The effectiveness of health interventions in cardiovascular risk reduction among emergency service personnel

Review Article

Abstract

Purpose

The physical demands and hazards associated with emergency service work place particular stress on responders’ cardiovascular systems. Indeed, cardiovascular disease (CVD) is a significant problem for emergency service personnel. Although it may be difficult to alter the cardiovascular health hazards associated with the work environment, it is possible for personnel to control their modifiable CVD risk factors, cardiovascular fitness levels and subsequently, reduce their CVD risk. This review aimed to determine the effectiveness and methodological quality of health interventions designed to mitigate CVD risk in emergency service personnel.

Methods

A literature search of electronic journal databases was performed. Sixteen relevant studies were assessed for methodological quality using a standardised assessment tool. Data regarding the effectiveness of each intervention were extracted and synthesised in a narrative format.

Results

Fifteen studies were rated ‘Weak’ and one study was rated ‘Strong’. Interventions which combined behavioural counselling, exercise and nutrition were more effective in improving cardiovascular health than nutrition, exercise or CVD risk factor assessment-based interventions alone. Further, CVD risk factor assessment in isolation proved to be an ineffective intervention type to reduce CVD risk.

Conclusion

Combined interventions appear most effective in improving the cardiovascular health of emergency service personnel. Accordingly, fire and emergency service agencies should consider trialling multifaceted interventions to improve the cardiovascular health of personnel and avoid interventions focused only on one of nutrition, exercise or CVD risk factor assessment. However, as most studies were methodologically weak, further studies of a higher methodological quality are needed.

