Inclusion professionals group

Transcription

1 Inclusion professionals group Date: 14 January 2015 Item No: 06 Title: Equality impact on fitness standards Presented by: D Dunlevey For Information or Decision: Information Introduction The Inclusion Professional Group were asked to consider the work being jointly funded by the Chief Fire Officer's Association (CFOA) and Fire Research and Training Trust and is supported by the Firefighters Charity for Bath University to examine the lifestyle of UK Firefighters and UK FRS employees, and to assess the physical and strength demands of fire-fighting to ensure the safety of operational UK fire-fighting personnel. The Bath Report is empirically substantiated and in terms of the sample and methodology no weaknesses, that may arise to a specific equality consideration, were found. However as such it is not recognising the physiologic variance by age and gender (and possibly ethnicity) of the cohort due to the nature of the work and the exact objectivity it sought to identify. A consideration of potential disproportionate impact on protected characteristics has been developed and is due to be included in the forthcoming guidance which is being prepared for Services. Below is a succinct overview of the Project for you information. Physical Demands Analysis The branch of the project that aimed to assess the physical demands of firefighting. This was completed by accurately measuring the physical exertion required to complete a selection of routine fire-fighting tasks in a large, varied group of UK firefighters, representative of the UK FRS population. A rigorous consultation process with a panel of highly-experienced firefighting staff was used to design and select the tasks and their paces. This was in order to ensure that we produced tasks that any operational firefighter would reasonably be expected to complete as part of their job. This research was based on maintaining firefighter safety, and provides scientific evidence for future UK FRS fitness standards directly from physical ability during operational duties and informs on how to protect firefighters during the physical tasks required as part of their job. This also has the potential to inform on future resources to services and strategies for improving opportunities for firefighters to remain healthy, fit and safe throughout their careers. The testing took place at the Fire Training College in Moreton-in-Marsh in April 2013 and the data collection went successfully. We received overwhelming positive feedback from the 62 firefighters who were involved, which included individuals (both retained and whole-time) from 15 different fire services. Currently, we have derived an empirically-valid cardiorespiratory fitness standard from our data, and we continue to work with the UK FRS to design a fitness management protocol for the effective and successful use of these data in the service. Page 1 of 3 Item 06 - Equality impact on fitness standards 14 January 2015

2 Health and Lifestyle Survey The branch of the project that aimed to describe the current lifestyle, health and well-being of UK Fire & Rescue service employees. A fully anonymised survey was launched online to all Fire & Rescue services in January 2013 for six months, containing a set of previously validated questions, allowing for a snapshot of health, physical activity and well-being in the UK Fire Service currently. This project will provide an opportunity to see what changes have happened over the past decade where no further comprehensive examination of the health of the UK FRS has been completed. The survey is now closed on the online forum, and data analysis is ongoing. Some preliminary statistics were presented at the FireFit conference in November 2013, and show some interesting associations between habitual physical activity, age and weight management, as well as the importance of sleep on well-being and health. Strength and Muscular Endurance Requirements of Firefighting It is acknowledged that the ability to be safe and effective during the physically arduous roles of a firefighter require more than simply cardiorespiratory fitness. This branch of the project aimed to identify which necessary actions within the role of a UK firefighter require the largest applications of physical strength. The secondary aim, was to examine what gym-based tasks could predict performance in these occupational-strength tasks, so that health and fitness advisors could use simple, readily available tests to monitor strength in serving firefighters. The data collection was completed in 51 participants (non-firefighters) with varied fitness and training experience, where individuals completed ladder manipulation tasks and gym-based strength tests to ascertain which components of strength predicted how well individuals performed on the operational tasks. Data analysis is on-going to determine what thresholds of strength on gym-based shoulder-press and rope pull-down tasks represent optimum strength for a firefighter. Consideration of potential disproportionate impact on protected characteristics presented by new fitness standards Operational firefighting is undertaken by men and women from the age of 18 to, in some cases, beyond the age of 60 years. The physical demands of critical firefighting activities have been established and minimum fitness standards are identified as part of this guidance to help protect firefighters and the public by ensuring that both firefighters and incident commanders have the minimum physical fitness requirements to carry out their duties safely and effectively. Firefighters have a professional responsibility to maintain fitness levels and competencies and Fire and Rescue Services are expected to help facilitate and support this through various means. Potential Disproportionate Impact In the wider population, cardio-respiratory fitness and muscular strength levels decline with age from early adulthood and are generally lower in females in all adult age groups when compared to males. Therefore the ability to maintain minimum levels of physical fitness for safe and effective firefighting may disproportionately impact on these characteristics and must be considered in the development of policy and procedure at each Fire and Rescue Service. This may need to include the differential application of interventions and support programmes. Due to the physiological variance in fitness capacity by age and gender, Services may find that older firefighters and women firefighters find it more difficult to maintain the determined minimum fitness standards than younger, male firefighters. This however, is by no means inevitable and the maintenance of healthy lifestyles and appropriate physical training programmes can substantially reduce this physiological decline. Due regard needs to be considered on how these occurrences, should they arise, are to be managed. Differential impact must be considered and, where reasonable, justifiable and proportionate, mitigated, without affecting the safety of firefighters and the public by undermining the maintenance of the minimum fitness standards identified in this guidance. Gender and Age variances may be extended to other characteristics protected under the Equality Act 2010; however no available data to substantiate such an impact has been identified. Therefore data collection and monitoring of the impact on minimum fitness standards needs to be developed and reported on through appropriate mechanisms to minimise this impact. Page 2 of 3 Item 06 - Equality impact on fitness standards 14 January 2015

