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Core strength: A new model for injury prediction and prevention

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  • Lunda & Associates

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Many work in injury prone awkward positions that require adequate flexibility and strength in trunk stabilizer muscle groups. Performance on a functional movement screen (FMS) that assessed those factors was conducted and an intervention was designed. A battery of FMS tests were performed on 433 firefighters. We analyzed the correlation between FMS performance and injuries and other selected parameters. An intervention to improve flexibility and strength in trunk stabilizer or core muscle groups through a training program was evaluated. The intervention reduced lost time due to injuries by 62% and the number of injuries by 42% over a twelve month period as compared to a historical control group. These findings suggest that core strength and functional movement enhancement programs to prevent injuries in workers whose work involves awkward positions is warranted.
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BioMed Central
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Journal of Occupational Medicine
and Toxicology
Open Access
Research
Core strength: A new model for injury prediction and prevention
WF Peate*1, Gerry Bates2, Karen Lunda3, Smitha Francis1 and
Kristen Bellamy1
Address: 1University of Arizona, Mel and Enid Zuckerman Arizona College of Public Health, Drachman Hall, 1295 N. Martin Avenue, Tucson,
Arizona, USA, 2Tucson Fire Department, Health and Safety, 421 South Church, Tucson, Arizona, USA and 3Lunda and Associates, 1636 North
Swan, Tucson, Arizona, USA
Email: WF Peate* - peate@email.arizona.edu; Gerry Bates - Gerry.Bates@tucsonaz.gov; Karen Lunda - k.lunda@worldnet.att.net;
Smitha Francis - francis@email.arizona.edu; Kristen Bellamy - bellamy@email.arizona.edu
* Corresponding author
Abstract
Objective: Many work in injury prone awkward positions that require adequate flexibility and
strength in trunk stabilizer muscle groups. Performance on a functional movement screen (FMS)
that assessed those factors was conducted and an intervention was designed.
Methods: A battery of FMS tests were performed on 433 firefighters. We analyzed the correlation
between FMS performance and injuries and other selected parameters. An intervention to improve
flexibility and strength in trunk stabilizer or core muscle groups through a training program was
evaluated.
Results: The intervention reduced lost time due to injuries by 62% and the number of injuries by
42% over a twelve month period as compared to a historical control group.
Conclusion: These findings suggest that core strength and functional movement enhancement
programs to prevent injuries in workers whose work involves awkward positions is warranted.
Background
The National Occupational Research Agenda (NORA) has
identified traumatic injury and intervention effectiveness
as two of its priority research areas. Injuries are the leading
cause of mortality and loss of potential years of life for
working individuals. This study focused on a unique
method of injury prediction and prevention in high risk
workers using a functional movement screen and core
strength intervention [1].
Many workers must deal with physically demanding tasks
that involve awkward positions and less than optimal
ergonomics. Fire fighting is a particularly hazardous pro-
fession with exposure to a host of chemical, biologic, and
physical hazards including musculoskeletal trauma. Fire-
fighters perform physically demanding tasks such as forci-
ble entry and rescues that are injury prone because of
maneuvers that compromise trunk stability and ergonom-
ically hazardous conditions Because of the nature of fire
fighting, these physical conditions are often difficult to
control.
There are over one million fire fighters in the United States
[2]. and the injury rates of firefighters are among the high-
est in all occupations [3]. Last year in the U.S. firefighters
sustained 88, 500 injuries while on duty [4]. Forty four
percent of all U.S. firefighters have suffered from sprains
and strains while on duty [5].
Published: 11 April 2007
Journal of Occupational Medicine and Toxicology 2007, 2:3 doi:10.1186/1745-6673-2-3
Received: 21 May 2006
Accepted: 11 April 2007
This article is available from: http://www.occup-med.com/content/2/1/3
© 2007 Peate et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Journal of Occupational Medicine and Toxicology 2007, 2:3 http://www.occup-med.com/content/2/1/3
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It is important for firefighters to be fit because they work
in physically unpredictable settings, and must maintain a
high level of fitness for at least 20 years before they are eli-
gible for retirement. Various strategies have been evalu-
ated to decrease the occurrence and the severity of fire
fighter injuries. These methods have focused on exercise
training, ergonomic coaching and flexibility improve-
ments [6]. A physical fitness intervention for firefighters
was shown to be effective in reducing injuries, but the
scope of the study was limited to back disorders [7]. A fire-
fighter flexibility training program did not find improve-
ment in injury incidence, though lost time, severity and
costs improved [8]. Workplace injuries are multi-factorial,
especially in occupations where work events are unpre-
dictable and task completion places rigorous demands on
the body. Furthermore, many ergonomic interventions
have limited applicability in certain firefighter tasks. For
example, a firefighter who must crawl under wreckage and
contort his or her body to rapidly rescue a trapped indi-
vidual has severe ergonomic challenges that are difficult
to address with standard ergonomic suggestions such as
"lift with your legs, not your back." Although many fire-
fighter exercise programs have focused on upper and
lower body strength, they have paid less attention to core
stability and strength (provided by spine stabilizers such
as the transversus and multifidi muscles) and the other
dimensions of movement that might decrease the chance
of injury in the above scenario [9]. As Wilson et al summa-
rize: "Core stability is the ability of the lumbopelvic hip
complex to prevent buckling and to return to equilibrium
after perturbation. Although static elements (bone and
soft tissue) contribute to some degree, core stability is pre-
dominantly maintained by the dynamic function of mus-
cular elements. There is a clear relationship between trunk
muscle activity and lower extremity movement" [10].
Current research suggests that decreased core strength may
contribute to injuries of the back and extremities, that
training may decrease musculoskeletal damage, and that
core stability can be tested using functional movement
methods [11-13].
The purpose of this study was to explore methods to better
assess the risk of firefighter injury due to functional move-
ment performance, and to decrease injuries by using that
information. The magnitude of injuries among firefighters
warrant efforts to develop and assess the effectiveness of
interventions. One approach has been to examine the
relationship between simulated firefighting tasks and
physical performance or functional measures [14].
Researchers have demonstrated that activities such as stair
climbing ability are related to certain functional measures
such as standing balance, reaction time, isometric muscle
strength [15].
Furthermore, improvements in core or static strength,
flexibility and the three dimensions of movement: accel-
eration; deceleration; and dynamic stabilization (the abil-
ity to maintain a stable posture while moving) have been
proposed as additional injury prevention possibilities for
fire fighters [16].
Our research objective was to determine whether results
of measurement of functional movement were associated
with a history of previous work-related injuries in this
high risk population and to conduct an intervention.
Functional movement screens were initially used to eval-
uate and rehabilitate patients with neuromuscular coordi-
nation issues, such as those with stroke or spinal trauma
[17,18]. More recently, functional movement screens
have been employed to assess the movement patterns of
athletes. Those with a lower performance score have been
found to be more likely to sustain an injury [19].
We used the functional movement screen (FMS) for fire
fighters because their job tasks often require maximal
physical performance, [20] thus making them "industrial"
athletes. The relation between the FMS score and age,
rank, tenure and gender was also assessed. If a correlation
existed between functional movement screen perform-
ance and injuries, then appropriate interventions such as
flexibility and core strength training could be initiated to
decrease fire fighter injury rates. A second arm of the study
involved a twelve month prospective analysis of such an
intervention.
