exercise training improves physiological responses and fitness levels at any age.

37yrs

59yrs

It’s never too late!!

Extracurricular Coronary

Firefit Conference 2008Firefit Conference 2008‘Fit for Service, Fit for the Future’‘Fit for Service, Fit for the Future’

Physiology of Ageing- and possible effects on firefighters

Kevin SykesKevin Sykes Professor of Occupational Health & FitnessProfessor of Occupational Health & Fitness

DirectorCentre for Exercise & Nutrition Science

University of Chester