3 Recommendations Below are a number of recommendations Services should consider to help minimise adverse impact. Please note that this list is not exhaustive: Use a suitably qualified fitness adviser who understands the role and requirements of firefighting that can provide professional advice and guidance to employees to help them maintain appropriate fitness levels throughout their career. Routinely monitor by age, gender and ethnicity the fitness levels, including comparable indicators achieved across operational staff identifying their duty system. The monitoring should be reported on regularly, and compared nationally, with an ability to identify specific and multiple variables. Develop individual service policies and practices that demonstrate due regard at its development stage and prior to implementation. Implementation will require monitoring to be accessible and recurring in method to identify any variances. Considered involvement of staff at all levels of implementation. Review systems of work and roles to ensure that they are fit for purpose. Consider the impact of any future research on the impact of the menopause in female operational staff. Page 3 of 3 Item 06 - Equality impact on fitness standards 14 January 2015

4 Physical Fitness Management Fitness Management Concept Physical fitness is a safety issue, and the main concept of the fitness management framework detailed in this guidance stems from the notion that without adequate physical fitness, physically demanding environments such as emergency duty activities, can place excessive strain upon the body and add considerable risk of injury from over-exertion such as a cardiac event. The fitness standards, produced from empirical scientific evidence, are accompanied by a framework for managing individuals with varying fitness levels, based on their likelihood of having the required level of physical fitness to perform necessary operational duties safely and effectively without undue physical strain. The frameworks follows a traffic light system, where: Green = Highly likely to be fit for operational duties. Amber = May or may not be fit for operational duties. Red = Highly likely to be unfit for operational duties. The amber section reflects the variance that exists between each individual s ability to cope with varied physically demanding firefighting duties

5 General Fitness Management Process 2

6 Cardiorespiratory Fitness Standards (VO 2 max) Please note: Currently the incident commander fitness management framework is in a suitable level of progress to be implemented. However, the fitness management framework specific for operational firefighters contains a section requiring a drillground fitness assessment, the exact design of which requires further research and should not yet be implemented. In the meantime, more information on drillground tasks for use in training for physical readiness are available within the Physical Training section. It is recommended that services begin implementing these tasks into their typical training activities. Operational Firefighters Those in a firefighting role should have their fitness categorised and managed in the following manner: GREEN - Equal to or above 42.3 mlso 2 /kg/min Should be considered physically fit for operational duties, having reached or exceeded the minimum acceptable level for their role. Fitness retested at yearly intervals. AMBER - Below 42.3 mlso 2 /kg/min but equal to or above 35.6 mlso 2 /kg/min Should be considered possibly unfit for operational duties. Should undergo further assessment to determine their suitability for operational duties by performing a drill ground assessment. In order to be considered safe to undertake a potentially maximal-intensity drill ground assessment, individuals should successfully pass a suitable physical activity risk assessment (see chapter on Safety). Those that pass the drill ground assessment should be considered fit, but be given appropriate exercise/fitness improvement advice and retested in 6- months. Individuals that fail a drill ground assessment should be removed from operational duties and given a fitness improvement plan and re-tested at suitable intervals until the individual has reached the GREEN fitness category or successfully completed the drill ground assessment. Those that do not pass a physical activity risk assessment should be referred to occupational health for further assessment since they are not yet considered safe to perform a potentially maximal-intensity drill ground 3