The functional movement screen consists of seven differ-
ent functional movements that assess: trunk or core
strength and stability; neuromuscular coordination; sym-
metry of movement; flexibility; acceleration; deceleration;
and dynamic stability. Each of these seven movements
corresponds to a firefighter activity. For example, one of
the FMS measures is the rotatory stability test. This test
requires the firefighter to maintain spinal column stability
with upper and lower trunk motion while balancing their
weight with one hand and knee on the floor. The maneu-
ver duplicates the fire fighter work practice of staying low
to the floor while entering a burning building (Heat rises.
Standing subjects the fire fighter to higher thermal
energy.). The other FMS tests and their correspondence to
fire fighter essential functions include:
Hurdle step: body mechanics while stepping over an
obstacle during a fire or rescue.
In-lunge movement: ability to take one long step forward
and lunge downward, such a while using an axe to open a
door during a fire.
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Shoulder mobility: firefighter lifting and placing a SCBA
(self contained breathing apparatus) respirator on their
back.
Stability push-ups (press-ups):core strength while reach-
ing through or around an obstruction during a fire or res-
cue.
Deep squat: ability to squat to avoid an overhead hazard
during a fire or rescue.
Active straight leg raise: flexibility of the lumbar-pelvic
complex and lower extremity muscles. Maintenance of
torso and pelvic stability during awkward positions at a
fire or rescue operation.
Methods
Subjects
Environment Occupational Health (EOH) Unit faculty of
the University of Arizona were awarded a contract to pro-
vide medical surveillance, and injury prevention and
treatment for Tucson Fire Department, an urban fire fight-
ing agency in a community of 765, 000. All 433 subjects
were involved in fire suppression activities and were on a
full duty status. Age at time of the study ranged from 21 to
60 years with a mean of 41.8 years for males and 37.4
years for females. The subjects were 408 male (94.2 per-
cent) and 25 female (5.8 percent).
Demonstration of the FMS tests was conducted by a
trained fitness coordinator. Informed consent was pro-
vided by a fire department representative.
Scores on the seven FMS tests were based on the fire-
fighter's ability to perform the respective test. Zero to three
points were possible for each of the seven tests (Total of
21 points). The maximum number of points was given if
the individual could fully perform the test without limita-
tion of movement or pain. Lesser points were given for
partial completion of the test and no points for failure to
complete any elements of the test.
The battery of FMS tests were performed on 433 firefight-
ers over a four week period in late 2004. We analyzed the
correlation between FMS performance and a history of
prior musculoskeletal injury from the fire department
database, and other selected parameters (age, gender, ten-
ure and rank).
One firefighter sustained a minor strain during the testing
process, and fully recovered one week later and was
returned to full duty.
The firefighters were then enrolled in a training program
designed by a multi-disciplinary team (occupational med-
icine physician, therapist, and fire department health and
safety officer). Twenty one seminars, each three hours in
length were conducted for groups of 20 firefighters over a
two month period. Each session emphasized functional
movement including the causation (inadequate core or
back stabilizing muscle strength, poor flexibility, and
improper body mechanics) and prevention of injuries. As
part of the training session, each firefighter then demon-
strated competency in the proper body mechanics in sam-
ple firefighter work settings. Firefighters are compelled to
work in injury prone situations such as bending forward
at the waist and reaching through the broken window of
a wrecked automobile while assessing a victim. In this sce-
nario core stabilizing muscles become fatigued and are at
risk of injury. Participants were taught techniques to
strengthen core muscles and to decrease mechanical load
on the affected parts of their musculoskeletal system dur-
ing these ergonomically challenging job tasks. For exam-
ple, firefighters were instructed to use an outstretched arm
held against a firm surface as a prop to decrease mechani-
cal load on the back when the firefighter's spine is in lum-
bar flexion. Firefighters were instructed how to analyze
the worksite and to use principles of functional move-
ment (how to adjust to the employee's range of motion by
moving closer to object to be lifted, to use postural relief
or props, and "tighten the gut" or recruit stabilizing mus-
cle before lifting). During each session, guidance and
practice on core or stabilizing muscle strength exercises
were offered. Demonstration of the exercises was pro-
vided by a trained co-worker. Core strength instructions
were provided to each participant. They were advised to
maintain a neutral position of the lumbar spine and to
contract the transversus abdominus (TA) muscle. Partici-
pants were shown that muscle's location in the anterior
abdominal wall. Photos of various methods of recruiting
and strengthening the TA with written explanations were
provided, along with verbal reinforcement of the material.
Once the firefighter demonstrated competency in basic TA
muscle tightening, physiotherapy balls and dowels were
employed to challenge the firefighter in different posi-
tions that mimicked firefighting tasks. See Figure 1
- Lie on your back, knees bent, feet flat on the floor.
- Tighten the gut to maintain a neutral position of the low
back (no arching or flattening)
- Lift up butt. Knees, hips and shoulders should all be in a
line.
- If the butt starts sagging, lift it back up. If the hamstrings
cramp, take a break and begin again.
- Add arm movement, one or both with or without
weight/resistance
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- Keep the butt up and the gut tight throughout the exer-
cise.
- 5–10 reps, 1–3 sets of each variation of the exercise.
- Progress to a one legged bridge.
- Assume position above, lift the right foot up off of the
floor.
- Extend knee out away from you (straighten the knee)
and then bring it back toward you.
- Repeat the bending and straightening of the knee/leg
- The straighter and lower the leg, the harder the exercise.
- Keep the butt up and the gut tight throughout the exer-
cise.
- Repeat with left leg off the floor.
- Add arm movement to leg movement and then add
weights/resistance.
- 5–10 repetitions, 1–3 sets of each variation of the exer-
cise.
See Figure 2.
- Correct physio-ball size equals a 90 degree knee bend
when sitting on the ball. If greater than 90, inflate the ball.
This does not need to be exact.
- Assume the starting position with shoulders on the ball,
feet on the floor, knees bent to 90.
- The more of the back that is on the ball, the more stable,
the easier the exercise.
- Shoulders, hips and knees in a line
- Tighten the gut
- Add arm movement, one or both with or without
weights/resistance
- Do not let the back arch or flatten.
Bridging with shoulders on a ballFigure 2
Bridging with shoulders on a ball.
Keeping the transversus abdominus contracted and using the upper and lower extremitiesFigure 1
Keeping the transversus abdominus contracted and using the
upper and lower extremities.
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- To increase the difficulty, add a small object between the
knees and squeeze or add a band around the knees and
push the knees apart
- Keep the gut tight and the butt up
- To further increase the difficulty, roll further off of the
ball so only the shoulders are on the ball.
- Perform 5 – 10 repetitions, 1 – 3 sets of each variation of
the exercise
Figure 3
- Correct physio-ball size equals a 90 degree knee bend
when sitting on the ball. If greater than 90, inflate the ball.
This does not need to be exact.
- Lye on your back, knees bent, soles of feet on the ball.
