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Ounce of Prevention is Worth a Pound of Cure

Every year, firefighters across the country die or are taken out of work due to preventable medical conditions. Many of these conditions could have been identified in annual medical screenings and exams and treated before resulting in loss of life or injury time-off.

 A Cardiac Stress Test may be a part of your fire department's routine physical exam or something your Primary Care Physician may suggest based on the nature of your work - but does just the thought of getting a "Treadmill" Stress Test give you chest pain you didn't have before?

Steve Vrieze (Volunteer Firefighter/EMT/Master Degree in Exercise Science) takes us into the University of Minnesota Medical Center in Cardiac Stress Testing to show us their facility and explains to us how this exam is administered and what to expect. 


By Steve Vrieze, MS, NREMT-B
It’s quite likely that you know someone with heart disease. Heart disease has established itself as the No. 1 killer in the United States (1). According the American Heart Association (AHA) 375,000 lives are claimed each year and 735,000 people suffer a heart attack per year.
Similar to the rest of the American population, the fire service feels the effects of heart disease too. Sudden cardiac death (SCD) is the leading cause of on duty firefighter deaths (2). In most research SCD is an umbrella term that typically groups causes of abrupt loss of heart function together. In fact, 45% of all duty related deaths are due to heart disease. Furthermore for every SCD event, almost 17 non-fatal cardiovascular events occur (3). This means many fire departments, while not dealing with line of duty deaths, are still losing personnel to heart disease. With these findings the National Fire Protection Association suggests fire departments focus on detectable heart problems through annual medical exams and wellness programs.
One method for evaluating detectable heart problems is a cardiac stress test. If you mention to your department or personal physician that you have had any type of chest discomfort, shortness of breath, or palpitations, it is likely you will be scheduled to have a stress test. Elements such as age, risk factors, and previous heart history are considered when ordering a stress test. However, given the before mentioned statistics of heart disease and the fire service, it is likely a physician would order a stress test regardless of risk factors and medical history. There are a variety of stress tests available: exercise and non-exercise, as well as with and without heart imaging. Given the physical nature of firefighting, an exercise stress test is likely the type of test chosen for a firefighter. When looking at the diagnostic value of a stress test we often talk about specificity and sensitivity in clinical exercise testing. Specificity is the percent of those without heart disease that will have normal test results. In most cases the specificity of a stress test is 84%. Sensitivity is the percentage of those with heart disease that will have abnormal test results, which is typically 66% (4). In basic terms this means if you have disease and don’t know it, a majority of the time it will be discovered through a cardiac stress testing. If there this imaging added to the test these numbers can be increased.
Once a stress test is scheduled there are a number of things to expect. First, understand there is often a discrepancy between how your physician describes the test to you and how the actual test is performed. An exercise stress test can be performed using a variety of devices. While a treadmill remains the most common modality for testing, an upright bicycle is often used, or a supine bicycle is possible. Some places may even use a simple step in which the patient steps up and down to an audio cue. Secondly, you may have to have an I.V. placed prior to testing. For those with a phobia of needles this can often be a test taking deal-breaker if the patient isn’t prepared for it. The I.V. serves two purposes; first for safety and second for administration of an imaging solution. If any type of imaging is ordered with the stress test an I.V. is a given.
While the modality that a stress test is performed on may be different, the process often follows a common pattern: resting baseline, exercise, and recovery. During the rest phase, a patient has their blood pressure and electrocardiogram (ECG) assessed as well as reviewing cardiac history and risk factors. An ECG is an electrical recording of the heart. The ECG will consist of 10 sticky electrodes placed in various locations on the torso. For patients with chest hair, expect that the hair will be shaved for maximal adherence of the electrodes. With the skin prepped and electrodes applied, a resting ECG will be recorded as well as blood pressure measured. Blood pressure and ECG are recorded in a supine or lying position as well as in a standing position to assess for any abnormal postural change. Once the patient’s resting hemodynamic measurements and ECG is assessed, it’s time for the main event.
The exercise portion of a stress test follows incremental, pre-programmed stages from a well-established protocol. A stage can range from 2-3 minutes at a set speed and incline. Each stage increases in difficulty. A patient’s blood pressure, heart rate, and ECG are recorded and assessed during each stage of exercise. Standard exercise protocols, such as Bruce, Balke, or Naughton, are used because of the extensively researched blood pressure and heart rate responses for each stage. If blood pressure increases too rapidly that can be a sign of future hypertension as well as potentially being associated with coronary artery disease. A blood pressure that drops with exercise is suggestive of poor cardiac pumping function and possibly suggestive of heart disease. The ECG is assessed for changes during each stage. Electrical changes on the ECG can suggest inadequate blood flow through the arteries of the heart. ECG changes are the primary indicator of heart disease during a stress test. It is these changes a physician is most interested in.
Exercise testing is often a symptom limited procedure, meaning the patient exercises as long as possible, exerting a maximal effort and stopping only because of fatigue or the development of symptoms such as chest pain, or shortness of breath, etc. However, testing can be terminated for other reasons, such target heart rate achievement, exaggerated blood pressure response, or significant ECG changes. The typical exercise portion of a stress test can last approximately 6-12 minutes.
Once exercise has been terminated, the recovery phase begins. In some situations where cardiac imaging is involved the patient may completely stop moving so the imaging can be performed. However in most situations the intensity of the modality is decreased to allow the patient to gradually cool down. The patient’s heart rate, blood pressure and ECG are continually monitored as the patient’s hemodynamics return to pre-exercise levels. The ECG is monitored for any changes that may develop in recovery which could be indicative of heart disease. Once the patient’s heart rate and blood pressure as well as ECG have returned normal resting levels or the established levels of the testing center, testing is done. If stress testing is performed with a competent, experienced, and efficient staff, a stress test can be completed in about an hour.
The idea of a stress test can elicit anxiety in a person. When armed with knowledge of what to expect during testing, the event can be a little less stressful. Additionally the risk of an adverse event occurring with a stress test is very low, about 1 in 5,000. A stress test can provide information as to how the body responds to calculated and controlled exertion, which provides an understanding of how the body might react to the rigors of firefighting. If heart disease is detectable with a stress test, it could be deadly on the fireground if undetected. An ounce of prevention is worth a pound of cure.
Mozaffarian, D, E.J. Benjamin, A.S. Go. et al. Heart disease and stroke statistics – 2015 update: a report from American Heart Association. Circ. 131:e29-e322, 2015.
Fahy, R.F. U.S. firefighter fatalities due sudden cardiac death 1995-2004. Nat Fire Prot Assoc J. 99:44-47, 2005.
Smith, D.L., D.A. Barr, S.N. Kales. Extreme sacrifice: sudden cardiac death in the US fire service. Extreme Physiology and Medicine. 2:6-15, 2013.
Fletcher, G.F, G.J. Balady, E.A. Amsterdam, et al. Exercise standards for testing and training a statement for healthcare professionals from American Heart Association. Circulation. 104:1694-1740, 2001.
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30 Thousand Facebook Strong Contest