Keywords

Cardiovascular disease Emergency services Risk factors Occupational health 

References

  1. Adams TD, Yanowitz FG, Chandler S, Specht P, Lockwood R, Yeh MP (1986) A study to evaluate and promote total fitness among fire fighters/Etude sur l ‘ evaluation et la promotion de la condition physique generale chez des pompiers. J Sports Med Phys Fitness 26(4):337–345Google Scholar
  2. Aisbett B, Wolkow A, Sprajcer M, Ferguson SA (2012) “Awake, smoky and hot”: providing an evidence-base for managing the risks associated with occupational stressors encountered by wildland firefighters. Appl Ergon 43(5):916–925CrossRefGoogle Scholar
  3. Anastasiou CA, Kavouras SA, Lentzas Y, Gova A, Sidossis LS, Melidonis A (2009) Diabetes mellitus is associated with increased intramyocellular triglyceride, but not triglyceride, content in obese humans. Metab Clin Exp 58(11):1636–1642CrossRefGoogle Scholar
  4. Anshel MH, Kang MS (2008) Effectiveness of motivational interviewing on changes in fitness, blood lipids, and exercise adherence of police officers: an outcome-based action study. J Correct Health Care 14(1):48–62CrossRefGoogle Scholar
  5. Balady GJ, Chaitman B, Driscoll D, Foster C, Froelicher E, Gordon N, Pate R, Rippe J, Bazzarre T (1998) Recommendations for cardiovascular screening, staffing, and emergency policies at health/fitness facilities. Circulation 97(22):2283–2293CrossRefGoogle Scholar
  6. Barcelo-Coblijn G, Murphy EJ, Othman R, Moghadasian MH, Kashour T, Friel JK (2008) Flaxseed oil and fish-oil capsule consumption alters human red blood cell n–3 fatty acid composition: a multiple-dosing trial comparing 2 sources of n–3 fatty acid. Am J Clin Nutr 88(3):801–809Google Scholar
  7. Blewett J, Blewett ME, Montgomery DH (1992) Worksite nutrition education can lower total cholesterol levels and promote weight loss among police department employees. J Am Diet Assoc 11:1382–1384Google Scholar
  8. Budd GM, Brotherhood JR, Hendrie AL, Jeffery SE, Beasley FA, Costin BP, Wu Z, Baker MM, Cheney NP, Dawson MP (1997a) Project Aquarius 5. Activity distribution, energy expenditure, and productivity of men suppressing free-running wildland fires with hand tools. Int J Wildland Fire 7(2):105–118CrossRefGoogle Scholar
  9. Budd GM, Brotherhood JR, Hendrie AL, Jeffery SE, Beasley FA, Costin BP, Wu Z, Baker MM, Cheney NP, Dawson MP (1997b) Project Aquarius 7. Physiological and subjective responses of men suppressing wildland fires. Int J Wildland Fire 7(2):133–144CrossRefGoogle Scholar
  10. Bunnell DE, Horvath SM (1989) Interactive effects of heat, physical work, and CO exposure on metabolism and cognitive task performance. Aviat Space Environ Med 60(5):428–432Google Scholar
  11. Byczek L, Walton SM, Conrad KM, Reichelt PA, Samo DG (2004) Cardiovascular risks in firefighters: implications for occupational health nurse practice. AAOHN J 52(2):66–76Google Scholar
  12. Cady LD Jr, Thomas PC, Karwasky RJ (1985) Program for increasing health and physical fitness of fire fighters. J Occup Med 27(2):110–114Google Scholar
  13. Carey MG, Al-Zaiti SS, Liao LM, Martin HN, Butler RA (2011) A low-glycemic nutritional fitness program to reverse metabolic syndrome in professional firefighters. Results of a pilot study. J Cardiovasc Nurs 26(4):298–304Google Scholar
  14. Cater H, Clancy D, Duffy K, Holgate A, Wilison B, Wood J (2007) Fatigue on the fireground: the DPI experience. In: Thornton RE (ed) Australasian fire authorities council/bushfire co-operative research centre annual conference, Hobart, Grand ChancellorGoogle Scholar
  15. Centre for Reviews and Dissemination (2009) CRD’s: Guidance for undertaking systematic reviews in health care. University of York, YorkGoogle Scholar
  16. Choi BC (2000) A technique to re-assess epidemiologic evidence in light of the healthy worker effect: the case of firefighting and heart disease. J Occup Environ Med/Am Coll Occup Environ Med 42(10):1021–1034CrossRefGoogle Scholar
  17. Cochrane Effective Practice and Organisation of Care Group (EPOC) (2002) EPOC data collection template. Cochrane Effective Practice and Organisation of Care GroupGoogle Scholar