- Tighten your gut to maintain a neutral lumbar spine (no
arching or flattening)
- Lift up your butt.
- If your butt starts sagging, lift it back up. If you can't, the
set is over.
- If the hamstrings cramp, take a break and begin again.
- Arms may need to provide support/stability on the
ground initially.
- Once stable, add arm movement, one or both with or
without weight/resistance
- Keep the butt up and the gut tight.
- The further the arms go overhead, the more the back
wants to arch.
- Prevent the arch by keeping the gut tight.
- If the back continues to arch, decrease the amount of arm
movement or decrease the weight/resistance until you can
maintain a neutral spine (no arching or flattening of the
back).
- 5–10 reps, 1–3 sets of each variation of the exercise
For one year following training, information on the type
and number of injury cases, cost of treatment, and lost
days due to injury were gathered by the organization's
worker's compensation department. The data was derived
from personnel, absentee and medical records for a one-
year period.
Statistical Analyses
Part One. Functional Movement Screen
Data was coded using Stata 8.0. For exploratory data anal-
ysis we used bivariate methods. The primary hypothesis
was assessed with multivariate analysis (logistic and linear
regression). Table 1 provides functional movement screen
summary descriptive statistics by overall score
Part Two: Intervention
All injury cases were reviewed for the year before this
study and the year following. ICD 9 codes were tabulated
and all injury cases underwent medical review. Injuries
not related to functional movement such as burns, abra-
sions, and lacerations were excluded from the analysis. A
historical control group was formulated and compared
with the intervention population.
Results
Part One. Functional Movement Screen
Based on simple linear regression, increasing age, rank
and tenure were associated with a lower functional move-
ment score. Each yearly increase in age resulted in a 0.1
unit decrease in overall score (p < 0.001). After adjusting
for age in multiple linear regression, firefighters with a his-
tory of prior injury scored 0.24 points lower than those
without history of prior injury, though this difference was
not statistically significant (p = 0.25). The outcome varia-
ble was dichotomized to pass (FMS score >16) and fail
(FMS score <16). Multiple logistic regression suggested
that after adjusting for participant age, the odds of failing
the functional movement screen were 1.68 (% confidence
interval: 1.04, 2.71) times greater for firefighters with a
history of any injury (p = 0.033).
Bridging with feet on the ballFigure 3
Bridging with feet on the ball.
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Part Two. Intervention
To test if the percent change in injuries before and after
intervention was significant, a two-sample test of propor-
tions was calculated. This test assumes under the null
hypothesis that the probability of injury pre- and post-
intervention are equal.
Comparing the number of injuries pre- and post-interven-
tion of these 433 firefighters, lost time injuries were
reduced by 62%, whereas total injuries were reduced by
44% compared to a historical control group. The two-
sample test of proportions indicated that significant
reductions were made among injuries of the back (p =
0.024) and upper extremities (p = 0.0303), however, no
significant change was found for injuries of the lower
extremities (p = 0.4624). Similar conclusions were
reached with lost time injuries – significant reductions in
both injuries to the back (p = 0.0036) and upper extremi-
ties (p = 0.0141). Results can be seen in Table 2.
Discussion
Based on linear regression, there is a correlation between
past musculoskeletal injury and FMS score. A history of an
Table 1: Summary Descriptive Statistics by Overall Score
Score Pass Fail
17 <17
Count 300 133
Percent 69.30% 30.70%
Age (yrs)
Mean 39.7 45.7
Median 40 46
S. Deviation 8.3 8.3
Min 23 24
Max 60 61 Z = -6.37, p < 0.001
Score
Mean 18.4 14.7
Median 18 15
S. Deviation 1.1 1.6
Min 17 7
Max 21 16 Z = -16.81, p < 0.001
Injured:
Yes 75 (25%) 43(32%)
No 225 (75%) 90(68%) Chi2 = 2.5, p < 0.114
# Injuries:
Mean 0.37 0.52
Median 0 0
S. Deviation 0.75 0.99
Min 0 0
Max 4 7 Z = -1.6, p < 0.11
Injured & Lost Work Time
Yes 32 (11%) 22 (17%) Chi2 = 2.9, p < 0.09
No 268 (89%) 111 (83%)
Rank (yrs):
Mean 7.6 11.4
Median 5 10
S. Deviation 6.6 7.8
Min 0 0
Max 32 31 Z = -4.7, p < 0.001
Tenure (yrs)
Mean 12.9 18.2
Median 11 19
S. Deviation 8.3 9.4
Min 1 1
Max 35 40 Z = -5.5, p < 0.001
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injury lowered the fire fighter FMS score by 3.44 (maxi-
mum of 21 points). See Table 3.
Based on logistic regression, there is no significant correla-
tion between injuries and FMS score. However, there was
a significant correlation between age, rank, and tenure
and FMS score as noted in Table 4.
NIOSH (the U.S. National Institute for Occupational
Safety and Health) has advised that occupational screen-
ing programs are a priority research area. The U.S. Preven-
tive Services Task Force has recommended specific
guidelines to decide if a screening test such as FMS is effec-
tive, and whether it will improve clinical outcomes [21].
For fire fighters, an important screening component is
essential---are fire fighters fit enough to safely perform the
demanding physical tasks of their occupation without risk
of injury?
To what degree did prior injuries hamper the subjects'
ability to perform the functional movement screen tests?
If a firefighter had residual physical limits from a past
injury would it be logical to assume their performance
would be diminished on our testing. Fortunately, all 433
firefighters complete a rigorous annual physical examina-
tion where such limitations would be noted. In addition
all firefighters after an injury must be cleared to return to
full unrestricted duties by the fire department occupa-
Table 3: Linear Regression
Simple Linear Regression
Outcome = (Overall Score - 21)
Model Variable Coeff P > |Z| 95% CI R-square
1 Constant 3.78 0.001 (3.57, 3.99)
Female -0.74 0.093 (-1.60, 0.13) 0.007
2 Constant -0.36 0.427 (-1.26, 0.54)
Age 0.099 0.001 (0.08, 0.12) 0.163
3 Constant 2.938 0.001 (2.64, 3.24)
Rank 0.091 0.001 (0.06, 0.12) 0.053
4 Constant 2.54 0.001 (2.18, 2.90)
Tenure 0.08 0.001 (0.06, 0.10) 0.120
5 Constant 2.6 0.001 (2.46, 2.75)
Any Injuries 3.69 0.001 (3.43, 3.95) 0.638
6 Constant 3.69 0.001 (3.46, 3.91)
# Injuries 0.12 0.328 (-0.12, 0.36) 0.002
7 Constant 3.7 0.001 (3.49, 3.92)
Injured & Lost Time 0.28 0.368 (-0.33, 0.89) 0.002
Multiple Linear Regression
Outcome = (Overall Score - 21)
Final Model Only
Model Variable Coeff P > |Z| 95% CI R-square Adjusted
1 Constant 0.99 0.001 (0.41, 1.57)
Age 0.04 0.001 (0.03, 0.05)
Any Injuries 3.44 0.001 (3.18, 3.71) 0.661
Table 2: Intervention Summary Descriptive Statistics
433 participants Number of injuries in historical control
group
Number of injuries in intervention
group
Percent Reduction (p-value*)
1. Total back, injuries 39 22 44% (0.024)
2. Total upper extremity injuries 29 15 48% (0.0303)
3. Total lower extremity injuries 10 7 30% (0.4624)
Lost time back injuries 29 11 62% (0.0036)
2. Lost time upper extremity injuries 21 8 62% (0.0141)
3. Lost time lower extremity injuries 8 3 62% (0.1292)
* Significance test estimated using a 2-sample test of proportion
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tional medicine specialist. The number of "walking
wounded" --- those who were on full duty, but with unde-
tected physical limits--- would thus be minor.
