Barriers, promoters, and predictors of cardiorespiratory and physical fitness among volunteer firefighters enrolled in the Cancer assessment and prevention study
Creators: name: Shah, Nimit N.
Publisher: name: No Publisher Supplied
Year: 2024

description: Background: Volunteer firefighters who constitute a substantial portion of the US fire service, face significant challenges in maintaining optimal physical and cardiorespiratory fitness (CRF). This can impact their firefighting performance and increase the risk of health issues, including injuries, cardiovascular disease, and certain cancers. Despite their crucial role in protecting communities, volunteer firefighters face unique organizational and individual level barriers to obtaining or maintaining optimal physical fitness. Objective and Specific Aims: This dissertation sought to investigate the prevalence, predictors, and influencers of physical fitness and CRF among volunteer firefighters enrolled in the Cancer Assessment and Prevention Study (CAPS), a sub-study of the national Fire Fighter Cancer Cohort Study (FFCCS). Three specific aims supported this goal: (1) investigate the prevalence and predictors of CRF among volunteer firefighters at different stages of their firefighting service and compare them to career firefighters, as well examine volunteer firefighters’ CRF in comparison to the general population of their respective state; (2) assess whether CRF levels among volunteer firefighters vary by fire department- and individual-level factors ; and (3) describe volunteer firefighters’ perspectives on how individual- and fire-department-level factors influence their physical fitness. Methods: This dissertation included 569 incumbent volunteer firefighters. Their fire service, demographic, health, and occupational data were collected through an enrollment survey, and CRF was calculated based on self-reported age, sex, BMI, and physical activity rating. Study 1 compared volunteer firefighters to 1,874 incumbent career firefighters in the FFCCS, assessing fitness, health behaviors, and demographics. Mean CRF associations were analyzed through multivariable linear regression with an interaction term for years of service. CAPS volunteer firefighters' CRF and health behaviors were compared to state-specific populations using the Behavioral Risk Factor Surveillance System data. In Study 2, CAPS volunteer firefighter enrollment data were linked to information from the CAPS fire department survey, providing fitness and organizational details for 515 CAPS volunteer firefighters in 34 departments. The analysis explored associations between CRF and individual-level current fire service characteristics, as well as fire department characteristics, using mixed multivariable linear and logistic regression models, with fire department region included as a random intercept. In Study 3, 28 CAPS participants were interviewed individually, or in small groups based on their years of firefighting service, using an interview guide. The questions focused on participants' perceptions of their physical fitness in relation to their lifestyle and the department's impact. Thematic analysis and systematic coding were employed to analyze the interview transcripts. Results: Study 1 found that on average volunteer firefighters had lower CRF than career firefighters and CRF among both groups was lower with more years of firefighting, with a greater magnitude among career firefighters. Study 2 showed that volunteer fire departments had a low prevalence of fitness related resources. Also, more frequent fire training was positively associated with volunteer firefighter CRF. In Study 3, five major themes emerged: (1) health and firefighting performance, (2) firefighter time and availability (3) departments’ responsibility to support members’ fitness, (4) fire training drills as a form of functional physical activity (5) fitness initiatives at the department. Conclusion: The findings from this dissertation contribute to the health and fitness literature among volunteer firefighters, an understudied majority of the US fire service. The results also provide evidence that this population has limitations with maintaining or improving their fitness. The findings also inform health or fitness strategies to design and create tailored interventions for volunteer firefighters and departments.