Firefighting is a physically demanding and hazardous profession. To effectively prepare firefighters for occupational demands, an appropriate exercise program must be designed. The exercise program parameters should be based on information generated from a needs analysis. A needs analysis provides the practitioner with critical information regarding physiological and biomechanical demands of job tasks, commonly incurred injuries, chronic diseases, and an assessment of the firefighter's physical ability. This article provides a description of a needs analysis and presents training strategies to improve work efficiency and reduce the prevalence of injuries and chronic disease among structural firefighters.
A needs analysis evaluates the physiological and biomechanical requirements of occupational tasks, common injuries incurred, and an assessment of each firefighter's ability to meet these diverse physical requirements. Collectively, this information provides feedback, which can be used to implement assessment and training practices specific to the needs of a fire department. Furthermore, practitioners can use the needs analysis data to track trends in individual work efficiency, injury and disease occurrence, employment lost time, and training performance outcomes.
A physiological analysis involves identification of occupational tasks (i.e., job task analysis) performed and the primary energy system(s) that these tasks use. Figure 1 provides a sample of a physiological analysis for structural firefighters. In brief, firefighters perform a variety of fire ground tasks that use each energy system. These tasks may involve advancing a charged hose line toward a burning structure (i.e., phosphagen energy system), dragging a victim from a burning structure (glycolytic energy system), and performing salvage tactics to reduce water damage (oxidative energy system). An effective training program must strategically apply exercise stimuli to address these varied metabolic demands. A discussion of appropriate training strategies to enhance work efficiency is presented in the Periodization section.
A biomechanical analysis is used to evaluate the primary movement patterns critical to occupational tasks. The practitioner must identify the primary planes of motion, the muscles, joints, and types of muscle contraction used to complete a given task. A sample biomechanical analysis and appropriate training exercises are provided in Table 1. It is important to note the similarities and novelties of movement patterns across fire ground tasks. For instance, many fire ground tasks are performed in the sagittal plane and require isometric contractions to stabilize the torso while performing unilateral extension of the ankle, knee, and hip. Per the specificity training principle, exercises should mimic movement patterns specific to those of fire ground tasks. Specificity practices will assist in the promotion of enhanced task performance and decrease risk of injury (29).
Because of impending occupational hazards, firefighters are at risk for a vast number of musculoskeletal injuries. Annually, firefighters incur approximately 80,000 injuries, which cost billions of dollars in treatment and lost time from employment (19,40). Researchers are focusing on evaluating intrinsic physical fitness characteristics to understand how firefighters should prepare for the often unpredictable extrinsic environment of fire operations (33). As a result, research has analyzed common risk factors of musculoskeletal injuries and proposed occupational safety recommendations and exercise training practices focused on the prevention of musculoskeletal injuries (2,32). For instance, greater aerobic capacity has been found to be associated with a reduced risk of injury in firefighters (33).
Firefighters perform physically demanding tasks in often unusual and hazardous environments, which challenge both the cardiovascular and musculoskeletal systems. Performing high-intensity tasks under load while breathing through a respirator is a common practice for a firefighter. Fire ground operations are often accompanied with slippery and/or unstable surfaces, space limitations, and limited visibility. Firefighters must be reactive and prepared to exert unpredictable degrees of strength, power, agility, and mobility at any time. Many tasks require whole-body-kinetic chain movements, which result in unpredictable loads and load transfers, resulting in musculoskeletal injury. Such circumstances leave firefighters prone to overuse and traumatic musculoskeletal injuries.
INJURY MECHANISMS AND TYPE
Because of the impending risks and potential hazardous work environments, musculoskeletal injuries are often associated with mechanisms related to 1 or a combination of the following: direct trauma, falling episodes, being struck by an object, carrying heavy objects/patient transport, overexertion, physical training, fire operations, or idiopathic (19,40). These indirect barriers increase the potential for compromised movement patterns, which result in potential overload to the musculoskeletal system. Volunteer versus full-time employment, age, obesity, and years of experience have also been linked to an increase in musculoskeletal injuries (18,19,32). Younger firefighters and those with less experience typically suffer ailments related to exhaustion, whereas older firefighters suffer musculoskeletal injuries (40). Thus, it seems appropriate for fire departments to provide specific strength, conditioning, and mobility components in a program to address the needs of diverse demographics within a fire department.