Thanks to awesome friends and fans like you, 555 Fitness now has 30,000 Facebook followers in just over 2 years time. It's just unreal to know that our mission and message can travel so far each and everyday.  You guys and girls are the reason the small staff here at 555 Fitness keeps pushing forward. Hearing and seeing your success stories each and everyday only proves that our movement is growing within the fire service. Eventually, change will occur, and you can know that you played a part in it. 

To thank you for your loyal support we have decided to have a little video contest on our Facebook wall. We want a short 1-2 minute video of you, and your crew living our motto of Train Hard Do Work in your station.  For every like your video gets, you'll get 1 point, for every share your video gets ( must be shared from  the 555 Fitness page) you get 2. Most points at the end of one week from this post, wins a grab bag of 555 Fitness gear for you and your crew.Seems easy enough, the rules are below.

 1) Video must be done in station 

 2) Video must have workout listed in it, with one element of the workout using the number 30 (please not 30,000 of anything ok guys). 30,000 of anything will be automatic disqualification and cause for psych eval. 

3) You have one week to post the video to our wall  from the time of this post 

4) Each like gets 1 point, each share from the 555 Fitness wall gets 2. Most points at the end of one week, wins a grab bag of 555 Fitness gear. 

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A Surprise Grant Award to a Department who is doing it RIGHT

555 Fitness was started with a mission in mind. To create a cultural change from within the fire service. All to often we are inundated with studies, programs, politics, equipment created by certain groups of individuals who use their power and influence and create change from the top. All too often this change is met with extreme backlash from the rank and file, which (with help from our friend the internet) only stirs the pot and makes these folks almost famous. All while no real change is actually occurring. 

Our experience has only showed us that our very simple and direct method of creating cultural change is working. Put up free workouts, share some tips here and there and create a very non judgmental area for emergency service providers to help their brothers and sisters get in shape.  Our use of the internet has brought people together from around the world. We have helped to start this change from within in numerous departments. Not by forcing anyone to workout, not by creating 143 page documents with multiple opened ended options, but by sticking to our philosophy of “Train Hard Do Work”. 