7 assessment (see section below on Safe for High Intensity Exercise). Those that are not considered safe to perform a drill ground assessment by occupational health should be removed from operational duties and given a fitness improvement plan and re-tested at suitable intervals until the individual has reached the GREEN fitness category or successfully completed the drill ground assessment. Those that are considered safe to undertake the drill ground assessment by occupational health should be allowed to do some and managed in the same manner as directed above. RED - Below 35.6 mlso 2 /kg/min Should be considered unfit and be removed from operational duties. Be given a fitness improvement plan and re-tested at suitable intervals until the individuals has reached the GREEN fitness category or successfully completed the drill ground assessment. Firefigh(ng*Personnel** Cardio%respiratory+(VO2)+Fitness+Test+Result &+ above+ Between and+ below+ (3) ++ 6+Month+ Re%Test+ 1+Year+ Re%Test+ Physical+AcHvity++ Risk+Assessment* (1)* Improvement++ Fit+For++ Ops+DuHes+ Fit+For++ Ops+DuHes+ Fitness+ Improvement+ Advice+ Pass+ Fail+ (2)+ Drill%Ground+Assessment+ Pass+ Fail+ (3)+ Refer+ to+ OHU+ + Unfit+/+ Unsafe+ + Removed+ From+ Ops+ DuHes+ + Remedial+ Training+ No+ Improvement Management+ Processes+ 1 +OH+++fitness+assessor+to+determine+suitable+Physical+AcHvity+Risk+Assessment+(minimum+Par%Q+) Those+that+fail+a+Physical+AcHvity+Risk+Assessment+may+be+considered+fit+to+undertake+a+drill+ground+assessment+ following+an+assessment++by+ohu Individuals+that+fail+drill+ground+test+or+have+a+confirmed+VO 2 +max+below+35.6+should+be+removed+from+operahonal+ duhes+even+in+the+absence+of+other+medical+risk+factors.+ 4

8 Incident Commanders Those in an incident command role should have their fitness categorised and managed in the following manner: GREEN - Equal to or above 36.8 mlso 2 /kg/min Should be considered physically fit for operational duty, having reached or exceeded the minimum acceptable level for their role. Fitness retested at yearly intervals. AMBER - Below 36.8 mlso 2 /kg/min but equal to or above 31.3 mlso 2 /kg/min Should be referred to occupational health and categorised as low, moderate or high risk based on a possible low level of fitness and other medical risk factors. Those considered low or moderate risk should be considered fit for operational duties, but be given exercise advice and retested at more frequent intervals (low risk 6 monthly; moderate risk 1-3 monthly). Those that are considered high risk should be should be considered unfit for operational duties, be removed from operational duties and given a fitness improvement plan and retested at suitable intervals until the individual has reached the GREEN fitness category or the AMBER fitness category and considered low or moderate risk by occupational health. RED Below 31.4 mlso 2 /kg/min Should be considered unfit and be removed from operational duties. Be given a fitness improvement plan and re-tested at suitable intervals until the individuals has reached the GREEN fitness category or the AMBER fitness category and considered low or moderate risk by occupational health. 5