There was a significant correlation between age, rank, and
tenure and FMS score.
These three variables are chronologically related and
increase with time in service as a fire fighter. In general,
flexibility and strength decline with age [22,23] and inju-
ries are more likely to accumulate.
There is a correlation between past musculoskeletal injury
and FMS score based on linear regression (An injury low-
ered the fire fighter FMS score by 3.44.), and there was a
significant correlation between age, rank, and tenure and
FMS score.
One of the major caveats to the 2-sample test of propor-
tions in this study is the loss of power from the underuti-
lization of paired data. McNemar's test would have been
better for assessing significant differences before and after
intervention, however, the paired data needed to calculate
those estimates were unavailable at the time of this analy-
sis. Still, the results of the 2-sample test of proportions
should provide a relatively unbiased estimate of the
before and after differences in injuries.
Conclusion
These findings suggest that development and implemen-
tation of functional movement enhancement programs to
prevent injuries in high risk workers such as firefighters is
warranted.
Acknowledgements
The authors thank the members of Tucson Fire Department for their par-
ticipation, and its administration for funding this study, and Seamus Rogan,
Jerry Poplin and Margaret Spencer of the Environmental Occupational
Health Unit, The College of Public Health, University of Arizona, Tucson,
Arizona, USA.
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Table 4: Logistic Regression
Simple Logistic Regression
Outcome = Overall Score Failure ( 16)
Model Variable Count OR P > |Z| 95% CI
1 Male 408 referent -- --
2 Age 433 1.09 0.001 (1.06,1.12)
3 Rank 433 1.07 0.001 (1.04,1.11)
4 Tenure 433 1.07 0.001 (1.04,1.10)
5 No Injuries 315 referent -- --
Any Injuries 118 1.43 0.115 (0.92,2.24)
6 # Injuries 433 1.22 0.093 (0.97,1.54)
7 No Time Lost 379 referent -- --
Injured & Lost Time 54 1.66 0.090 (0.92,2.98)
Multiple Logistic Regression
Outcome = Overall Score Failure ( 16)
Significant Models Only
Model Variable OR P > |Z| 95% CI LROC
1 Age 1.09 0.001 (1.06, 1.12)
Any Injuries 1.68 0.033 (1.04, 2.71) 0.703
2 Age 1.09 0.001 (1.06, 1.12)
# Injuries 1.29 0.044 (1.01, 1.66) 0.702
3 Age 1.09 0.001 (1.06, 1.12)
Injured & Lost Time 1.85 0.054 (0.99, 3.44) 0.702
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... For the latter it could be cases where safety glasses were provided and only the educational components were different and thus evaluated (Adams, 2013). In some cases, it was difficult to evaluate the precise comparison condition, for example, when a historical cohort group was used (Peate et al., 2007). ...
... A few studies that appeared relevant from abstract review were not analyzed Benavides, 2007;Hernández Navarrete, 2010;Lanoie & Streliski, 1996;López-Rojas et al., 2013;Porru et al., 2009;Urban et al., 2012); these were all in a language that none of the authors managed to a sufficient level to allow a reasonable review. (Gregersen, 1996;Hilyer et al., 1990;Johnson & Owoaje, 2012;Levine et al., 2012;Peate et al., 2007;Santaweesuk et al., 2014). ...
... In one CBA study there were significant gender and work-time differences (Carrivick et al., 2002); in another there were differences in the fitness of control and intervention groups, as intervention soldiers were less fit on entry compared with their historical control counterparts (Knapik et al., 2004). In one case it was difficult to know whether it was equivalent groups, when no information on the historical control group was provided (Peate et al., 2007). ...
Article
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Limited knowledge regarding the relative effectiveness of workplace accident prevention approaches creates barriers to informed decision‐making by policy makers, public health practitioners, workplace, and worker advocates. The objective of this review was to assess the effectiveness of broad categories of safety interventions in preventing accidents at work. The review aims to compare effects of safety interventions to no intervention, usual activities, or alternative intervention, and if possible, to examine which constituent components of safety intervention programs contribute more strongly to preventing accidents at work in a given setting or context. Studies were identified through electronic bibliographic searches, government policy databanks, and Internet search engines. The last search was carried out on July 9, 2015. Gray literature were identified by searching OSH ROM and Google. No language or date restrictions were applied. Searches done between February and July of 2015 included PubMed (1966), Embase (1980), CINAHL (1981), OSH ROM (NIOSHTIC 1977, HSELINE 1977, CIS‐DOC 1974), PsycINFO (1806), EconLit (1969), Web of Science (1969), and ProQuest (1861); dates represent initial availability of each database. Websites of pertinent institutions (NIOSH, Perosh) were also searched. Included studies had to focus on accidents at work, include an evaluation of a safety intervention, and have used injuries at work, or a relevant proxy, as an outcome measure. Experimental, quasi‐experimental, and observational study designs were utilized, including randomized controlled trials (RCTs), controlled before and after (CBA) studies, and observational designs using serial measures (interrupted time series, retrospective cohort designs, and before and after studies using multiple measures). Interventions were classified by approach at the individual or group level, and broad categories based on the prevention approach including modification of: Attitudes (through information and persuasive campaign messaging). Behaviors (through training, incentives, goal setting, feedback/coaching). Physiological condition (by physical training). Climate/norms/culture (by coaching, feedback, modification of safety management/leadership). Structural conditions (including physical environment, engineering, legislation and enforcement, sectorial‐level norms). Attitudes (through information and persuasive campaign messaging). Behaviors (through training, incentives, goal setting, feedback/coaching). Physiological condition (by physical training). Climate/norms/culture (by coaching, feedback, modification of safety management/leadership). Structural conditions (including physical environment, engineering, legislation and enforcement, sectorial‐level norms). When combined approaches were used, interventions were termed “multifaceted,” and when an approach(es) is applied to more than one organizational level (e.g., individual, group, and/or organization), it is termed “across levels.” Narrative report review captured industry (NACE), work setting, participant characteristics, theoretical basis for approach, intervention fidelity, research design, risk of bias, contextual detail, outcomes measures and results. Additional items were extracted for studies with serial measures including approaches to improve internal validity, assessments of reasonable statistical approaches (Effective Practice of Organization of Care [EPOC] criteria) and overall inference. Random‐effects inverse variance weighted meta‐analytic methods were used to synthesize odds ratios, rate ratios, or standardized mean differences for the outcomes for RCT and CBA studies with low or moderate levels of heterogeneity. For studies with greater heterogeneity and those using serial measures, we relied on narrative analyses to synthesize findings. In total 100 original studies were included for synthesis analysis, including 16 RCT study designs, 30 CBA study designs, and 54 studies using serial measures (ITS study designs). These studies represented 120 cases of safety interventions. The number of participants included 31,971,908 individuals in 59 safety interventions, 417,693 groups/firms in 35 safety interventions, and 15,505 injuries in 17 safety interventions. Out of the 59 safety interventions, two were evaluating national prevention measures, which alone accounted for 31,667,110 individuals. The