Thirty-four percent of moderate-to-severe injuries incurred on the fire ground are classified as a sprain or strain (19). Strains and sprains predominately occur to the lower extremity, trunk/lumbar spine, and the shoulder (32). Recently, Poplin et al. (32) reported that “lifting” efforts (e.g., patient transport, physical exercise, and training drills) were among the primary contributors to 76% of all sprains and strains, which occurred exclusively to the lower leg and lumbar spine. Additional research has reported similar findings, which indicate that the lumbopelvic region is a primary area of interest when preparing firefighters for work related stressors (29).
Deficits in muscular strength, mobility, and neuromuscular control have been reported to contribute to musculoskeletal injury risk (20,24,29). Deficits are often linked to a lack of regular exercise and specificity of training routines (29). Research has demonstrated that achieving an adequate physical fitness level has been associated with a decreased injury occurrence (33). Although the efforts to improve musculoskeletal deficits are well documented in the literature, these efforts are often limited in a practical setting due to lack of monetary resources to support the hiring of qualified fitness professionals and availability of adequate training facilities (32). In a recent report among firefighters, a majority of the musculoskeletal injuries resulted from physical training (32). Although not explicitly stated by the authors, these findings are likely attributed to the potential deficits in the management of fitness training programs. The impending threat for musculoskeletal injury and reported cases of training injuries calls for the need of professional guidance and well-managed programs by qualified strength and conditioning professionals.
It has been reported that faulty movement patterns may predispose individuals to injury and are the result of poor neuromuscular control, muscle weakness, and/or muscle imbalances (20,29). Improper movement patterns have been surmised to create unnatural stressors on the kinetic chain resulting in poor biomechanics and inefficient load transfers (24,29). Furthermore, occupational tasks often require detailed movement characteristics, which facilitate potential overuse mechanisms and/or temporary faulty patterns predisposing firefighters to injury (20,29,32). In addition, firefighters may be required to perform fire ground tasks in awkward positions, which compromises movement efficiency and potentially increases the risk of injury. In theory, efforts to balance muscle deficits and mimic proper occupational movement patterns may reduce the risk of injury and promote better management practices. For instance, Peate et al. (29) reported a 42% reduction of injury and 62% decrease in time lost due to injury in firefighters after an intervention that targeted flexibility and strength exercises for the proximal muscles that support the pelvis, spine, and trunk. The authors concluded that improving mobility and strength at these proximal segments likely improved the firefighters' ability to function and adapt to awkward and unpredictable body positions associated with occupational hazards (29). Table 2 summarizes exercise selection to reduce injury risk. Given the importance of functional movement for firefighters, it seems logical to use functional movement tests for prescreening or monitoring occupational preparedness. These tests are discussed in the Firefighter Assessments section below.
CARDIOVASCULAR DISEASE RISK
Although not considered an acute occupational injury, cardiovascular disease (CVD) is a significant concern that produces fatalities within the Fire Service. Approximately, 100 deaths occur among on-duty firefighters each year (10). Forty-five percent of these deaths were due to CVD (10). Most of the reported cardiac events were associated with a clustering of CVD risk factors, such as hypertension, diabetes, dyslipidemia, obesity, and a sedentary lifestyle (4,8,9,34). A comprehensive list of CVD risk factors and associated thresholds is provided elsewhere (30). Many firefighters possess elevated CVD risk profiles leading to on-duty cardiac events and in some cases, early retirement (4). Although there are numerous wellness strategies to decrease the risk of CVD (e.g., smoking cessation, dietary modification, etc.), the focus of this section is on the relationship between firefighter physical fitness and CVD risk, and the physical activity recommendations for health benefits.