  18. Cuddy JS, Gaskill SE, Sharkey BJ, Harger SG, Ruby BC (2007) Supplemental feedings increase self-selected work output during wildfire suppression. Med Sci Sports Exerc 39(6):1004–1012CrossRefGoogle Scholar
  19. Deeks JJ, Dinnes J, D’Amico R, Sowden AJ, Sakarovitch C, Song F, Petticrew M, Altman DG (2003) Evaluating non-randomised intervention studies. Health Technol Assess (Winchester, England) 7(27):iiiGoogle Scholar
  20. Devaney M, Noone P (2008) Is lifestyle screening worth it? Occup Health 60(1):27–29Google Scholar
  21. Dumville J, Torgerson D, Hewitt C (2006) Reporting attrition in randomised controlled trials. BMJ 332(7547):969–971CrossRefGoogle Scholar
  22. Effective Public Health Practice Project (1998) Quality assessment tool for quantitative studiesGoogle Scholar
  23. Elliot DL, Goldberg L, Duncan TE, Kuehl KS, Moe EL, Breger RKR, DeFrancesco CL, Ernst DB, Stevens VJ (2004) The PHLAME firefighters’ study: feasibility and findings. Am J Health Behav 28(1):13–23CrossRefGoogle Scholar
  24. Elliot DL, Goldberg L, Kuehl KS, Moe EL, Breger RKR, Pickering MA (2007) The PHLAME (Promoting Healthy Lifestyles: alternative Models’ Effects) Firefighter Study: outcomes of two models of behavior change. J Occup Environ Med 49(2):204–213CrossRefGoogle Scholar
  25. Fahs CA, Huimin Y, Ranadive S, Rossow LM, Agiovlasitis S, Echols G, Smith D, Horn GP, Rowland T, Lane A, Fernhall B (2011) Acute effects of firefighting on arterial stiffness and blood flow. Vasc Med 16(2):113–118CrossRefGoogle Scholar
  26. Fahy R (2005) US Firefighter fatalities due to sudden cardiac death, 1995–2004. National Fire Protection Association, QuincyGoogle Scholar
  27. Faria IE, Faria EW (1991) Effect of exercise on blood lipid constituents and aerobic capacity of fire fighters/Effet de l ‘ entrainement physique sur les lipides sanguins et la capacite physique aerobie chez des pompiers. J Sports Med Phys Fitness 31(1):75–81Google Scholar
  28. Froom P, Melamed S, Kristal-Boneh E, Benbassat J, Ribak J (1999) Healthy volunteer effect in industrial workers. J Clin Epidemiol 52(8):731–735CrossRefGoogle Scholar
  29. Gamble RP, Stevens AB, McBrien H, Black A, Cran GW, Boreham CA (1991) Physical fitness and occupational demands of the Belfast ambulance service. Br J Ind Med 48(9):592–596Google Scholar
  30. Gledhill N, Jamnik VK (1992) Characterization of the physical demands of firefighting. Can J Sport Sci 17(3):207–213Google Scholar
  31. Gomel M, Oldenburg B, Simpson JM, Owen N (1993) Work-site cardiovascular risk reduction: a randomized trial of health risk assessment, education, counseling, and incentives. Am J Public Health 83(9):1231–1238CrossRefGoogle Scholar
  32. Green JS, Crouse SF (1991) Mandatory exercise and heart disease risk in fire fighters. A longitudinal study. Int Arch Occup Environ Health 63(1):51–55CrossRefGoogle Scholar
  33. Grundy SM, Benjamin IJ, Burke GL, Chait A, Eckel RH, Howard BV, Mitch W, Smith SC Jr, Sowers JR (1999) Diabetes and cardiovascular disease: a statement for healthcare professionals from the American heart association. Circulation 100(10):1134–1146CrossRefGoogle Scholar
  34. Hara M, Sasaki S, Sobue T, Yamamoto S, Tsugane S (2002) Comparison of cause-specific mortality between respondents and nonrespondents in a population-based prospective study: ten-year follow-up of JPHC Study Cohort I. J Clin Epidemiol 55(2):150–157CrossRefGoogle Scholar
  35. Hastings JD, Kruyer WB (2002) Sudden incapacitation: occupational aviation medicine perspectives. Occupational Medicine (Philadelphia, Pa) 17(2):197–209Google Scholar
  36. Hawe P (2000) Intervention for late life depression in residential care. How much trial and error should we tolerate in community trials? Br Med J 320(7227):120Google Scholar
  37. Higgins JPT, Green S (editors) (2009) Cochrane handbook for systematic reviews of interventions. 5.0.2Google Scholar
  38. Jackson N, Waters E (2005) Criteria for the systematic review of health promotion and public health interventions. Health Prom Int 20(4):367–374CrossRefGoogle Scholar
