First Responders, Fitness, & Heart Disease

First responders face countless challenges and are heroes. Whether we are talking about firefighters responding to motor vehicle collisions and structure fires, police officers running towards violence, or an emergency medical technician performing life-saving medical care to members of our communities. While we are certainly grateful for these services, I know myself and many others probably take for granted the services our first responders provide. 

We often see the sacrifices made by first responders in the news. However, we often don’t consider the sacrifices made in day-to-day life, much less the long-term consequences of life as a first responder. Whether we are talking about physical, emotional, or mental health, the stress placed upon first responders can compound into a real problem. 

It is important we acknowledge the difference between unavoidable stress and avoidable stress. 

There are certain stressful aspects of the job as a first responder that are simply unavoidable due to emergency response. Whether being called to fight fires, working night shifts and responding to calls at 3 am, or even dealing with serious injuries and even death. 

Obviously, this is just the tip of the iceberg, but these events represent just a few aspects of life as a first responder that create high amounts of unavoidable stress. However, there are negative stressors to the health of first responders that can be mitigated. Some of these include “obesity, high blood pressure, smoking status, poor nutrition, poor hydration, and lack of physical activity and physical fitness.” 

So, while certain risk factors and stressors are accepted as unavoidable, we want to focus on how to help first responders lower their risks where they can - primarily through exercise. 

Let’s look at the problem first, after all, you can’t solve what you don’t identify. 

Heart Disease & Obesity

It is no secret that heart disease and obesity kill. 

This is not a problem that is found solely in the first responder community by any means. Heart disease was the number one cause of death in the United States in 2021 even beating out cancer. 

While there are certainly genetic and biological reasons at play here, often serious complications with heart disease can be mitigated or avoided with lifestyle changes especially those complications that occur when a person is young. 

The biggest factors in our health and wellness are nutrition, exercise, sleep, stress management, and having healthy relationships - regardless if you are a first responder or not. 

So, obviously, heart disease and obesity are serious problems in our society today, but what does it specifically have to do with first responders? 

A study in 2009 pointed out that police officers are more likely to be overweight or obese than the general population. Similarly, “Among nine Midwestern states in the U.S., nearly 83% of police officers were overweight (BMI > 25).” Given the well-known link between obesity and almost all chronic diseases, this is alarming, to say the least. Some other statistics to consider, “Officers are 25% more likely to die (or suffer a disability) from heart disease than from a violent suspect.” and “Police officers face a 30-70 times higher risk of sudden cardiac death when involved in stressful situations – which, let’s face it, is an everyday possibility.” While these statistics are focused on law enforcement officers the same idea certainly applies to other first responders. 

Well, the problem becomes even more evident when you look at factors that are part of a first responder’s life. 

Let’s take nutrition first. Eating well can be a challenge for the general population for a number of factors. Whether it is due to taste, convenience, or other factors, now add on top of that the challenges faced by first responders. What type of food is open late at night for night shift police officers? Inconsistent schedules, snacking, and food choices can lead to potentially poor nutrition choices. Now, certainly, there are some real challenges faced, however, it is important to note that many first responders have chosen to make nutrition a priority which should be applauded and hopefully emulated. 

Sleep. This one is easy. As humans, we were not designed to work night shifts and sleep during the day. Firefighters and EMTs often wake up three-plus times during the night to respond to calls. This disrupts all kinds of processes the body needs from sleep. Taking naps when possible and prioritizing sleep when off duty are two ways to help improve sleep quality. However, while nutrition can be improved and controlled, poor sleep at times is unavoidable as a first responder. 

Stress management and relationships certainly depend on the individual, but needless to say, the job of a first responder doesn’t make these areas any easier. 

Exercise is the final aspect. This one is a great opportunity to improve health that is in the control of the districts and the individual. 

We all know training is important, but why is it especially important for first responders?


Physical Training & Health Risks

As a first responder, you likely went through an academy for many months, where intense PT was required. However, now your physical fitness is more or less on you. What do you do?

