title: Fire fit: assessing comprehensive fitness and injury risk in the fire service.
abstract: OBJECTIVE
  This study sought to develop a comprehensive measure of fitness that is predictive of injury risk and can be used in the fire service to assess individual-level health and fit-for-duty status.
  
  
  METHODS
  A retrospective occupational cohort of 799 career fire service employees was observed over the years 2005-2009. An equally weighted score for comprehensive fitness was calculated based on cardiovascular fitness, muscular strength, endurance, flexibility, and body composition. Repeated measures survival analyses were used to estimate the risk of any injury, sprain or strain, and exercise-related injuries in relation to comprehensive fitness.
  
  
  RESULTS
  A well-distributed comprehensive fitness score was developed to distinguish three tiers of overall fitness status. Intraclass correlations identified flexibility, total grip strength, percent body fat, and resting heart rate as the most reliable fitness metrics, while push-ups, sit-ups, and aerobic capacity demonstrated poor reliability. In general, individuals with a lower comprehensive fitness status had an increased injury risk of injury as compared to the most fit individuals. The risk of any injury was 1.82 (95% CI 1.06-3.11) times as likely for the least fit individuals, as compared to individuals in the top fire fitness category, increasing to 2.90 (95% CI 1.48-5.66) when restricted to sprains and strains.
  
  
  CONCLUSIONS
  This 5-year analysis of clinical occupational health assessments enabled the development of a relevant metric for relating comprehensive fitness with the risk of injury. Results were consistent with previous studies focused on cardiorespiratory fitness, but also less susceptible to inter-individual variability of discrete measurements.
authors.affiliation: Center for Applied Biomechanics, University of Virginia, Charlottesville, VA, USA. poplin@virginia.edu.|Division of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA. poplin@virginia.edu.
authors.forename: Gerald S
authors.initials: GS
authors.lastname: Poplin
authors.affiliation: Division of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Roe
authors.affiliation: Division of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
authors.forename: Jefferey L
authors.initials: JL
authors.lastname: Burgess
authors.affiliation: Division of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
authors.forename: Wayne F
authors.initials: WF
authors.lastname: Peate
authors.affiliation: Division of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
authors.forename: Robin B
authors.initials: RB
authors.lastname: Harris
mesh_terms: D050154:Adiposity; D000328:Adult; D005080:Exercise Test; D005260:Female; D061388:Firefighters; D018737:Hand Strength; D006339:Heart Rate; D006801:Humans; D008297:Male; D060051:Occupational Injuries / Q000453:epidemiology*; D010809:Physical Fitness / Q000502:physiology*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D015206:Southwestern United States / Q000453:epidemiology; D013180:Sprains and Strains / Q000453:epidemiology; D014938:Work Capacity Evaluation
keywords: Firefighter; Injury risk; Occupational health and fitness