  39. Joseph PN, Violanti JM, Donahue R, Andrew ME, Trevisan M, Burchfiel CM, Dorn J (2009) Police work and subclinical atherosclerosis. J Occup Environ Med 51(6):700–707CrossRefGoogle Scholar
  40. Kales SN, Soteriades ES, Christophi CA, Christiani DC (2007) Emergency duties and deaths from heart disease among firefighters in the United States. N E J Med 356(12):1207–1215CrossRefGoogle Scholar
  41. Kelley GA, Kelley KS, Vu Tran Z (2005) Aerobic exercise, lipids and lipoproteins in overweight and obese adults: a meta-analysis of randomized controlled trials. Int J Obes 29. Nature Publishing GroupGoogle Scholar
  42. Kodama S, Tanaka S, Saito K, Shu M, Sone Y, Onitake F, Suzuki E, Shimano H, Yamamoto S, Kondo K, Ohashi Y, Yamada N, Sone H (2007) Effect of aerobic exercise training on serum levels of high-density lipoprotein cholesterol: a meta-analysis. Arch Intern Med 167(10):999–1008CrossRefGoogle Scholar
  43. Kožená L, Frantík E (2001) Psychological and physiological response to job stress in emergency ambulance personnel. Homeostas Health Dis 41(3–4):121–122Google Scholar
  44. Lancaster T, Stead LF (2005) Individual behavioural counselling for smoking cessation. Cochrane Database Syst Rev (Online) (2):CD001292Google Scholar
  45. Liberman AM, Best SR, Metzler TJ, Fagan JA, Weiss DS, Marmar CR (2002) Routine occupational stress and psychological distress in police. Policing Int J Police Strateg Manag 25(2):421–441CrossRefGoogle Scholar
  46. Maguire BJ, Hunting KL, Smith GS, Levick NR (2002) Occupational fatalities in emergency medical services: a hidden crisis. Ann Emerg Med 40(6):625–632CrossRefGoogle Scholar
  47. McMurray RG, Harrell JS, Griggs TR (1990) A comparison of two fitness programs to reduce the risk of coronary heart disease in public safety officers. J Occup Med 32(7):616–620CrossRefGoogle Scholar
  48. McMurray RG, Ainsworth BE, Harrell JS, Griggs TR, Williams OD (1998) Is physical activity or aerobic power more influential on reducing cardiovascular disease risk factors? Med Sci Sports Exerc 30(10):1521–1529CrossRefGoogle Scholar
  49. Nagaya T, Yoshida H, Takahashi H, Kawai M (2006) Policemen and firefighters have increased risk for type-2 diabetes mellitus probably due to their large body mass index: a follow-up study in Japanese men. Am J Ind Med 49(1):30–35CrossRefGoogle Scholar
  50. Nicol A, Botterill J (2004) On-call work and health: a review. Environ Health Glob Access Sci Source 3(15)Google Scholar
  51. Pejic RN, Lee DT (2006) Hypertriglyceridemia. J Am Board Fam Med 19(3):310–316CrossRefGoogle Scholar
  52. Perseghin G, Scifo P, De Cobelli F, Pagliato E, Battezzati A, Arcelloni C, Vanzulli A, Testolin G, Pozza G, Del Maschio A, Luzi L (1999) Intramyocellular triglyceride content is a determinant of in vivo insulin resistance in humans. Diabetes 48(8):1600CrossRefGoogle Scholar
  53. Phillips M, Raines J, McConnell G, Nichols D, Aisbett B (2008) The aerobic energy demands of simulated tanker-based wildfire fighting tasks. Paper presented at the American College of Sports Medicine 55th annual meeting, Indianapolis, Indiana, May 28th–31stGoogle Scholar
  54. Rajaratnam SM, Barger LK, Lockley SW, Shea SA, Wang W, Landrigan CP, O’Brien CS, Qadri S, Sullivan JP, Cade BE, Epstein LJ, White DP, Czeisler CA (2011) Sleep disorders, health, and safety in police officers. JAMA. J Am Med Assoc 306(23):2567–2578CrossRefGoogle Scholar
  55. Ramey SL, Downing NR, Franke WD (2009) Milwaukee police department retirees: cardiovascular disease risk and morbidity among aging law enforcement officers. AAOHN J 57(11):448–453CrossRefGoogle Scholar
  56. Reinhardt T, Ottmar R (2004) Baseline measurements of smoke exposure among wildland firefighters. J Occup Environ Hyg 1(9):593–606CrossRefGoogle Scholar
  57. Rychetnik L, Frommer M, Hawe P, Shiell A (2002) Criteria for evaluating evidence on public health interventions. J Epidemiol Commun Health 56(2):119–127CrossRefGoogle Scholar
  58. Savine M (1993) Sound controversy, sound advice. Law Enforce Technol 20:38–41Google Scholar