CARDIORESPIRATORY FITNESS AND CARDIOVASCULAR DISEASE RISK
Sufficient levels of cardiorespiratory fitness are necessary to safely perform fire ground tasks and maintain cardiovascular health (4). Specifically, several essential fire ground tasks require an energy expenditure of at least 42 mL·kg−1·min−1 (i.e., 12 metabolic equivalents [METs]) (25,41). Interestingly, Baur et al. (4) examined the cardiorespiratory fitness levels among a cohort of over 900 firefighters and found that only 44% exceeded a 12-MET aerobic capacity. Furthermore, Baur et al. (4) evaluated the relationship between cardiorespiratory fitness and CVD profiles among firefighters. The researchers reported that firefighters who had an aerobic capacity greater than 12 METs possessed favorable triglyceride, cholesterol, and fasting glucose levels compared with firefighters who did not achieve 12 METs. Moreover, epidemiological research in the general population suggests that improving maximal aerobic capacity by 1 MET is associated with a 15% reduction in CVD risk (21). Thus, it is important to enhance firefighters' cardiorespiratory fitness to improve occupational physical ability and reduce the risk of cardiovascular disease.
PHYSICAL ACTIVITY RECOMMENDATIONS
Physical activity recommendations to reduce CVD risk consist of accumulating (>10 minutes bouts) 30 minutes per day of moderate-intensity (>64% of maximum heart rate) physical activity on at least 5 days per·week (5). Durand et al. (9) investigated the physical activity in a sample of over 500 firefighters. Greater than 75% of the firefighters engaged in less than the recommended amount of physical activity (9). In addition, this investigation demonstrated that an increase in exercise frequency had the most beneficial effect on reducing CVD risk (9). Other studies have also demonstrated that enhanced physical fitness and physical activity levels facilitate a reduction in CVD risk factors (4,9,21,34).
Obesity, a positive risk factor for CVD, is of particular concern in the Fire Service. Obesity is often assessed using body mass index (BMI). However, it is important for practitioners to understand that BMI is limited by its ability to identify the composition of tissues and the distribution of fat mass. Therefore, alternative assessments are recommended to evaluate body composition and fat distribution, such as skinfold and waist circumference measures, respectively. Regarding obesity in the Fire Service, Durand et al. (9) reported that nearly 90% of the participating firefighters in the study were classified as overweight or obese. Increasing fat loss through exercise and dietary behaviors is important to reduce the risk of CVD because some research seems to refute the notion that individuals can be “fit, but fat.” Specifically, Farrell et al. (11) demonstrated that possessing a high cardiorespiratory fitness level did not decrease the risk of cardiovascular disease mortality among overweight and obese individuals. Therefore, the physical activity recommendations to manage body weight and prevent gradual unhealthy body weight gain in adulthood include performing at least 150 minutes per week of moderate-intensity physical activity (7). Performing greater than 250 minutes per week of moderate-intensity physical activity is associated with clinically significant weight loss (7). In summary, 1 effective strategy for improving CVD risk factors among firefighters is through regular participation in a comprehensive exercise program.
It is important to regularly assess the physical fitness, functional movement, and occupational physical ability of each firefighter. These assessments provide critical information regarding occupational preparedness, potential for injury, efficacy of current training practices, and evaluation of training objectives. The physical fitness assessments should include valid, yet practical measurements of occupationally relevant physiological outcomes. For structural firefighters, these measurements should include tests for strength, power, muscular endurance, anaerobic threshold, and aerobic capacity. Table 3 provides a summary of suggested tests to evaluate these outcomes. Currently, there are no physical fitness standards for incumbent structural firefighters in the United States. However, it is recommended that structural firefighters possess a minimum aerobic capacity of 42 mL·kg−1·min−1 (25). Data collected in assessments should be used to evaluate physical fitness levels across the fire department, establish personal goals, design an appropriate exercise prescription, and evaluate progress for each firefighter.
Functional movement assessments should be performed to identify muscular imbalances, muscular weakness, and faulty movement patterns. The functional assessments should be multifactorial to encompass static, dynamic, linear, and multiplanar movement patterns that are specific to the occupational demands of firefighters. Establishing a baseline performance before being assigned duty responsibilities will enable practitioners to monitor overall, developing, and/or declining performance variables pertinent to the safety of firefighters. Examples of commonly used assessment tools are provided in Table 3.