Well, exercise is one of the most important things you can do for your overall health, first responder or not. Before we dive into the benefits for overall health and reducing obesity and heart disease, consider the necessity of training just to perform the job of a first responder. 

Firefighter Ryan Starling put it this way, "We're signing up to do this. Our job is demanding. People are counting on us – it's not our choice. I always say, as soon as you take the oath, you lose the right to be out of shape." 

Often as first responders, you may feel you get into a constant cycle of low-risk, low-acuity calls that don’t require a high level of fitness. However, it is critical to always maximize your PT so that when the high-risk, high-acuity emergency call comes you are ready. 

There are obviously certain aspects of being a first responder that requires much greater levels of fitness and strength than most any other job.

 For this reason alone, proper exercise is critical for first responders. He goes on to say, "What kind of life are you going to have after you retire? If you've had a knee replacement here, shoulder replacement there, you won't be able to play with your grandkids. The more physically fit you stay, then the better chance you have at a good retirement." 

And finally, "Working out is great, because you get that endorphin release. You're going to be stressed – don't take it out on your family or anything else. It will keep building and building if you don't have a release. Whatever you do, don't take that stress home."

If we go back to the five areas of health, Starling clearly points to the fact that exercise not only helps with your fitness but also your relationships and stress management. This is so important because chronic stress is a large contributor to heart disease. 

Okay, but how else does exercise help fight medical emergencies like heart disease and obesity?

From 2010-2019, 56.2% of firefighter fatalities were caused by stress or overexertion. 

Now certainly, exercise won’t bring this number to zero. However, exercise can play a role in helping to reduce this number. At the most basic level, exercise is a controlled stressor. 

Your intensity, the weight used, and duration are all going to play a part in determining just how much stress you put yourself under. The key word is controlled, the more often we can put ourselves in stressful but controlled environments, the better we will be at handling the ones we can’t control. Our bodies need this type of controlled stress as it allows us to adapt, gain muscle, and become fitter. However, there is a point of diminishing return or even negative return which we call overtraining. As a whole, this isn’t a problem for first responders, but that’s not to say it can’t become one. If the conversation shifts from concerns about obesity and heart disease to overtraining, we are going to be in a very, very good place. 

One study states, “Heavy physical exertion can trigger the onset of AMI [acute myocardial infarction], particularly in people who are typically sedentary. This association was evaluated among 1,228 confirmed cases of AMI. The incidence of AMI within one hour of strenuous physical activity (Six METs and above) was 4.4%. The relative risk was 50-fold higher among sedentary (exercise less than once per week) persons than those who exercised regularly (more than five times per week), as compared to those with less strenuous or no physical exertion.” 

Basically, the point here is that heavy physical work is going to increase your risk for AMI - also known as a heart attack, which ultimately can lead to an even more serious cardiac arrest. As a first responder, it is unavoidable that you will be put in a position of strenuous exertion, so the question becomes how do you mitigate that risk.

According to this study - exercise, which can decrease your chances by 50-fold. 

Another major concern for first responders is cancer. Many firefighters are especially at risk here due to their exposure to smoke. While exercise may not directly affect lung cancer, it certainly won’t hurt and will allow you to fight back against inactivity and obesity. A study “found that people who did 1.25 hours of vigorous or 2.5 hours of moderate activity a week had a 31 percent lower risk of dying of cancer than those who didn’t work out.” Also, “being overweight or obese is a factor in an estimated 14% to 20% of cancer deaths in the US.” While there is no one solution to preventing cancer, prioritizing exercise especially as a first responder is a great place to start - especially when so many other health factors (sleep, nutrition, stress, and relationships) are more difficult to control.

A final major concern is injuries.

It is no secret that members of the emergency medical services, fire service, and law enforcement have a physically demanding job.

Deputy Chief Jerry Schramm, Lancaster EMS Director of Operations says,  “We know that 44 percent of our work injuries are due to improper lifting and moving. And nearly one-quarter of EMS providers nationwide experience career-ending back injuries within the first four years of their career.” 

While preventing injuries is also impossible, there are ways to help prevent injuries.