9 Incident(Commander( Cardio0respiratory((VO2)(Fitness(Test(Result ( 36.8(and( Above( Between(( (31.4( (36.7( 31.3(and( Below(( Incident(Command(Roles(0(Fitness(Management(Process( Regular( Re0Tests( (2)( 1(Year(( Re0Test( Refer(to(OHU( (1)( Refer(to( OHU( Improvement( Safe(for( Ops( DuDes( Safe(for( Ops( DuDes( Lower( Risk( Moderate( Risk( Higher( Risk( Removed( from(ops( DuDes( Remedial( Training( Fitness(Improvement(Advice( No( Improvement( Management( Processes( 1( OH(to(risk(straDfy(individuals(in( AMBER (fitness(category:( LOWER(risk(=(No(addiDonal(risk(factors(along(with( at#risk (fitness.( MODERATE(risk(=(1(or(more(risk(factor(that(elevate(overall(health(risk(along(with( at#risk (fitness(score.( HIGHER(risk(=(1(or(more(risk(factor(that(significantly(elevates(health(risk(along(with( at#risk (fitness.( ( 2 (Retest(Frequency(0(LOWER(risk((6(months),(MODERATE(risk(+(those(in(Remedial(Training((103(months)(( 6

10 Fitness Improvement The fitness management framework recommends stages of remedial training and improvement advice for individuals who fall within specific categories of physical fitness. Cardio-respiratory fitness Cardio-respiratory fitness (VO 2 max) is often measured in units of millilitres of oxygen, per kilogram of body mass, per minute (ml/kg/min)...or some combination of both. Because cardio-respiratory fitness values in these guidelines are expressed per kilogram of body weight, it means that levels of fitness can be improved purely by a reduction in body weight, and not solely by exercise training alone. Therefore, both exercise training and changing dietary habits are powerful tools for fitness improvement. What changes can be expected? Individual responses to physical training and/or weight loss from calorie restriction can vary considerably. Therefore, it is difficult to be highly prescriptive with a recommended dose of exercise and/or weight reduction. Factors such as age, gender, current activity level as well as genetic factors can all influence rates of change. A qualified fitness professional will be able to develop suitable fitness training programmes that will help firefighters to achieve their fitness goals taking into consideration many of these factors. However, some general guidelines have been established from population norms for both fitness improvement and healthy weight reduction with associated timescales (shown below). These can be used as a guide for planning timeframes of improvement. 7

11 Fitness Improvements From Weight Loss Reductions in body weight by kg (1 2 lb.) per week, by adhering to a calorie controlled diet, are considered safe for achieving long term weight loss for overweight individuals. 1,2 While weight loss greater than 0.9 kg per week may be possible without medical supervision this rate of weight loss can be unhealthy, increasing the risk of other health problems including malnutrition and gallstones, as well as potentially causing general feelings of tiredness and ill health. Based on these guidelines: Favorable weight loss: Would constitute ~ 0.8 kg body mass loss per week. Adequate weight loss: Would constitute ~ 0.5 kg body mass loss per week. Inadequate weight loss: Would constitute less than 0.5 kg body mass loss per week. The table below gives general guidelines for tracking an individual s weight loss during an improvement plan. Do note, however, that most individuals will not lose weight at a constant rate, meaning some weeks observed weight may be above/below target weights. Weight loss (kg) Week week weeks weeks weeks weeks weeks weeks Good Adequate Inadequate <0.5 <1.0 <2.0 <3.0 <4.0 <5.0 <6.0 As explained above, weight loss itself improves VO 2 max level in the absence of fitness training. 1 American College of Sports Medicine (2006). ACSM s Guidelines for Exercise Testing and Prescription. 7th Edition. Lippincott, Williams and Wilkins. London. 2 NHS Work out how much weight you need to lose: 8