remaining nine safety interventions used other types of measures, such as safety exposure, safety observations, gloves or claim rates. Strong evidence supports greater effects being achieved with safety interventions directed toward the group or organization level rather than individual behavior change. Engineering controls are more effective at reducing injuries than other approaches, particularly when engineered changes can be introduced without requiring “decision‐to‐use” by workplaces. Multifaceted approaches combining intervention elements on the organizational level, or across levels, provided moderate to strong effects, in particular when engineering controls were included. Interventions based on firm epidemiologic evidence of causality and a strong conceptual approach were more effective. Effects that are more modest were observed (in short follow‐up) for safety climate interventions, using techniques such as feedback or leadership training to improve safety communication. There was limited evidence for a strong effect at medium‐term with more intense counseling approaches. Evidence supports regulation/legislation as contributing to the prevention of accidents at work, but with lower effect sizes. Enforcement appears to work more consistently, but with smaller effects. In general, the results were consistent with previous systematic reviews of specific types of safety interventions, although the effectiveness of economic incentives to prevent accidents at work was not consistent with our results, and effectiveness of physiological safety intervention was only consistent to some extent. Acute musculoskeletal injuries and injuries from more long‐time workplace exposures were not always clearly distinguished in research reports. In some studies acute and chronic exposures were mixed, resulting in inevitable misclassification. Of note, the classification of these events also remains problematic in clinical medicine. It was not possible to conduct meta‐analyses on all types of interventions (due to variability in approach, context, and participants). The findings presented for most intervention types are from limited sources, and assessment of publication bias was not possible. These issues are not surprising, given the breadth of the field of occupational safety. To incorporate studies using serial measures, which provide the only source of information for some safety interventions such as legislation, we took a systematic, grounded approach to their review. Rather than requiring more stringent, specific criteria for inclusion of ITS studies, we chose to assess how investigators justified their approach to design and analyses, based on the context in which they were working. We sought to identify measures taken to improve external validity of studies, reasonable statistical inference, as well as an overall appropriate inferential process. We found the process useful and enlightening. Given the new approach, we may have failed to extract points others may find relevant. Similarly, to facilitate the broad nature of this review, we used a novel categorization of safety interventions, which is likely to evolve with additional use. The broad scope of this review and the time and resources available did not allow for contacting authors of original papers or seeking translation of non‐English manuscripts, resulting in a few cases where we did not have sufficient information that may have been possible to obtain from the authors. Our synthesis of the relative effectiveness of workplace safety interventions is in accordance with the Public Health Hierarchy of Hazard Control. Specifically, more effective interventions eliminate risk at the source of the hazard through engineering solutions or the separation of workers from hazards; effects were greater when these control measures worked independently of worker “decision‐to‐use” at the worksite. Interventions based on firm epidemiological evidence of causality and clear theoretical bases for the intervention approach were more effective in preventing injuries. Less effective behavioral approaches were often directed at the prevention of all workplace injuries through a common pathway, such as introducing safety training, without explicitly addressing specific hazards. We caution that this does not mean that training does not play an essential function in worker safety, but rather that it is not effective in the absence of other efforts. Due to the potential to reach large groups of workers through regulation and enforcement, these interventions with relatively modest effects, could have large population‐based effects.
... Como alternativa para essa possível limitação, o treinamento funcional (TF) vem se consolidando como uma estratégia empregada não apenas com o objetivo de promover o aprimoramento do desempenho físico, mas também voltado ao processo de reabilitação e prevenção de lesões [11]. Segundo Hibbs et al. [12], o TF consiste em um conjunto de movimentos multiarticulares caracterizados por níveis de alta e baixa intensidade, chamados também de exercícios intermitentes, que são realizados visando tanto a melhoria do controle, estabilidade e coordenação motora, via modulação do sistema nervoso central "core stability" como o aumento da massa muscular "core strength", sendo esta considerada uma adaptação ao treinamento de sobrecarga. ...
... Em observação ao destaque apresentado pelo TF nos dias atuais, observa-se na literatura um grande número de estudos relatando as possíveis respostas adaptativas decorrentes da sua prática, destacando-se aumentos de força e equilíbrio em mulheres e homens destreinados ou considerados irregularmente ativos [13], acentuação dos níveis de potência muscular em atletas [14], aceleração do período de recuperação muscular pós-exercício extenuante [15], além da redução do risco de lesões ortopédicas e melhoras do processo de reabilitação em indivíduos que apresentam funções laborais de risco [11]. ...
Article
Introdução: O treinamento funcional surge como uma nova proposta para melhora de inúmeras capacidades funcionais como equilí­brio, força muscular, melhora do condicionamento fí­sico e como uma forma de treinamento intervalado. Objetivo: O presente estudo tem como objetivo verificar o efeito de 6 semanas de treinamento funcional sobre a composição corporal de alunos de academia fisicamente ativos. Métodos: Foram recrutados 26 voluntários, 14 pessoas do sexo feminino e 12 do sexo masculino, todos fisicamente ativos com idades entre 18 e 50 anos. O treinamento constituiu de 2 a 3 sessões semanais com 60 minutos de aula. Foram coletados dados antropométricos como espessuras de dobras cutâneas, IMC (í­ndice de massa corporal), estatura, MC (massa corporal em kg), percentual de gordura (%G). Todos os dados foram analisados e comparados antes e depois do treinamento e expressos em valores de média e desvio padrão. Em seguida, utilizou-se os teste T de Student de amostras pareadas para a comparação do iní­cio "pré" e "pós" 6 semanas do treinamento e o ní­vel de significância adotado foi de P < 0,05. (P(T ≤ t) bi-caudal). Resultados: Todos completaram os treinamentos propostos no perí­odo de 6 semanas com 85% de frequência de treino. Os resultados obtidos foram significantes para mulheres e homens obesos e não obesos e se determinou a significância, através do teste T de Student de amostras pareadas, o valor de (P < 0,05). Também foram comparados com trabalhos de outros autores nos quais a significância comparada demonstra que houve redução da massa corporal nos voluntários. Conclusão: Conclui-se que o efeito sobre a composição corporal de 6 semanas de treinamento funcional foi significativo, obtendo resultados para diminuição da massa corporal.Palavras-chave: educação fí­sica, treinamento funcional, composição corporal.
... Any disturbance in these skills while moving will further make a player prone to several injuries and decreases output during the game [6]. Recently, it has been recognized that in different movement patterns, muscular imbalance, poor neuromuscular control, and instability in the core muscles are the risk factors for athletic injuries [7,8]. ...