Now with the help our partners Brute Force Training , Life Aid Beverages, Topical Biomedics (makers of Topricin Healing Cream), and Top Secret Nutrition, 555 Fitness is proud to announce we are able to provide a special grant to a fire department who is leading the way in firefighter fitness. The Roebuck Fire District in Spartanburg County, South Carolina will be the first winner of this Brute Force Training grant, and will be receiving a variety of functional fitness equipment provided by Brute Force. Please visit their site here to learn more about their products:  http://www.bruteforcetraining.com

This department is one of many that the fire service can look to and emulate. They are changing the culture and doing what is RIGHT for the members of the community, the firefighter and their families.  

Keeping in mind that what is easy isn't always right, and what is right isn't always easy, the Roebuck FD did the unthinkable. The administration set physical fitness standards, and the members held each other ACCOUNTABLE without exceptions. Below is some info about the Roebuck Fire District and how they created positive cultural change from within. Keep in mind, their policies are very simple and to the point and as you will see, this change was created from within. 

To understand why we chose Roebuck fire department as this surprise grant recipient, we would like you to read their story, in their words:

The Roebuck Fire District is a combination department covering 24 square miles of suburban Spartanburg County in S.C.  We have 13 career firefighters, and 6 volunteers (3 of which work for other FD’s).   We run approx. 600-700 calls per year with very limited medical first response, and work Automatic Aid with 5 local departments for structure fires.  Annually we respond to well over 100 reported structure fires in our primary, and auto aid areas.

 We hold annual physicals in March every year and there is where our official transformations began this year.  Unofficially, we heard that there was going to be a new Dr. coming to our contract agency that performs our physicals, and we heard that he was a “no-nonsense” kind of guy.  Honestly, we were scared of the outcome, because we all knew that changes had to be made, but we were really good at making excuses. One of the guys (that would end up on light duty) knew he was going to busted pretty hard, so he began early trying to diet and lost about 20 lbs before physicals… but that is about all the pre-gaming we had.  When March rolled around, we completed physicals, and anxiously awaited the phone calls.  The Doctor called Chief after reviewing physical info, and told him that he was not going to approve 3 of our firefighters for clearance to wear a respirator.  Our physicals are referenced to NFPA 1500, but qualifying factors for “NO CLEARANCE” are BMI over 40%, quality of Pulmonary Function Test, Stress test on bike, and blood work.  It is important to state that all 3 of ours that did not get cleared were NOT REMOVED FOR WEIGHT ONLY, but had other medical issues that were directly related to obesity.  Some of these were cholesterol problems, hypertension, pre-hypertension and kidney function issues.  The combination of weight, bmi and other health issues caused the Dr. to make his decision.  When he called Chief, he knew this was not going to be a popular decision, but told Chief that essentially, he refused to have the blood of Spartanburg County Firefighters on his hands and wasn’t going to sign off when the indications were that he shouldn’t.  (Gotta love a Doctor with some integrity!)  

The administrative staff then had a meeting and determined that PT was no longer going to be optional at our FD.  We had allowed our staff to voluntarily work out forever, and had not been successful.  After determining that continuing to do the same thing would yield the same results, we made the big change.  This did not come easy for us at all.  There was push back, and excuse making, and every trick in the book to circumvent the system by those of us who were not put on light duty, but the other 3 had no choice… They were given 90 days to make significant improvement to their overall health and then they would be re-evaluated by the physician.  We then decided as a group that we were going to do whatever it takes to support those 3 guys and get them back on the rig.   The 3 were required to meet every 2 weeks and have supervised weigh-ins.  Progress was slow at first, but evident and then all of us started weighing in and seeing results.  After the first month, daily PT was a routine, not a chore anymore.  Sure we still tried to get out of working out, but our shift mates would hold us accountable and make sure that we pushed past the moment of weakness and get through the PT.  Two members were the first to be returned to full duty after approx. 45 days of mandatory PT and the last returned to full duty clearance after 2 ½ months on light duty.  

Since then, all of our staff have seen awesome results, not just in weight loss, but overall function and job performance ability.  Collectively since March, our career staff has lost right at 200 lbs, and that number is increasing every day.  

We have gone from only being able to do 20 minutes (avg) work out each shift, to now at least an hour each shift.  Our stamina on calls is much improved, and our overall ability to perform repeatedly on calls during our shifts is drastically improved.  

We will have much more measurable overall health and wellness statistics to compare after our next physicals, but I am hoping that our department serves as an example of what can be done with the right attitude and direction from our staff, Chief and physician making the right decisions.  


Do you know of a fire department who is doing something like this?  Let us know. 


We would like to congratulate the Roebuck Fire District, not just in winning the grant, but in doing what was hard, doing what is right for their employees. We would also like to thank all of our corporate sponsors for their support of not just 555 Fitness, but the fire service as a whole. 

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