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Cardiorespiratory Fitness Predicts Cardiovascular Risk Profiles in Career Firefighters

Baur, Dorothee M. MD, MS; Christophi, Costas A. PhD; Tsismenakis, Antonios J. MD; Cook, E. Francis ScD; Kales, Stefanos N. MD, MPH

Journal of Occupational and Environmental Medicine: October 2011 - Volume 53 - Issue 10 - p 1155–1160
doi: 10.1097/JOM.0b013e31822c9e47

Objective: Evaluate the association between cardiovascular disease (CVD) risk factors and cardiorespiratory fitness (CRF) in firefighters.

Methods: Cross-sectional study of 968 male career firefighters. Cardiorespiratory fitness was measured by maximal exercise tolerance tests. Cardiovascular disease risk parameters included body composition, resting vital signs, and metabolic profiles. Group comparisons were performed using χ2 test, analysis of variance, and general linear regression with/without adjustment for age and body mass index (BMI).

Results: Higher metabolic equivalents categories were significantly associated with lower diastolic blood pressure, body fat, triglycerides, low-density lipoprotein cholesterol and total/high-density cholesterol ratio, and higher high-density lipoprotein (P ≤ 0.0272, age and BMI adjusted).

Conclusions: Increasing CRF has beneficial independent effects on CVD risk factor profiles among firefighters. Higher CRF was beneficial regardless of BMI; nevertheless, increasing BMI had strong independent unfavorable effects. Firefighters should be encouraged to increase their CRF to decrease their future risk of CVD.

From the Harvard School of Public Health, Department of Environmental Health, Environmental and Occupational Medicine and Epidemiology, Boston, Mass (Drs Baur, Christophi, Kales and Tsismenakis); The Cambridge Health Alliance, Harvard Medical School, Employee Health and Industrial Medicine, Cambridge, Mass (Drs Baur, Kales, and Tsismenakis); Cyprus International Institute for Environmental and Public Health in association with Harvard School of Public Health, Cyprus University of Technology, Limassol, Cyprus (Dr Christophi); Boston University School of Medicine, Boston, Mass (Dr Tsismenakis); and Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (Dr Cook).

Address correspondence to: Stefanos N. Kales, MD, MPH, Occupational Medicine, The Cambridge Health Alliance, 1493 Cambridge St Macht 427, Cambridge, MA 02139 (,

Stefanos N. Kales has served as expert witness in legal cases involving firefighters.

©2011The American College of Occupational and Environmental Medicine