Article
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Introduction: The objective of this study is to find the effectiveness of core muscle strength training on dynamic balance and muscle endurance among junior field hockey players. Material and Methods: The study was conducted with 30 regular junior hockey players (15 in the control group and another 15 in the experimental group). The modified Star Excursion Balance Test (mSEBT) and Biering-Sorensen muscle endurance tests are used to assess dynamic balance and endurance. In the control group, the participants continued their formal training without undergoing any intervention. At the same time, the players in the experimental group performed the core muscle strength training daily for 45 minutes per session for eight weeks. Results: The result showed a statistically significant difference seen on both mSEBT and Biering Sorensen Endurance test between the control and experimental groups. The mSEBT had a higher mean score in the experimental group, right limb (97.6%) and left limb (97.9%), than the control group right limb (91.7%) and left limb (92.6%). The mean endurance time in the experimental group had a higher endurance time of (135.4 sec) than the control group (176.2 sec). Conclusion: This study showed that core muscle strengthening exercises enhance the dynamic balance and endurance in junior field hockey players.
... La mayoría de las gimnastas de ambos grupos obtuvieron puntuaciones entre 18-20 puntos, correspondiente a un nivel aceptable, siendo estos resultados coincidentes con los hallados en los estudios de Vernetta et al., Gil-López et al. y Vernetta et al. 20,27,28 , en adolescentes que practicaban actividades deportivas como judo, baloncesto y GA, debido posiblemente a la relación existente entre el desempeño motor en patrones de movimientos básicos con la práctica en actividades físi-cas organizadas 29 . Igualmente, teniendo en cuenta estas puntuaciones, se puede suponer que los entrenamientos a los que están sometidas los diferentes deportistas de los estudios anteriores, tienen un efecto significativo en los resultados más óptimos del FMS 20,30 . ...
Article
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Objective: To identify possible differences in movement quality through the functional movement screen (FMS) between injured and non-injured adolescent acrobatic gymnasts in the last season. Method: descriptive, comparative, cross-sectional study involving 20 adolescent female gymnasts divided into two groups, one composed of 9 gymnasts who had suffered an injury in the last season (14,7±1,56) and the other composed of 11 gymnasts who had not suffered any injury (13,9±2,25). The FMS battery was used, consisting of seven tests: deep squat, hurdle step, in-line lunge, shoulder mobility, active straight leg raise, trunk stability in push-ups, trunk rotational stability. Results: Of the nine gymnasts who had sustained an injury, 66.6% were located in the lower limb, ankles and knees. The results of the total functional assessment of FMS using the Mann Whitney U statistic for independent samples showed no statistically significant differences between groups (Z = -.393; p > 0.05), with the average range of FMS being similar in both cases (10.05 and 11.06 in injured and non-injured gymnasts respectively). It also showed the absence of significant differences in each of the tests of the battery, and no relationship was found through Spearman’s R statistic, between the overall FMS score and the group of injured gymnasts. Conclusion: The results of the FMS total score were slightly higher in gymnasts who were not injured last season, as well as slightly better in all the lower body tests, hence the FMS can be used as a preventive programmed to detect possible deficiencies.
... Sin embargo, es importante identificar asimetrías y "0" en la recopilación de datos (Cook et al., 2014). El FMS ha demostrado que es posible trabajar desequilibrios funcionales luego de ser detectados para reducir la posibilidad de lesión en la población que obtiene un resultado negativo al realizar la prueba, que sería una cuenta menor de 14 puntos (Peate et al., 2007). ...
Article
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Mediante la investigación se analizaron los efectos de un programa de ejercicio físico en la condición motriz de la comunidad universitaria durante la pandemia (COVID-19). Se aplicó en una muestra de 659 estudiantes que completaron las 7 pruebas del cribado de movimiento funcional (FMS). El resultado parcial fue que el 15,02% de los estudiantes se encontraban en el rango de mayor riesgo de lesión con actividad física; al finalizar la intervención en la población universitaria se tiene como resultado positivo la reducción del 11,53% en este rango y que un 96,51% de los estudiantes participantes culminaron el programa de ejercicio físico con un menor riesgo de lesión con actividad física, según los parámetros del FMS. Así se concluye que un programa de ejercicio físico tiene un efecto protector en el componente motriz.
... De acuerdo con lo reportado por Butler et al. (2013), en base a un análisis con 108 bomberos, identificaron que una puntuación de corte de FMS d» 14 puntos podría servir como un predictor de riesgo de lesión considerando las altas tasas de incidencia durante la ocupación laboral. En esta misma línea, Peate et al. (2007) describieron una correlación significativa entre el puntaje FMS y el historial de lesiones musculo esqueléticas, así también una reducción en la incidencia de lesiones por medio de un programa de acondicionamiento específico en 433 bomberos. Por el contrario, Shore et al. (2020) mostraron que no hay una asociación entre el puntaje de corte FMS y un mayor riesgo de lesión en una muestra de 581 bomberos. ...
Article
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Objetivo: El objetivo de este estudio fue describir la funcionalidad motriz de bomberos por medio de la batería Functional Movement Screen (FMS), e identificar su relación con factores antropométricos de riesgo cardiovascular (RC). Método: Participaron un total de 139 bomberos, de los cuales 122 corresponden a hombres y 17 a mujeres pertenecientes a 16 compañías de bomberos de la comuna de Valparaíso, Chile. Se aplicó la batería de evaluación FMS y se tomaron medidas de perímetro cintura (PC), índice de masa corporal (IMC) y el índice cintura-estatura (ICE). Resultados: Para las mujeres se reportaron correlaciones bajas entre el FMS y las variables antropométricas de RC, mientras que para los hombres estas correlaciones fueron significativas y negativas entre FMS y las variables PC, ICE e IMC (r = -,37, p < ,001; r = -,34, p < ,001; –-,40, p < ,002), respectivamente. El 64,02% de los participantes en ICE se clasificó en un alto RC (≥ ,50) y en el IMC un 73% en las categorías de sobrepeso y obesidad. De acuerdo con los resultados de la evaluación FMS, el 45,33% de los participantes presentan una baja funcionalidad motriz. Conclusión: La baja funcionalidad motriz y los elevados valores en parámetros antropométricos de RC son factores que debería preocupar a comunidades como las compuestas por bomberos, quienes desarrollan labores de alta exigencia física y mental, en condiciones extremas que muchas veces pueden poner en peligro la salud de los propios voluntarios. Abstract. Objective: The aim of this study was to describe the motor function of firefighters by using the Functional Movement Screen (FMS) battery and to identify its relationship with anthropometric factors of cardiovascular risk (CR). Methods: A total of 139 firefighters participated, of those 122 were men and 17 were women, belonging to 16 fire companies of the municipality of Valparaíso, Chile. The FMS evaluation battery was applied, and waist circumference (WC), body mass index (BMI), and waist-height index (WHI) measurements were taken. Results: For women, low correlations were reported between FMS and CR anthropometric variables, while for men, these correlations were significant and negative between FMS and the variables of PC, ICE, and IMC (r = -,37, p < ,001; r = -,34, p < ,001; -,40, p < ,002). The 64.02 % of the participants were classified in high CR (≥,50) and by BMI index 73% were in the overweight and obese category. According to the results of the FMS assessment, 45.33% of the participants present low motor functionality. Conclusion: The low motor functionality and the high values in anthropometric parameters of CR are factors that should be of concern to communities such as those composed of firefighters, who perform physically and mentally demanding work in extreme conditions that can often endanger the health of the volunteers themselves.
