Fitness & Law Enforcement: “the Good, the Bad & the Health Benefits”

1. Fitness & Law Enforcement:“the Good, the Bad & the Health Benefits” STEFANOS N. KALESMD, MPH, FACP, FACOEM DIVISION CHIEF, OCCUPATIONAL & ENVIRONMENTAL MEDICINE MEDICAL DIRECTOR, EMPLOYEE HEALTH & INDUSTRIAL MEDICINE CAMBRIDGE HEALTH ALLIANCE ASSOCIATE PROFESSOR OF MEDICINE HARVARD MEDICAL SCHOOL ASSOCIATE PROFESSOR & DIRECTOR, OCCUPATIONAL MEDICINE RESIDENCY, HARVARD SCHOOL OF PUBLIC HEALTH

2. Fitness & Law Enforcement: Outline Relationship between PA, Fitness & CVD PA, Fitness and Stress and Well-being PA, Fitness and musculoskeletal injuries

3. Risk Factors for CHD Events during the Follow-Up: Smoking Hypertension Excess Adiposity (Excess Fat / Weight) Hyper-insulinemia (DM and Pre-DM…) High Cholesterol

4. Police: 1996 Informal Study Justice Academy Survey of 168 NC Police Heart Attack Survivors 76% were NOT regular exercisers 60% overweight ( > 16 pounds above ideal weight) 53% high cholesterol 46% smokers 46% hypertension

5. Long Stretches of relative inactivity Emergencies & Cardiovascular Risk Brief periods of intense, unpredictable, life-threatening action Adrenergic surges and high demands on CV system Kales et al

6. Triggers / Strenuous Duties Tobacco Sedentary Behavior Poor Diet Pollution (gases & particulates) Noise Stress Shiftwork / Sleep Deprivation Known CHD or Equivalent Genetics Baseline habits Initial Body Composition & Fitness Level Hypertension Dyslipidemia Diabetes Obesity Death Disease Disability SubclinicalDisease +/- LVH Regular Exercise Physical Activity Healthy Diet Adequate Sleep Moderate EtOH Acute CVD Events Progression of Atherosclerosis

7. Physical Activity:

8. Physical Fitness, Activity and CHD Risk. (Williams, 2001) Persons in the >/=75%ile of Fitness >/=60% Lower Risk Williams PT. Physical fitness and activity as separate heart disease risk factors: a meta-analysis. Med Sci Sports Exerc. 2001 May;33(5):754-61

9. Physical Activity and RF for CVD Franke & Anderson JOM 1994

10. Physical Activity and RF for CVD Franke & Anderson JOM 1994

11. Exercise Tolerance Test Time as a f(x) of PA & BMI Frequency Duration Intensity

12. TC/HDL Ratio as a f(x) of PA & BMI Frequency Duration Intensity

14. Low CRF Predicts Abnormal Exercise Testing in Firefighters Kales et al

15. Physical Activity, Stress and the Metabolic SyndromeYoo et al. 2009 386 male LEOs- 23.1% had Metab. Syndrome Regardless of stress levels, PA is associated with reduced risk for the Metab. Syndrome Metab. Syndrome was not significantly associated with perceived stress, physical activity was protective (r=0.225, P<0.0001) Independent and combined influence of physical activity and perceived stress on the metabolic syndrome in male law enforcement officers. Yoo HL J Occup Environ Med. 2009

16. Physical Activity, Stress and the Metabolic Syndrome Highly active LEOs have a reduced risk for the MS compared with low and moderately active LEOs. Criteria used to define a “high” PA level was modest. >/= 150 min of moderate-intensity PA per wk or >/= 60 mins of vigorous-intensity PA per wk Independent and combined influence of physical activity and perceived stress on the metabolic syndrome in male law enforcement officers. Yoo HL J Occup Environ Med. 2009

17. Physical Activity, Fitness + Musculoskeletal Disorders 332 police officers Officers with the highest fitness level were less likely to experience sprains+back pain Exercise >/=30 min, 4X/wk: 73% lower risk of Back Pain Markedly obese (BMI>35): 300% higher risk of back pain after controlling for age/gender/job category. Correlation between physical activity, fitness, and musculoskeletal injuries in police officers. Nabeel et al. Minn.Med.2007

18. To be Fit or Not Fit… • Fitness essential for the most highly demanding moments… • However, the routine physical demands of police work are too low to maintain physical fitness • Stamford BA et al.MedSci Sports. • Smolander et al. J Int Arch Occup Environ Health.

19. Questions