An assessment of occupational physical ability should also be conducted. Testing should be developed in collaboration with subject matter experts (e.g., fire department training officer) and composed of simulated fire ground tasks commonly performed by a given fire department (see sample of tasks listed in Figure 1 and Table 1). These tasks may be timed and performed continuously or discontinuously in the order for which they are typically performed on the fire ground. It is important to note that the occupational assessment described herein is not intended to be used for punitive or promotional purposes, but strictly to estimate firefighters' ability to perform common fire ground tasks.
PROGRAM DESIGN FOR FIREFIGHTERS
Firefighting is a dangerous profession that requires maximal physical exertion to complete occupational tasks. Specifically, performance of fire ground tasks requires sufficient levels of several fitness attributes, including power, strength, muscle endurance, anaerobic endurance, and aerobic endurance (13,36). As a practitioner, it is important to design strength and conditioning programs that enhance these attributes as well as any deficiencies identified for a given firefighter by the needs analysis assessments.
There are numerous variables that serve as a foundation to designing strength and conditioning programs for firefighters. These variables include exercise selection and order, training frequency, and exercise session parameters. Exercises should be selected based on task-specific movement patterns identified in the biomechanical analysis (Table 1). In general, exercises that are functional and use major muscle groups and multiple joints should take precedence in the training program (i.e., core exercises). Examples of core exercises for firefighters include the deadlift, lunge progressions, unilateral row, and shoulder press. It is generally recommended that power and other core exercises are typically performed before assistance exercises (26).
From an injury reduction standpoint, recent literature has identified the muscles that support the spine, pelvis, and trunk to be critical in preventing injury and improving performance outcomes (23). The incremental stability provided by the spinal musculature is said to provide a proximal base of support, which allows the hips and pelvis to absorb, transfer, and develop forces (23). The adjacent segments of the spine, pelvis, and trunk are intersegmentally dependent on 1 another and should be trained synergistically to mimic the mobility and stability needs of common ground fire tasks (23). The spinal stabilizers are traditionally trained with low-load isometric muscular endurance tasks, such as planks. However, more recent literature suggests that additional strength and power training should be incorporated for the muscles supporting the proximal segments to the specific needs of one's activities (23). Combining low-load static stability exercises targets the spinal stabilizers, whereas heavier loads will prompt increases in strength and power of all the muscles that support the spine, pelvis and trunk. Thus, training kinetic chain mobility in sequence with endurance, strength, and power movements specific to occupational demands seems necessary. Adding unstable surfaces, such as foot discs or stability platforms will cause perturbation moments, which can help enhance the muscular control for the lumbopelvic region and trunk necessary when completing fire ground tasks (20,23). Strength and power movements with plyometric and/or multiplanar stimuli at low and high speeds will assist in promoting strength/power gains necessary for completing rotational demands. At a minimum, performing mobility, strength, and neuromuscular control training exercises that mimic occupational requirements seems to be appropriate in maintaining preparedness and reducing risk of injury (29).
Training frequency depends on numerous factors including the firefighter's training status and the periodization scheme. It is recommended that beginners perform 2–3 resistance training sessions per week, intermediate lifters perform 3–4 sessions per week, and advanced lifters perform 4–7 sessions per week (26). The training frequency of some firefighters may be dictated by a given fire department's policy for on-duty physical training and the department's work schedule (e.g., on-duty every 3 days). This may mean that firefighters may only be on-duty 2–3 days per week. A practitioner must consider how to make efficient use of this time and whether to “assign” exercise during off-duty days.
Improvements in select fitness attributes (e.g., power, strength, endurance) are achieved based on the composition of the exercise stimulus. The exercise stimulus is produced by the combination of the training intensity, volume, and recovery parameters used in an exercise session. These parameters are summarized in Table 4. Training intensity is critical as it dictates which fitness attributes will be improved. Training volume is the product of load, repetitions, and sets. Periodization of training intensity and volume should be systematically manipulated over a macrocycle to achieve the desired fitness and functional outcomes (see Periodization Strategies section).