... These types of activities are easier to research as the movements are isolated, the environment is controlled, and specific injury-causing positions can be identified. Methods such as marker-based motion analysis, electromyography, and the Functional Motion Screen can be easily used to analyze firefighters in this setting (Peate et al. 2007;Norris and Olson 2011;Lane et al. 2019). It is likely that training injuries are more difficult to prevent than exercise injuries because training activities occur in uncontrolled environments that aim to simulate emergency situations where the firefighters wear PPE while engaging in dangerous tasks (Fernando et al. 2016;Salar et al. 2017). ...
Article
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Objectives To summarize the current research on the occurrence of firefighter exercise and training injuries and to describe the nature of these injuries. Methods Scoping review methods were used to identify articles and extract information relevant to firefighter exercise and training injuries. Relevant articles were identified from MEDLINE, Web of Science, CINAHL, Embase, PubMed, and through hand-searching. Results A total of 1053 articles were identified, and 23 met the inclusion criteria. Nine studies were retrospective analyses of injury data, 13 studies used surveys to identify injuries in the past year, and 1 study reviewed U.S. firefighter injury reports. Three studies included both career and volunteer firefighters, 2 studies included career firefighters, 2 studies include volunteer firefighters, 1 study include recruits and 16 studies did not specify the career status. The occurrence of exercise and training injuries from 22 of the 23 studies ranged from 8.1 to 55.3% of reported injuries. One study found that 3 out of 15 fire departments identified exercise and training as the most common cause of their firefighter injuries. The 13 articles that reported the type of injuries identified musculoskeletal disorders as the most common type of injury (32% to 79% of reported injuries). The ankle, knee and leg were identified as the most commonly injured areas of the body. Conclusions Training injuries are common in firefighters and must be prevented. Future research is needed to identify root causes of training injuries to guide prevention strategies.
Article
OBJECTIVES The purpose of the present study was to investigate the effects of a core training program on functional movement screen, skill performance, competitive state anxiety, and trait sport confidence of college football players.METHODS College football players were divided into core training ( n =25) and control ( n =16) groups. Core training was conducted for a total of 12 weeks of 2 sessions per week with 50 minutes per session. Pre, mid (6 weeks), and post (12 weeks) tests measured functional movements, and skill performance such as dribbling, agility, speed, momentum and competitive state anxiety, trait sport-confidence. For analysis of study results, descriptive statistics, and two-way ANOVA with repeated measures were used.RESULTS The study results showed overall improvements for the core training group in functional movement test scores, skill performance, and competitive state anxiety, trait sport-confidence. In addition, the core training group also showed significant improvement in the total factors, except for hurdle step, and rotary stability.CONCLUSION In conclusion, data shows a core training program improves functional movement screen scores, skill performance, competitive state anxiety, and trait sport-confidence of college football players.
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Introducción: El Functional Movement Screen (FMS) es una herramienta de evaluación de la calidad del movimiento humano. En actividades físicas artísticas o deportes de componente estético-artísticos la calidad de movimiento es un factor importante para el rendimiento y la prevención de lesiones. Objetivo: Valorar la calidad de movimiento aplicando el Functional Movement Screen (FMS) en estudiantes de circo y gimnastas de acrobática de competición. Método: Estudio descriptivo, comparativo y transversal donde participaron 34 sujetos (20 practicantes de gimnasia acrobática y 14 estudiantes circenses). Se usó la batería FMS, compuesta por siete pruebas: sentadilla profunda, paso de valla, estocada en línea, movilidad de hombro, elevación activa de la pierna recta, estabilidad del tronco en flexiones, estabilidad rotatoria del tronco. Resultados: se observó una relación estadísticamente significativa de signo positivo a través del estadístico R de Spearman, entre la puntuación global del FMS y el tipo de práctica (p= ,000). Los gimnastas presentan mejor calidad de movimiento que los estudiantes de circo, con diferencias estadísticamente significativas, puntuando mejor en todas las pruebas. Conclusión: se corrobora una relación entre la práctica de GA y una mayor puntuación del FMS.
Article
Background: Emergency Medical Services (EMS) professionals frequently experience job-related injuries, most commonly overexertion or movement injuries. Data on injury reduction in EMS professionals is limited. The Functional Movement Screen (FMS) is a movement analysis tool suggested to predict musculoskeletal injury, but it has not previously been evaluated for EMS professionals. Objective: To evaluate the effectiveness of the FMS to predict musculoskeletal injury among EMS professionals. Methods: In October 2014, EMS professionals employed in an urban third-service EMS agency volunteered to participate in FMS administered by certified screeners. Age, sex, height and weight were recorded. After screening, participants were instructed on exercises to correct movement deficiencies. We reviewed recorded injuries from 2013 to 2016. We performed descriptive statistics. With logistic regression modeling, we described factors that predicted musculoskeletal injury. We generated a receiver operating curve (ROC) for FMS prediction of musculoskeletal injury. Results: 147 of 240 full-time employees participated in the FMS. Participants' mean age was 33.7 years (SD = 9.6) and the majority (65%) were male. The median initial FMS score was 14 (IQR 11-16). Area under the ROC curve was 0.603 (p = 0.213) for FMS ability to predict any musculoskeletal injury within two years. Female sex was associated higher odds of injury (OR 3.98, 95% CI 1.61-9.80). Increasing age, body mass index (BMI) category, and FMS score≤14 did not predict musculoskeletal injury. Conclusion: The FMS did not predict musculoskeletal injury among EMS professionals.
Article
The purpose of this study was to investigate the changes in cardiovascular risk factors for a group of firefighters (n = 74) over a 6-year period. Subjects were full-time firefighters employed by a moderate-to-large municipality. Each subject was tested a minimum of 4 out of a possible 7 years (x = 5.97) and underwent an assessment of body fat percentage (by underwater weighing), body weight, total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and grip strength. Blood analysis was performed by a College of American Pathologists-accredited laboratory; grip strength was assessed using a handgrip dynamometer. Functional aerobic impairment was computed using age norms and a time-on-treadmill estimation of aerobic capacity (VO2max). A repeated measures analysis of variance was used to analyze the data. Results showed little significant change over time in cardiovascular risk markers. However, VO2max was found to be below age-predicted averages, and body fat percentage was found to be significantly above age-predicted averages.
Article
To better understand the health of older people, it is valuable to go beyond conventional measures of disease and self-perceived health and utilize assessments of functional status and disability. Physical decrements can be characterized at the level of organs and body systems (impairments); the organism as a whole (functional limitations); and the person in the context of the environment and its challenges (disability). To understand the dynamics of the pathway leading from disease to disability, it is critical to measure functional limitations that can be assessed through either self-report or standardized objective measures of physical performance. Both of these approaches may be used to evaluate functions such as grasping objects, walking, and climbing stairs. In aging research, measures of functional limitation are utilized as outcomes that indicate the impact of disease, impairments, and other risk factors on function. In turn, measures of functional limitation can be used to characterize the functional status of individuals and populations, and are powerful predictors of various adverse outcomes, including incident disability in people not currently disabled. Functional limitation measures add substantially to our knowledge about older populations, but further work is needed to promote their standardization and use in both clinical and research settings.