12 Therefore, when weight reduces purely from calorie restriction, fitness improvements of the following magnitude can be expected: 10% weight reduction = ~11% fitness improvement. 15% weight reduction = ~18% fitness improvement 20% weight reduction = 25% fitness improvement If weight loss is not purely from caloric restriction, and includes a physical training programme, there is a possibility that the new stimuli will result in an increase in muscle mass that may outweigh fat loss. For these reasons, the assessment of body fat percentage in conjunction with weight measurements will help to determine appropriate weight loss from body fat. Fitness Improvements From Exercise Training Aerobic capacity has been observed to increase at a rate of approximately 4-15% over 2-10 week training periods, respectively in a mixture of previously untrained or recreationally active participants. 3,4 Similar to weight loss, responses to training can vary depending on the individual and the type of training being performed. However, a consistent well-planned aerobic fitness programme will help achieve improvements in aerobic capacity, with weight loss as a likely secondary consequence. Based on these guidelines: - Good improvement: would constitute 1.5% improvement in cardiorespiratory fitness per week. - Adequate improvement: would constitute 0.5% improvement in cardiorespiratory fitness per week. - Inadequate Improvement: would constitute no change (or a decrease) in cardiorespiratory fitness per week. 3 Sloth M, Sloth D, Overgaard K, Dalgas U Effects of sprint interval training on VO2max and aerobic exercise performance: A systematic review and meta-analysis. Scand J Med Sci Sports ;23(6):e Kent W The effects of sprint interval training on aerobic fitness in untrained individuals: a systematic review. Br J Sports Med 2011;45:A8 9

13 Safety Physical exercise is a safe activity for most people and it remains one of the single most important contributors to good health. However, the beneficial effects of exercise can come at a cost and risks of injury including more serious incidents such as heat attack whilst small, are associated with beginning an exercise programme or performing an exercise test. 1 Most people do not require a medical check up before taking part in exercise. However, individuals should be advised to consult with their occupational health unit or their own doctor if there are any doubts about their ability to take part in moderately vigorous exercise. 2 It is important to remember, that the risk of an exercise related event such as a heart attack, or worse cardiac death are greatest amongst individuals performing unaccustomed physical activity and greatest during vigorous intensity physical activity. 2 Therefore, if individuals are appropriately screened prior to exercise and given proper instruction on how to progress steadily with an exercise programme, many of these risks can be greatly reduced. In addition, being physically fit, exercising regularly and maintaining appropriate levels of fitness will also reduce the risks of injury from either a sudden onset of exercise and / or maximal or supramaximal intensity exercise. Operational personnel should be physically prepared for intensities similar to those of operational duties. A qualified fitness professional will be able to help develop appropriate screening methods and administer tailored fitness advice in order to support firefighters throughout their careers. Pre-Exercise Health Screening Pre-exercise health screening reduces the risk of an untoward event associated with starting an exercise programme, performing an exercise test or becoming more physically active by identifying known diseases and risk factors. 2 Self administered questionnaires such as the Physical Activity Readiness Questionnaire (Par-Q) or the AHA/ACSM Health/Fitness Pre-Participation Screening Questionnaire (see Key Resources) are considered the minimally accepted screening tools before beginning an exercise programme. 2 These types of pre-exercise screening tools are useful as 1 Thompson, P.D. (2001). Cardiovascular risks of exercise. Avoiding sudden death and myocardial infarction. The Physician and sports medicine, 2001, Vol.29(4), pp American College of Sports Medicine, ACSM s Guidelines for Exercise Testing and Prescription (9 th edition). Lippincot Williams & Wilkins, Philadelphia.

14 they allow the majority of individuals to determine their own suitability to exercise without the need to consult with a medical or fitness professional. In 2007, the Par-Q was updated to the Par-Q+ with the aim of reducing barriers for low to moderate intensity physical activity participation for everyone, regardless of their age, sex, or health status. The new risk stratification and physical activity participation clearance strategy significantly reduces the barriers to physical activity participation for everyone. This includes paper and online versions of the new Physical Activity Readiness Questionnaire for everyone (PAR-Q+) and the online electronic Physical Activity Readiness Medical Examination (eparmed-x+). The PAR-Q+ and eparmed-x+ (see Key Resources) can be used to determine your readiness for increased physical activity participation or a fitness appraisal. 3 Pre-Participation Screening Before Exercise Testing Whilst the complications associated with exercise testing appear to be relatively low, the ability to maintain a high degree of safety depends on knowing when NOT to perform an exercise test on an individual. 4 Therefore, it is important to perform an initial screening of participants relative to risk factors and / or symptoms for various chronic diseases (cardiovascular, pulmonary, and metabolic), as this will optimise their safety during an exercise test. The test administrator should ensure that there are no medical contra-indications to the participant performing a test. Predictive Exercise Tests Many fire & rescue services choose to administer submaximal predictive exercise tests on firefighters to determine fitness for operational duties. 5 These tests are described in further detail in the section on fitness tests but include tests such as: Chester Step Test Chester Treadmill Test (prediction) Submaximal exercise testing provides a quick, simple and relatively low risk means of effectively assessing cardio-respiratory fitness American College of Sports Medicine, ACSM s Resource Manual for Guidelines for Exercise Testing and Prescription (6 th edition). Lippincott Williams & Wilkins, Philadelphia. 5 FireFit Steering Group. Survey on fitness testing in Fire and Rescue Services: FireFit Conference 2011.