There are several challenges that practitioners face when designing appropriate exercise programs for structural firefighters. First, unlike many athletes, firefighters do not have the luxury of training within the framework of designated seasons (e.g., off-/in-season), and therefore must continuously be prepared to perform at sufficient levels. Second, the practitioner is responsible for maximizing the capacity of competing fitness attributes required for the performance of fire ground tasks (e.g., muscular strength versus aerobic endurance). This presents a challenge because research demonstrates that concurrent training of competing fitness attributes may produce an “interference effect,” thus reducing improvements in 1 or both of these fitness attributes (12). Third, it is important to understand how to appropriately train firefighters on- and off-duty to maximize occupationally specific physiological adaptations, while minimizing residual fatigue that may negatively affect subsequent fire ground performance and risk of injury. This article reviews theoretical concepts and empirical data to elucidate appropriate training strategies to overcome the inherent challenges of developing effective training programs for structural firefighters.
Periodization is a methodological strategy used to manipulate training intensity, volume, and specificity within defined cycles of a training program to optimize performance and minimize the risk of overtraining (26). Periodized training programs have been shown to be superior to nonperiodized programs to improve strength and power in a wide variety of populations (35). There are many periodization strategies available. A brief review is provided of commonly used periodization strategies and a discussion of which strategies may be most appropriate for structural firefighters. These training strategies include linear, nonlinear, block, conjugate, circuit, and concurrent.
Linear periodization is characterized by a progressive change (increase or decrease) in training intensity and volume throughout a macrocycle or annual cycle (duration: 1 year) and is generally considered most appropriate for lesser trained individuals. Although there are different interpretations of microcycle construction (e.g., heavy day versus light day) within the framework of linear periodization, the overall trend typically represents an increase in training intensity and decrease in volume for targeting strength/power and decreased intensity and increased volume for targeting endurance outcomes (37). Empirical data indicate that concurrent linear periodization of aerobic and resistance training is effective at improving firefighter aerobic capacity and muscle endurance after 16 weeks of training (38).
Nonlinear periodization (i.e., “undulating”) is characterized by large daily or weekly fluctuations in training intensity and volume (26) and may be more appropriate for trained individuals given that the training stress is typically greater than linear periodization. Nonlinear periodization may include training the upper body for strength/power and lower body for muscle endurance during the first exercise session of a microcycle (duration: ∼1 week); followed by training, the upper body for muscle endurance and lower body for strength/power during the second exercise session. One investigation compared the effects of linear versus nonlinear periodized programs on simulated fire ground performance (31). This study demonstrated that although both training groups improved simulated fire ground performance compared with baseline, the nonlinear periodized program yielded superior performance on the simulated fire ground test.
Block periodization has been used for decades to train Olympic athletes in European countries. Block periodization is characterized by a high concentration of training workloads with a focus on a minimal number of fitness outcomes within a single training phase. The training phases or “Blocks” (i.e., mesocycles) are classified as accumulation, transmutation, and realization. The entire cycle of these blocks lasts about 5–10 weeks. The accumulation phase (2–6 weeks) serves as a general preparatory period and is characterized by moderate training intensity, high volume, and moderate movement/metabolic specificity. The focus is typically on improving aerobic endurance and/or basic strength because these outcomes may have longer training residuals (16). The transmutation phase (2–4 weeks) is similar to the specific preparatory period and represented by high training intensity, moderate/high volume, and high movement/metabolic specificity. The focus is on anaerobic and muscular endurance, which possess slightly shorter training residuals (16). The realization phase (1–2 weeks) is similar to the competition period and is characterized by high training intensity, low volume, adequate recovery between exercise sessions, and high movement/metabolic specificity. The focus is typically on power and speed, given their short training residuals (16). Although limited, empirical evidence seems to support the use of block periodization to improve anaerobic and aerobic outcomes in athletic populations (28,39). Its effectiveness has not been evaluated among firefighter populations. The use of block periodization for firefighters may be beneficial because unlike nonlinear periodization, it tends to focus on minimal target outcomes during a training block, thus reducing an “interference” effect. In addition, the utilization of short training cycles facilitates the maintenance of nontargeted fitness attributes and allows for frequent evaluation of occupationally relevant physiological adaptations.
