Healthy Firefighters USA Program

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1 Healthy Firefighters USA Program Corporate: Bob Antonacci MSEd Exercise Physiologist Satellite: Chris Krogedal BS Exercise Physiologist Healthy Firefighters USA is a division of Fitness Appraisal, Inc. We have been implementing fitness and wellness programs for firefighters since Healthy Firefighters USA Programs complies with the following agencies requirements and recommendations: Fitness Component outlined in the Fire Service Joint Labor Management WellnessFitness Initiative NFPA 1583 Standards on Recommended Practice For Fire Fighter Physical Performance and Conditioning Program OSHA Safety Order Section 5144 concerning respirator compliance certificates "A program of physical fitness, health and wellness should be an objective at every fire department as a means for potentially reducing fire fighter injuries. The program should be designed to enable members of the department to develop and maintain appropriate levels of physical fitness." International Association Of Fire Chiefs Policy Statement Proposed by the Health and Safety Committee and Approved by the IAFC Board of Directors December We offer three program options designed to improve the health and fitness status of firefighters.

2 ON SITE SERVICES The blood profile is conducted 1 week prior to the assessments. The following services are performed during a two hour screening session. Ealth Health Risk Profiling See Appendix I

3 Blood Profile Metabolic Syndrome Body Composition Blood Pressure Visceral Fat Analysis EKG Max Stress Test with O2 & CO2 analysis Lifestyle Questionnaire: Three day diet inventory, Risk Stratification and Family History Profile. Medical Referral For High Risk Individuals: Appendix I- Any firefighter with abnormal lab results, EKG or blood pressure-resting or exercise. Labs: Kidney and Liver function, uric acid, minerals, protein, Cholesterol, HDL, LDL, VLDL, Triglycerides & Glucose. CBC and CReactive Protein for age 40 and above. Baseline Screening: Hearing and Vision Screening Respiratory Analysis Blood Pressure SPO2 Resting EKG The following High Risk Classification Will Be Identified: Elevated Atherogenic Index of Plasma Insulin resistance is often associated with increased triglyceride (TG) and decreased HDL-cholesterol (HDL-C) concentrations and increased small LDL particles. The Atherogenic Index of Plasma (AIP), defined as log(tg/hdl-c), has recently been proposed as a marker of plasma atherogenicity because it is increased in people at higher risk for coronary heart disease and is inversely correlated with LDL particle size. Metabolic Syndrome Metabolic syndrome is a combination of medical disorders that, when occurring together, increase the risk of developing cardiovascular disease and diabetes.[ According to the American Heart Association and the National Heart, Lung, and Blood Institute, metabolic syndrome is present if you have three or more of the following signs:

4 Blood pressure equal to or higher than 130/85 mmhg Fasting blood sugar (glucose) equal to or higher than 100 mg/dl Large waist circumference (length around the waist): o Men - 40 inches or more o Women - 35 inches or more Low HDL cholesterol: o Men - under 40 mg/dl o Women - under 50 mg/dl Triglycerides equal to or higher than 150 mg/dl Type II Diabetes Individuals with type 2 diabetes are at high risk for and have a higher mortality from coronary heart disease (CHD). A cluster of cardiovascular risk factors associated with insulin resistance, a core defect in this disease, contributes to this increased risk for CHD. Clients will be classified as having pre-diabetes (glucose ) or diabetes (glucose 126 or higher). Hypertension Blood pressure readings of 140/90 or above. Measurements taken on both arms while resting in the sitting position. Obesity Body fat percentage measurement over 33% for males and 38% for females. Using the skinfold technique and bioelectrical impedance methods.

5 Firefighter Physical Performance Testing Protocol Physical Fitness Age: One minute sit-up test, maximum push-up test, flexibility, body fat percentage and Max VO2. Health Age: CHD risk, BP, Body Fat, and Max VO2. Physical Performance Score: Age, Max VO2, 2 min sit-ups, push-ups, body weight, body fat%, lean body weight, grip strength, pull-ups and vertical jump. Computer Report Processing And Consultation: A 20 minute consultation reviewing the 15 page report evaluating all of the testing data including exercise and nutrition recommendations. The Max VO2 test will measure expired O2 and CO2 while exercising to determine accurately your maximum oxygen consumption (cardiovascular endurance capabilities), anaerobic threshold (lactic acid accumulation), aerobic threshold (minimal lactic acid accumulation), fuel utilization (carbohydrates and fat utilization),optimal fat burning zone, oxygen extraction in the lungs, heart rate training zones and cardiac output. This information is vital that can be used to improve the physical capabilities of a firefighter. Furthermore, a 9 or 12 lead EKG will be utilized to monitor heart rhythm during maximal exercise. Any resting or exercise EKG abnormalities will be documented and a copy will be provided to the firefighter coupled with a medical referral.

6 PHYSICAL PERFORMANCE TEST AND PHYSICAL FITNESS AGE PROTOCOL PULL-UP TEST Starting position from a dead hang arms fully extended and knees bent. Pull-up while maintaining a NO SWING position until the chin rises above the bar. Return to the starting position. No HIP UPS are allowed. No movement of the knees or swinging of the body while pulling up. Total number used in the performance score calculation. Ideal Score=10 for males and 5 for females. 4 points per pull-up. No influence on physical fitness age. SIT-UP TEST Start with shoulder blades touching the mat with hands touching fingers behind your head and palms covering your ears. Begin the sit-up with elbows out and the sit-up is completed when the back breaks the 90 degree plane. Return to the starting position with shoulder blades touching the mat. No bouncing off the bench is allowed. No hip extensions are allowed. Palms/hands cannot come off the ears. One minute count used for the fitness age and 2 minute count used in the performance score calculation. 31 sit-ups for males and 25 for females in one minute= 18 year old. Ideal Score is 69 in 2 minutes points per sit-up.