15 Performance Exercise Tests Performance tests where an individual is required to meet a set performance criteria (such as time or distance) to pass a fitness test do not rely on assumptions based on predicting maximal heart rate and may be considered more accurate than some sub-maximal tests. However, some of these performance tests are less controlled and may push individuals into vigorous and potentially maximal exercise intensities. Due to the increased risks involved in these higher intensities of activity, more detailed pre-exercise health screening procedures may be required for this type of testing. These tests include: Multi-Stage Shuttle Run Test (bleep test). Chester Treadmill Test (Performance). Drill Ground Assessments. In a controlled setting (such as a treadmill walk test), a heart rate monitor can be used to monitor an individual s exertion and a test administrator can choose to stop the exercise at a sub-maximal level before reaching an exercise intensity that may be unsafe for that individual. In some testing forms (bleep test or drill-ground environment) this may not be possible. In these tests, it may be necessary for individuals to be considered safe to perform potentially maximal intensity exercise prior to beginning one of these tests. At a minimum, individuals should complete (and pass) a physical readiness questionnaire (such as the PAR-Q+). Guidelines for exercise testing are published by both the American College of Sports Medicine, the British Association of Sport and Exercise Science and Exercise and Sport Science Australia, which can be useful when developing appropriate preexercise risk assessment procedures. Fire & rescue services should have agreed written procedures and policies that detail the safety measures in place to ensure firefighters are safely and properly managed during physical training activities including exercise tests. Note: No set of guidelines for exercise testing and participation can cover all situations. Local policies and risk assessments vary, and specific programme procedures are also properly diverse. 8

16 Considerations for Appropriate Physical Activity Risk Assessment What is considered an appropriate pre-activity risk assessment is perhaps not as straightforward as we would all like. Pre-exercise health screening procedures must be valid, cost-effective and time-efficient but most importantly be robust enough to protect the health & safety of those performing physical activity or an exercise test as far as reasonably practicable. Opinions may differ between, fitness, medical and health & safety professionals. It is therefore imperative that fire & rescue services seek cross-departmental agreement on the most appropriate approach to preexercise screening for their circumstances. In 2011, a survey conducted with the FireFit conference delegates indicated the exercise testing practices from 34 fire & rescue services across the UK: 94% of services undertook fitness testing for all firefighters. 85% of services undertook pre-participation health screening prior to administering a fitness test. 65% of services undertook pre-exercise blood pressure measurements. 83% of services used either the Chester Step Test (54%) Multistage Shuttle Run Test (15%) or Chester Treadmill Test (24%) as their primary method for exercise testing. Key Resources: Electronic Self-Administered Pre-Exercise Screening Questionnaires: Physical Activity Readiness Questionnaire for everyone (PAR-Q+) Physical Activity Readiness Medical Examination (eparmed-x+) Paper Self-Administered Pre-Exercise Screening Questionnaires: Physical Activity Readiness Questionnaire for everyone (PAR-Q+) Page 1 Physical Activity Readiness Medical Examination (eparmed-x+) Pages 2-4 AHA/ACSM Health/Fitness Pre-Participation Screening Questionnaire Physical Activity Readiness Questionnaire (Par-Q) Websites: American College of Sports Medicine Exercise and Sport Science Australia

17 British Association of Sport & Exercise Scientists Books / Resources: ACSM's Guidelines for Exercise Testing and Prescription, Ninth Edition Perceived Exertion. American College of Sports Medicine Exercise and Sport Science Australia: Pre-Exercise Screening System.