Article
This prospective investigation was done to evaluate five strength and fitness measurements and the subsequent occurrence of back injuries in 1652 firefighters for the years 1971 to 1974. The prospective measurements included flexibility, isometric lifting strength, bicycle ergometer exercise measurements of two-minute recovery heart rate, diastolic blood pressure at a heart rate of 160 beats per minute and watts of effort required to sustain heart rate at 160. Three fitness and conditioning groups were established by multivariate ranking and regression techniques (259 high, 266 low, and 1127 middle) and the subsequent back injuries were tabulated for the three groups. The results showed a graded and statistically significant protective effect for added levels of fitness and conditioning (least fit, 7.1% injured; middle fit, 3.2% jured; and most fit, 0.8% injured). It was concluded that physical fitness and conditioning of firefighters are preventive of back injuries and that further investigations are warranted to study other injuries and physical fitness in this physically active occupational group.
Article
The present study of 469 municipal firefighters examined the effect of flexibility training on the incidence and severity of joint injuries. Both flexibility measures and costs (lost time and medical care costs) were investigated in this study. Significant differences were found in flexibility scores of the experimental and control subjects with overall flexibility increased in the experimental group. Although incidence of injury was not significantly different for the experimental and control groups, injuries sustained by the experimental group resulted in significantly less lost time costs. Findings indicate that the flexibility training program had a beneficial effect on reducing the severity and costs of joint injuries in this firefighter population.
Article
The purpose of this study was to evaluate the physiological adaptation and job performance changes of fire fighters following 14-weeks of supervised exercise and to generate additional guidelines for wellness programs among fire fighters and allied personnel. Fifty fire fighters were randomly selected to participate. Twenty-five men engaged in aerobic, anaerobic and stretching exercises and 26 men maintained their 'normal' lifestyle. Maximal oxygen consumption (VO2max), resting and exercise 12-lead ECG, hydrostatic weighing, pulmonary function, muscle strength (Cybex), blood lipid analysis, and 3 performance drills were performed on all subjects before and after the 14-weeks of training. Following training the exercise group, when compared to the control, showed a significant increase in VO2max, arm and leg endurance and job related skills. Both groups had significant increases in cholesterol and low-density lipoprotein and a decrease in high-density lipoprotein. The experimental group had a significant decrease in resting heart rate and diastolic blood pressure. It was concluded that a regular exercise program coupled with healthy lifestyle instruction is beneficial in improving exercise capacity and job performance among fire fighters and should be implemented in all fire departments.
Article
Twenty-six physical performance variables were assessed on 100 professional fire fighters and correlated against timed measures of five sequentially performed fire fighting tasks and against fractionated heart rates collected during performance of the fire fighting tasks via Holter monitoring of the ECG. Canonical correlation analysis revealed that two factors, physical work capacity and resistance to fatigue, accounted for the fractionated time and heart rate data. The first factor, influenced heavily by the average intra-task heart rate (L = 0.94) and by the approximately equal weights for the five simulated tasks (-0.53 less than L less than -0.36), reflected the fact that relatively high muscular strength and endurance, coupled with a near maximal aerobic capacity effort, were required to complete the simulated tasks. The battery of physical performance variables best predicting the first factor (R2 = 0.63) included maximal heart rate, sit-ups, grip strength, age, and submaximal oxygen pulse. The second factor (R2 = 0.39), most heavily loaded by the simulated rescue (L = 0.70) and chopping tasks (L = 0.42), appeared to represent an ability to complete all tasks quickly by exhibiting a resistance to fatigue brought on by the demands of the earlier tasks. The battery of physical performance variables best predicting the second factor included lean body weight, maximal heart rate, final treadmill grade, age, and percent fat. This study demonstrated that physiological factors related to the performance of occupational tasks can be identified and measured.
As a means of reducing the increasing incidence of musculoskeletal injuries in firefighters, the authors offer a framework for a program that would integrate hazard control and health promotion approaches. Particular focus is placed on the role of ergonomics and physical fitness factors in preventing these injuries.
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Information on which strategies have been shown to be effective, which are ineffective, and which strategies have been inadequately evaluated is important for both public policy and future research. The objective of this study was to provide systematic reviews of the literature on important strategies to prevent occupational, including agricultural, injuries. The Injury Control Research Centers (ICRCs) funded by the National Center for Injury Prevention and Control (NCIPC), Centers for Disease Control and Prevention, and Centers for Agricultural Injury funded by the Division of Safety Research, the National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention, identified 12 important occupational and agricultural injury-prevention strategies or areas of research. Systematic reviews of the literature were conducted to identify relevant controlled trials and studies. These were critically reviewed and summarized. A total of 12 reviews were conducted on a range of topics in the occupational injury field. Few randomized controlled trials were found; most controlled studies were either comparisons over time and/or across different populations. In several areas we were limited to summarizing the descriptive literature. Nevertheless, summaries of these studies provide meaningful conclusions about the effectiveness of various interventions to decrease morbidity and mortality from selected occupational and agricultural injuries. A large body of literature on occupational, public health, or injury prevention interventions exists. The summary of this literature provides a framework to both direct policy and guide future research efforts.
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To better understand the health of older people, it is valuable to go beyond conventional measures of disease and self-perceived health and utilize assessments of functional status and disability. Physical decrements can be characterized at the level of organs and body systems (impairments); the organism as a whole (functional limitations); and the person in the context of the environment and its challenges (disability). To understand the dynamics of the pathway leading from disease to disability, it is critical to measure functional limitations that can be assessed through either self-report or standardized objective measures of physical performance. Both of these approaches may be used to evaluate functions such as grasping objects, walking, and climbing stairs. In aging research, measures of functional limitation are utilized as outcomes that indicate the impact of disease, impairments, and other risk factors on function. In turn, measures of functional limitation can be used to characterize the functional status of individuals and populations, and are powerful predictors of various adverse outcomes, including incident disability in people not currently disabled. Functional limitation measures add substantially to our knowledge about older populations, but further work is needed to promote their standardization and use in both clinical and research settings.
Article
Strength and conditioning professionals who work with collegiate football players focus much of their time and effort on developing programs to enhance athletic performance. Although there has been much speculation, there is little scientific evidence to suggest which combination of physical characteristics best predicts athletic performance in this population. The purpose of this investigation was to examine the relationship among 6 physical characteristics and 3 functional measures in college football players. Data were gathered on 46 NCAA Division I college football players. The 3 response variables were 36.6-m sprint, 18.3-m shuttle run, and vertical jump. The 6 regressor variables were height, weight, percentage of body fat, hamstring length, bench press, and hang clean. A stepwise multiple regression analysis was performed to screen for variables that predict physical performance. Regression analysis revealed clear prediction models for the 36.6-m sprint and 18.3-m shuttle run. The results of this investigation will help strength and conditioning specialists better understand the variables that predict athletic performance in Division I college football players.