One of the biggest ways is establishing correct movement patterns.

More often than not injuries sustained are the result of a poor movement pattern whether in the gym or life. With the example above of back injuries and “improper lifting and moving” learning to properly brace and even practicing farmer’s carries and deadlifts is a great way to help prevent those injuries. There are a ton of resources online for proper exercise technique so I won’t get into that, but please please remember to prioritize good movement over the weight. Ego lifting causes more injuries than almost anything else in the gym. 

As far as injuries sustained on the job a recent study found, “Firefighters who possess higher levels of physical fitness (i.e., increased VO2max, muscular strength, and muscular endurance) are able to meet the demands of the job, display improved performance, and may reduce their risk of cardiac event and injury as compared to their more unfit peers.”

Simply put, to better avoid injuries you need to put your body through consistent controlled stress. While you can get injured working out, your risk of injury due to a lack of working out is far greater. Injuries often occur when we place extreme stress on our bodies that our bodies aren’t prepared for. The greater the gap between what you do every day and the stress the greater the risk for injury. This is why people often pull their hamstrings when sprinting if they haven’t run in a while; however, elite sprinters are at a much lower relative risk of hamstring injury because their baseline capacity is higher. 

Bringing this back to first responders, if you are a police officer involved in a chase on foot and you run a mile or two casually every couple of weeks your capacity is going to be significantly less than if you regularly do interval running. Not only will you not be as prepared for the task, but your risk of injury, if you exert yourself fully, is increased because your muscle tissues aren’t prepared for the stress you are trying to exert. 

While both firefighters and law enforcement officers certainly perform different jobs, they often are responding to the same emergency calls together - whether it be a burning building, motor vehicle collisions, or emergency medical calls needing treatment.

Both firefighters and police officers need to be in great cardio shape and have adequate strength, and both will face issues related to stress and PTSD in dealing with emergency management.

However, let’s look at some of the different challenges each profession faces as it relates to the health risks above. 

Firefighters face unique challenges as it relates to their health - whether dealing with hazardous materials or fighting wildland fires and everything in between. Probably the biggest concern is the toxic chemicals that firefighters are exposed to during structure fires. These chemicals are not only the biggest reason for cancer in many firefighters but also play a big role in heart disease alongside extreme temperatures and overexertion. While exercise isn’t going to cure all the inherent risks of the fire service, it does help with overexertion as well as just being physically prepared for stressful emergency situations - whether physical or mental. 

On the other hand, police officers face their own challenges.

While not often dealing with fighting fires, police officers instead face challenges in dealing with - and sometimes fighting with - people. While the majority of the time a police officer spends is not in high-speed chases or physical altercations, that is certainly an aspect of the job. One of the biggest concerns here is injuries. Now certainly, there are injuries, some even life-threatening, that our brave police officers face that are an inherent risk of the job. However, the more prepared you are at that moment the better. One of the best ways to prepare is to exercise. It’s easier to sprint when needed if you sprint often. It’s easier to control your heart rate during dangerous physical altercations when you’ve done it before. Again, going back to the example earlier, we are just trying to increase your baseline so that you are better prepared for whatever comes your way. 

So what does appropriate exercise look like as a first responder?

There are a ton of resources for this and many that are more qualified than me, however, let’s look quickly at some basic principles to start. 

The first thing to consider when doing any form of exercise is your goals.

Some goals include fat loss, increased strength, gaining muscle, running a half marathon, etc. You then want to do an assessment of where you are at. Are you currently obese? Do you have difficulty performing your job at times because you are out of breath? Can you breathe really well, but aren’t as strong as you like? 

These are all questions you want to consider before figuring out exactly how you want to train. For example, let’s say you have above-average strength, but are slightly obese and have difficulty with cardio-based movements - whether in the gym or at work. For this individual, you are going to want to resistance train (bench, squat, pull-ups), perform HIIT (high-intensity interval training), and some longer cardio workouts. Don’t worry it’s not as complicated as it sounds. 

Simply put, you want to work your muscles in what we call compound movements. 