  59. Smith DL, Petruzzello SJ, Kramer JM, Misner JE (1997) The effects of different thermal environments on the physiological and psychological responses of firefighters to a training drill. Ergonomics 40(4):500–510CrossRefGoogle Scholar
  60. Smith DL, Manning TS, Petruzzello SJ (2001) Effect of strenuous live-fire drills on cardiovascular and psychological responses of recruit firefighters. Ergonomics 44(3):244–254Google Scholar
  61. Smith D, Petruzzello SJ, Chludzinski MA, Reed JJ, Woods JA (2005) Selected hormonal and immunological responses to strenuous live-fire firefighting drills. Ergonomics 48(1):55–65CrossRefGoogle Scholar
  62. Soler R, Leeks K, Razi S, Hopkins D, Griffith M, Aten A, Chattopadhyay S, Smith S, Habarta N, Goetzel R, Pronk N, Richling D, Bauer D, Buchanan L, Florence C, Koonin L, MacLean D, Rosenthal A, Koffman D, Grizzell J, Walker A (2010) A systematic review of selected interventions for worksite health promotion: the assessment of health risks with feedback. Am J Preven Med 38(2S):S237–S262CrossRefGoogle Scholar
  63. Soteriades ES, Smith DL, Tsismenakis AJ, Baur DM, Kales SN (2011) Cardiovascular disease in US firefighters: a systematic review. Cardiol Rev 19(4):202–215CrossRefGoogle Scholar
  64. Staley JA (2009) “Get firefighters moving”: Marketing a physical fitness intervention to reduce sudden cardiac death risk in full-time firefighters. Soc Market Quart 15Google Scholar
  65. Sterud T, Hem E, Ekeberg O, Lau B (2008) Occupational stressors and its organizational and individual correlates: a nationwide study of Norwegian ambulance personnel. BMC Emerg Med 8:16CrossRefGoogle Scholar
  66. Superko HR, Bernauer E, Voss J (1988) Effects of a mandatory health screening and physical maintenance program for law enforcement officers. Phys Sportsmed 16(9):99–102; 104; 106; 109Google Scholar
  67. Swank A, Adams K, Barnard K, Benning J, Ottersbach M, Bowerman J (2000) A comparative analysis of cardiovascular disease risk factors for volunteer firefighters. Clin Exerc Physiol 2(November):199–203Google Scholar
  68. Tambalis K, Panagiotakos DB, Kavouras SA, Sidossis LS (2009) Responses of blood lipids to aerobic, resistance, and combined aerobic with resistance exercise training: a systematic review of current evidence. Angiology 60Google Scholar
  69. Tharkar S, Kumpatla S, Muthukumaran P, Viswanathan V (2008) High prevalence of metabolic syndrome and cardiovascular risk among police personnel compared to general population in India. J Assoc Phys India 56:845–849Google Scholar
  70. Thomas BH, Ciliska D, Dobbins M, Micucci S (2004) A process for systematically reviewing the literature: providing the research evidence for public health nursing interventions. Worldviews Evid Based Nurs 1(3):176–184CrossRefGoogle Scholar
  71. Thompson PD, Franklin BA, Balady GJ, Blair SN, Corrado D, Estes NA 3rd, Fulton JE, Gordon NF, Haskell WL, Link MS, Maron BJ, Mittleman MA, Pelliccia A, Wenger NK, Willich SN, Costa F (2007) Exercise and acute cardiovascular events placing the risks into perspective: a scientific statement from the American Heart association council on nutrition, physical activity, and metabolism and the council on clinical cardiology. Circulation 39(5):886–897Google Scholar
  72. Thomson CA, Harris RB, Craft NE, Hakim IA (2005) A cross-sectional analysis demonstrated the healthy volunteer effect in smokers. J Clin Epidemiol 58:378–382CrossRefGoogle Scholar
  73. Violanti JM, Vena JE, Petralia S (1998) Mortality of a police cohort: 1950–1990. Am J Ind Med 33(4):366–373CrossRefGoogle Scholar
  74. Williams BE, Petersen SR, Douglas K (1996) Physiological responses of training officers during live fire training. Fire Eng 149(9):45–49Google Scholar
  75. Zimmerman FH (2012) Cardiovascular disease and risk factors in law enforcement personnel: a comprehensive review. Cardiol Rev 20(4):159–166CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Centre for Exercise and Sports ScienceDeakin UniversityBurwoodAustralia
  2. 2.Bushfire Co-operative Research CentreEast MelbourneAustralia

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