The conjugate sequence system was developed for power lifters as a method to enhance strength and power. The conjugate system is a training strategy centered on 3 distinct methods, including maximal effort method, dynamic effort method, and repetition method. The goal of the maximal effort method is to enhance basic strength and is characterized by high training intensity (load ≥90% 1 repetition maximum [RM]) and low training volume with adequate recovery. The goal of the dynamic effort method is to improve power output using high contraction velocities, which are facilitated by low/moderate training intensities (50–60% 1RM) and high volumes. Finally, the repetition method is used to enhance metabolic efficiency through circuit-based training. These methods are typically combined within a microcycle. Although frequently used in athletic and power lifting populations, there is limited published research on the effectiveness of the conjugate sequence system.
Circuit training is typically composed of performing 1 set of multiple exercises in sequential order. The training parameters commonly include the use of submaximal loads (e.g., ≤85% 1RM), multiple repetitions per set (e.g., ≥6 repetitions), and brief interexercise recovery periods (e.g., ≤60 seconds). Circuit training seems to be a viable training strategy for structural firefighters given that it simulates the aerobic and anaerobic demands of fire ground tasks (1).
Concurrent training is characterized by the simultaneous development of strength and endurance outcomes. This method of training seems beneficial for firefighters given that fire ground tasks require these fitness attributes. However, research has demonstrated that concurrent training for strength and endurance may inhibit the development of either outcome (15,22,27). This unfavorable training effect is commonly referred to as the “interference phenomenon” (12). The presence of an interference effect is supported by applied concurrent training interventions and basic research indicating that there may be incompatible cellular responses that produce muscular hypertrophy (i.e., peripheral strength adaptations) versus mitochondrial biogenesis (i.e., peripheral aerobic adaptations; (14)). Garcia-Pallares and Izquierdo (12) presented several empirically based training strategies to minimize the interference effect. A brief description of these strategies is provided. First, use highly concentrated training loads focusing on 1 strength and 1 endurance outcome per micro/mesocycle. Second, to minimize an interference effect of concurrent training on strength/power adaptations, do not perform more than 3 resistance training sessions per week. Third, avoid performing concurrent resistance training focused on hypertrophy/local muscular endurance (i.e., 75–80% 1RM) with high-intensity aerobic training (i.e., 95–100% V[Combining Dot Above]O2max), as these “noncompatible” stimuli produce conflicting peripheral muscular adaptations. Alternatively, it is recommended to incorporate compatible training stimuli, such as strength/power training with low- or high-intensity aerobic training; or hypertrophy/muscle endurance resistance training with low-intensity aerobic training. Fourth, performing aerobic and resistance exercises on the same day may produce residual fatigue that will negatively affect strength performance. Thus, it is recommended to perform the resistance training exercises first, followed by aerobic exercise or separate the exercise sessions by at least 8 hours. Finally, during concurrent training, it may be more effective to not perform resistance training exercises to failure to improve strength and muscular power compared with training to failure (17). Consistently performing resistance training exercises to failure increases training intensity and volume and may induce greater muscle damage and residual fatigue that negatively affects the quality of subsequent resistance and aerobic training sessions. More research is necessary to more clearly understand the effects of these concurrent training strategies for firefighters.
APPLICATIONS OF TRAINING STRATEGIES FOR FIREFIGHTERS
Periodized training strategies designed for intermediate-to-advanced firefighters should be directed at (a) optimizing occupational preparedness throughout the year, (b) minimizing the interference effect of (essential) competing fitness attributes, and (c) prescribing training parameters (on- and off-duty) to maximize physiological adaptations while minimizing acute residual muscular fatigue that may impair subsequent fire ground physical ability and increased injury risk.