These are movements that use multiple large muscle groups as well as involve multiple joints - think squats, overhead press, deadlifts, etc. Start at a relatively light intensity and slowly build up over time. For HIIT, or high-intensity interval training, the goal is to get your heart rate close to your max, rest, and then repeat. Again start slow and build up over time. There are a ton of movements you can do here - run, burpees, squats, lunges, etc. 

Finally, you want to do some longer cardio in what we call zone 2 - there are five heart rate zones with 1 being a slow walk and 5 being max intensity. Zone 2 is what we would consider a conversational pace heart rate, meaning you are moving and exerting effort, but you can hold a conversation with a quick pause for breath every now and then. The goal is to spend at least forty minutes at this heart rate for a workout. This type of training is important for your overall heart health and building a base for being able to endure which can certainly be important as a first responder. 

Let’s talk about when and how often to work out. 

One of the benefits of being a first responder in some districts is the time allowed for physical training. For instance, if you are a firefighter, you may already have thirty minutes or an hour set aside for exercise or maybe some free time later in the evening, obviously depending on your district. Hopefully, you have some gym equipment, but if you there is a lot you can do with your body weight. For instance, at gyms across the U.S., there is a workout known as Murph performed on Memorial Day in honor of a fallen Navy Seal, Michael Murphy. It consists of running, pullups, pushups, and air squats all while wearing a weighted vest. While you may not have a weighted vest, a great substitution could be an air pack. It is an incredible workout, whether you use a weight vest or not. 

Under-funding for our emergency response teams has always been an issue, and one of the things we are passionate about at Freedom Fitness Equipment is providing gym equipment that is under your budget. 

We want to fit as many pieces of equipment as possible into your budget, even if it means smaller margins for us.

At Freedom Fitness Equipment, we have a program built specifically for first responders, whether you are at an underfunded/underbudgeted station, or want to improve cancer, cardiac arrest, and injury outcomes. We want to make sure you have the equipment your district needs in order to be prepared for whatever situation you run into. Please contact us, we would love to help and work with you. 



“5 Long-Term Health Risks for Firefighters.” Firefighter’s Support Alliance, 16 May 2019,

Budnyk, Mary Beth. “Helping First Responders Avoid On-the-Job Injuries.” Pennmedicine.Org, 23 May 2023,

Calams, Sarah. “Quiet Warrior: How CrossFit Has Helped One Firefighter Become the Best He Can Be.” FireRescue1, 13 July 2018,

Childs, Dan. “Firefighters at Higher Risk for On-the-Job Heart Attacks.” ABC News, 7 Mar. 2007,

Chizewski, Annmarie, et al. “Fitness Fights Fires: Exploring the Relationship between Physical Fitness and Firefighter Ability.” International Journal of Environmental Research and Public Health, 9 Nov. 2021,

Dawes, Jay. “Barriers to Exercise for First Responders: Dealing with Time and Motivation.” FireRescue1, 9 Feb. 2023,

“FASTSTATS - Leading Causes of Death.” Centers for Disease Control and Prevention, 18 Jan. 2023,

“Firefighter Fatalities in the United States.” U.S. Fire Administration, 1 Dec. 2022,

“Heart Attacks: In the Top 5 Causes of Police Officer Deaths. the Statistics Are Alarming.” Police Health, Accessed 20 June 2023.

Loewen, Brandon, et al. “Evidence-Based Exercise for Structural Firefighters -a Brief Review.” National Strength and Conditioning Association (NSCA), 11 Sept. 2020,

Patil, Harshal, and Anthony Magalski. “Sudden Cardiac Arrest during Sports Activity in Middle Age.” American College of Cardiology, 30 Sept. 2015,

Snarr, Ronald L., et al. “Physical Fitness Initiatives in the Fire Service – Barriers and Benefits.” National Strength and Conditioning Association (NSCA), 3 Jan. 2020,

Violanti, John M, et al. “Life Expectancy in Police Officers: A Comparison with the U.S. General Population.” International Journal of Emergency Mental Health, 2013,

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