7 PUSH UP TEST Starting position hands slightly wider than shoulder width, palms facing forward, feet together and arms extended. Chest must touch the mat on the bottom stage of the push up and the back must touch the pad on the upper stage of the push-ups. No stopping allowed. Total number used for the fitness age and in physical performance score calculation. 54 push-ups males and 49 modified push-ups for females=18 year old. Ideal Score is 50 push-ups for males and 24 for females points per push-up. BIOELECTRICAL IMPEDANCE ANALYSIS For accurate results you must not be over hydrated or dehydrated. Do not drink water up to one hour prior to your assessment. Do not exercise up to one hour to your assessment. Body fat value used in the fitness age calculation. Body fat value and lean body weight used in the performance score calculation. 9.9% fat for males and 16.8% females=18 year old. Ideal Score= 19% for males and 23% for females points for every % fat points per pound of lean body weight. MAX VO2 TEST Do not consume any food up to three hours prior to your test. Do not exercise up to four hours prior to your test. Continue taking any prescription medications. Value used in the fitness age and in the performance score calculation. Max VO2 of 53 ml/kg/min for males and 45 for females=18 year old. Ideal Score=Max VO2= points for every 1 ml.

8 SIT AND REACH TEST One leg on bench down leg bent at 90 degrees. Reach with hands on top of each other and touching the ruler. Knee MUST stay flat on bench during the reach. Must hold the stretch position for one second. Average value of right and left leg used in the fitness age calculation. Average of 5 inches past toes for males and 6.3 for females =18 year old. No influence on performance score. VERTICAL JUMP TEST The height of the jump tester device is adjusted while standing under the measuring stick with arm FULLY EXTENDED. NO stepping before leaping. Value used in the performance score calculation. Ideal Score=21 inches points for every inch jumped. No influence on physical fitness age. GRIP TEST Arm bent at 90% during the ENTIRE TEST. Highest value obtained from either hand will be used in the performance score calculation. Ideal Score=60 kg for males and 48 for females points for every kg. No influence on physical fitness age. PERFORMANCE AWARD CLASSIFICATIONS Gold Status: Silver: Bronze: Ideal Score: 1500 or above.

9 PRICE: $300/participant. Optional Services: OSHA Respiratory Compliance Program Medical Questionnaire Administration: $10/00. C-Reactive Protein- A blood profile to measure inflammation of the coronary arteries. Recommended for firefighters 40 and over. $ CBC-Complete Blood Count, Hemoglobin, Red blood cell, white blood cells, lymphs and measures of inflammation and infection: $ Hearing/Vision Screening: $ Hep B Surface Ab and TB Blood Test: $ Testing Set-Up at Camp Roberts FD.

10 Max VO2 testing at Paso Robles Fire Department. CLIENT REFERENCES Big Bear Fire Department Chief Willis (909) Barona Fire Department Ken Kremensky (619) Barstow Fire Department Chief Ross (760) Paso Robles Fire Department Administration of Fit For Duty Program Brian Lewis (805)

11 Camp Roberts Fire Department Ken EIcher (805) Atascadero Fire Department Tom Brikenfeld Rialto Fire Department Eric Gardner Morongo Fire Department Efrain Vargas (951) Ross Valley Fire Department Chief Mark Mills (405) Solana Beach and Del Mar Fire Departments Chief Mike Stein (760) Prescott Fire Department Chief Dan Morgan (928)

12 Appendix I What Specific Profile Can Identify A Firefighter Who May Be At Risk For Coronary Heart Disease Or Death From A Cardiovascular Event? Fitness Appraisal, Inc. has been implementing health and fitness assessments on firefighters for 30 years throughout the state of California. During this period we were aware of 11 firefighters who had documented coronary heart disease or died of a cardiovascular event among fire departments we evaluated. The following information displays the risk profile of this population. % RISK FACTORS PRESENT 46 OR OVER TRIGLYCERIDES ABOVE 150 AIG >.1 CHD RISK % ABOVE 9 CHOLESTEROL ABOVE 200 HDL BELOW 50 BLOOD PRESSURE 140/90 + MAX VO2 <40 METABOLIC SYNDROME SIGNIFICANT FAMILY HISTORY CURRENT OR FORMER SMOKER SYMPTOMS EKG-ST DEPRESSION HS-CRP ABOVE 1(only 3 evaluated) 100% 91% 91% 91% 91% 88% 72% 70% 63% 40% 27% 27% 27% 100%

13 Firefighters who had documented coronary heart disease or died from a cardiovascular event had the following profile: All were 46 and over and 91% had Moderate to High AIP, CHD Score above 8 and 2 or more CHD risk factors. AIP-Elevated Atherogenic Index of Plasma Insulin resistance is often associated with increased triglyceride (TG) and decreased HDL-cholesterol (HDL-C) concentrations and increased small LDL particles. The Atherogenic Index of Plasma (AIP), defined as log(tg/hdl-c), has recently been proposed as a marker of plasma atherogenicity because it is increased in people at higher risk for coronary heart disease and is inversely correlated with LDL particle size. CHD Risk Score: Framingham Coronary Heart Disease Risk Score (SI Units) Estimates risk of having coronary heart disease at 10 years (SI units). The following parameters are used to calculate the risk: Sex (validated only for male/female, no transgender/intersex) Age (not validated for 74 or over) Total Chol (mmol/l) HDL (mmol/l) BP (mm Hg) to choose a category, uses the highest category. Diabetic? Smoker?

14 The following parameters were less significant among the firefighters who had documented coronary heart disease or died of a cardiovascular event (40%, 27% 27%, 27% occurrence).

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