Structural firefighters are responsible for protecting properties and saving lives during emergency operations. Despite efforts to prepare firefighters for these hazardous occupational demands, the unfortunate reality is that the incidence of health morbidities is increasing within the fire service. Specifically, cardiovascular disease, cancer, and mental health disorders are among the most documented morbidities in firefighters. Pubmed and Google Scholar search engines were used to identify peer-reviewed English language manuscripts that evaluated firefighters’ occupational health threats, allostatic factors associated with their occurrence, and evidence-based strategies to mitigate their impact. This narrative review provides fire departments, practitioners, and researchers with evidence-based practices to enhance firefighters’ health.

Objective: High cardiorespiratory fitness (CRF) is associated with reduced markers of oxidative stress and cardiovascular disease (CVD) risk factors; however, this relationship has not been elucidated in firefighters. The purpose of this study was to examine differences in markers of CVD risk between firefighters who have either high or low levels of CRF. Methods: Forty-six firefighters participated in a maximal graded exercise test and a dual-energy x-ray absorptiometry scan and provided a fasted blood sample. V˙O_2max values were categorized based on American College of Sports Medicine guidelines to establish high- and low-fitness groups. Results: High fitness firefighters demonstrated significantly higher high-density lipoprotein cholesterol and lower markers of CVD risk: cholesterol, triglycerides, low-density lipoprotein cholesterol, insulin, homeostatic model assessment for insulin resistance, C-reactive protein, and advanced oxidation protein products concentrations. Conclusion: Firefighters are encouraged to maintain high CRF to reduce risk of CVD.

Background: Age is considered an independent cardiovascular disease (CVD) risk factor, but limited data exist concerning the impact of age and years in the fire service on firefighter health and physical performance. Objectives: We assessed the impact of age and years in the fire service on structural firefighter health and physical performance. Methods: 142 firefighters completed an annual clinical assessment. General linear model (GLM) multivariate and univariate analyses were performed across age groups, with years of fire service experience as a covariate. Partial Eta squared (η_p²) values for the GLM statics and Cohen’s d for pairwise comparisons were used to assess effect size. Results: GLM analyses revealed statistically significant differences (p < 0.05) for several demographic, body composition, blood biomarker, and physical performance parameters. Pairwise comparisons revealed that younger firefighters displayed more favorable health and fitness profiles than their older counterparts. Interestingly, when accounting for years of fire service experience, differences for only the following variables remained: body mass index, waist circumference, lean mass, visceral adipose tissue, triglycerides, cardiopulmonary exercise test time-to-exhaustion, and VO₂max. Conclusions: These findings suggest differences in CVD risk biomarkers, physical fitness levels, and body composition metrics across age groups. However, years of fire service experience appears to have a greater impact on these variables, suggesting that firefighters’ time in the fire service may accelerate the effects of aging on these outcomes. While age-specific health interventions are recommended to manage and mitigate CVD risk effectively, there also should be consideration for the years of fire service.

Objective: The present study examined novel and classic cardiovascular disease (CVD) risk factors among career firefighters to understand better the associations between physiological stress, oxidative stress, inflammation biomarkers, and CVD risk. Methods: Associations between muscular and cardiorespiratory fitness (CRF) measures, body composition, physiological stress, and novel/classic CVD risk factors were assessed among 97 career male firefighters. Results: Muscular fitness/CRF, adiposity, body composition, and blood lipids were associated with CVD risk as measured by biomarkers for insulin resistance, inflammation, and oxidative stress. No associations between physiological stress biomarkers and CVD risk factors were found. Conclusions: Firefighters should improve their muscular fitness/CRF and body composition to reduce CVD risk.

Firefighters (FFs) and law enforcement officers (LEOs) have heightened cardiovascular disease (CVD), with data suggesting that ≈45% of on-duty FF fatalities are related to CVD, while LEOs have a 1.7 times higher CVD prevalence than the general public. This study compared CVD risk biomarkers, fitness, and body composition between FFs and LEOs. Ninety-eight career, structural male FFs (age = 35.1±9.6 yrs; weight = 94.3±15.4 kg; height = 178.4±13.2 cm) and seventy-three career LEOs (age = 41.4±9.0 yrs; weight = 92.3±16.8 kg; height = 179.6±8.1 cm) from local departments were studied. Participants completed a maximal cardiopulmonary exercise test (CPXT), where VO2max was estimated from the Foster equation. Fasted blood was collected to assess CVD risk biomarkers. Dual-energy X-ray absorptiometry assessed body composition, and waist and hip measures were taken. Analyses with and without women participants were conducted to assess differences in CVD risk biomarkers, fitness, and body composition between the FFs and LEOs. Effect sizes were calculated and reported as Cohen’s d. Univariate general linear model (GLM) analysis of covariance (ANCOVA) were conducted to account for age as a covariate, wherein partial Eta squared (ηₚ²) values were used to assess effect size for the GLM statistics. FFs had higher (p<0.05) CPXT exercise times (FFs: 10.9±1.6 min; LEOs: 10.3±2.0 min; d=0.366) compared to LEOs. FFs also had higher (p<0.05) advanced oxidation protein products (FFs: 134.8±90.1 µM; LEOs: 106.8±67.6 µM; d=0.342), blood cortisol (FFs: 14.2±5.0 µg/dL; LEOs: 12.5±5.6 µg/dL; d=0.325), and waist-to-hip ratios (FF: 0.95±0.06; LEO: 0.89±0.08; d=0.792). These findings suggest that while FFs demonstrated greater CPXT time-to-exhaustion, they also expressed higher stress and CVD risk biomarkers concentrations than LEOs. These data suggest that occupation-specific characteristics and stressors may play a role in the CVD risk profile of first responders.