To optimize occupational preparedness throughout the year, it would seem that block periodization would be effective given the repeated short training cycles (5–10 weeks) and focus on a minimal number of fitness attributes during each training block. Thus, proper sequencing of training targets will enhance the targeted attributes during stimulation, while not spending extensive time away from stimulating any single fitness attribute. A sample block periodization scheme is presented in Figure 2. Note that the training targets focus on fitness attributes proposed to have longer training residuals during the accumulation block (i.e., strength and aerobic endurance), attributes with moderate training residuals during the transmutation block (i.e., anaerobic endurance), and attributes with short training residuals in the realization block (i.e., speed/power). Furthermore, the conjugate method was selected to develop strength and power during the accumulation block to provide a maximal effort day to focus on strength development and a dynamic effort day to reduce the training stress and focus on power development (note: the repetition method was omitted during this training phase to minimize the number of targeted fitness attributes). During the transmutation block, a circuit-based resistance training strategy was selected to improve anaerobic and muscular endurance. An example of specific recommendations for circuit training parameters for firefighters is provided elsewhere (3). Finally, during the realization block, task-specific tactical training would be performed using firefighter equipment. This exercise training may take the form of an obstacle course composed of simulated fire ground tasks.
Given that muscular strength and aerobic endurance are essential to firefighter performance, we chose to concurrently train these outcomes during the accumulation and transmutation blocks. To minimize the interference effect of simultaneously improving strength and endurance outcomes, it is recommended to perform resistance exercises first during an exercise session. Furthermore, it is recommended to use compatible resistance and endurance training loads. Therefore, during the accumulation phase, we combined high-intensity resistance training with moderate- and high-intensity endurance training. During the transmutation block, the resistance training focus is on local muscular endurance; therefore, the compatible endurance training intensity is below anaerobic threshold.
The strength and conditioning program described above assumes that the firefighter has some resistance training experience (i.e., intermediate or advanced) and a requisite physical fitness level. However, the reality is that many firefighters are unfit and/or overweight or obese, thus not prepared for the physical demands of this type of training program. Therefore, in these cases, practitioners should use the progression principle regarding resistance and aerobic training exercises and focus on weight management. Thus, it may be more appropriate to initially implement a linear periodized training program to develop a physiological foundation and focus on improving body composition. Individual firefighter's performance and health needs, as identified by the needs analysis' assessments, should be addressed on a case by case basis. For example, specific mobility deficiencies may be addressed after the exercise session, whereas additional aerobic exercise may be prescribed during off-duty days.
Finally, although the goal of exercise training is to produce specific physiological adaptations to enhance work efficiency, it is important to understand how acute muscle fatigue induced by on- and off-duty training may impair subsequent fire ground physical ability and risk of injury. For instance, Dennison et al. (6) demonstrated that simulated fire ground work efficiency decreased by 10% immediately after a circuit training exercise session. At this time, it is unknown how other modes and intensities of training may affect subsequent fire ground performance. However, it is logical to suggest that firefighters train on-duty during low-volume emergency call times or at the end of a shift to reduce the probability of responding to a call while substantial fatigue has accumulated. Likewise, when exercising off-duty, consideration should be given to how the exercise session may produce muscle soreness and residual fatigue that could negatively affect on-duty physical ability. Exercising at an appropriate intensity to produce physiological adaptations without excessive soreness and fatigue requires that firefighters use the progression principle for training intensity and volume, and conservatively introduce novel exercises. Regardless of when training is performed, it is paramount that the practitioner communicates with each firefighter to determine how they responded to a given exercise stimulus and modify the program parameters accordingly.
Practitioners face inherent challenges in developing appropriate exercise programs for structural firefighters. Conducting a needs analysis and implementing appropriate periodization strategies may help to overcome these challenges and improve firefighter preparedness, safety, and health. General training recommendations should target movement patterns and energy systems, which mimic specific fire ground tasks, and additional aerobic endurance training may be necessary to reduce the risk of chronic disease. Applying these programmatic strategies will protect the most valuable piece of equipment in the Fire Service, the firefighter.
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