Still Need Proof?

One of the sixteen initiatives for reducing line of duty deaths (LODD) in the “Everyone Goes Home” campaign is physical fitness. What troubles me about this program is the mouthing of a platitude without any real follow up. It’s like dental hygiene: don’t have to floss every day; just those teeth that you’d like to keep. By that I mean we continue to preach about the need, but really don’t follow up with standards.

In a study conducted by Harvard University School of Public Health and published today in the journal of the American College of Sports Medicine, men who engaged in vigorous exercise had their risk of fatal heart attack cut by 22%.

“We studied vigorous exercise because of its stronger association with coronary heart disease,” said Andrea Chomistek, Sc.D., the lead author of the study. “While we discovered that vigorous-intensity exercise decreases a man’s risk of heart attack, we also were able to partially determine why. The benefits of exercise on a man’s levels of HDL-C, or ‘good’ cholesterol, account for approximately 38 percent of that decrease. Other important markers included vitamin D, apolipoprotein B and hemoglobin A1c.”

There were 18,225 men who participated in the study, of which 454 suffered a nonfatal heart attack or died from CHD (coronary heart disease) during the 1994-2004 data collection window. After the 10-year period, 412 men with CHD were matched to controls based upon age, smoking status and their date for providing a blood sample.

“As expected, traditional cardiovascular disease risk factors were more common among cases than controls,” said Chomistek. “Men who suffered a nonfatal heart attack or died from coronary heart disease had less ‘good’ cholesterol, more ‘bad’ cholesterol and were more likely to have high blood pressure, high cholesterol and diabetes.”

The study, “Vigorous Physical Activity, Mediating Biomarkers, and Risk of Myocardial Infarction,” is published in this month’s issue of Medicine & Science in Sports & Exercise®, the official journal of ACSM.

The U.S. Centers for Disease Control and Prevention ranks heart disease as the nation’s leading cause of death among men. Between 70 and 89 percent of all sudden cardiac events occur in men, and nearly half of men who have a heart attack before age 65 die within eight years. And of course, heart disease continues to lead the list of LODDs for firefighters.

None of this really comes as a surprise. But regrettably, until we actually start to recruit and select the most fit- people who have a real penchant towards fitness being a priority, we’ll continue to see the results of sedentary living.

“Our Fathers Fought the Second World War”

This familiar refrain written by Billy Joel (from the hit song Allentown) came to mind today as I and hundreds of other grateful people at BWI airport stood and applauded for the nearly 25 minutes that it took to unload the arriving Southwest Airlines flight that conveyed scores of Second World War veterans from Detroit. We were occupying ourselves with the usual activities of checking emails, surfing the net when the gate agent announced that an honor flight of WWII vets were on the in-bound flight. Would we all welcome them? Would we?

But of course! Flags were handed out and a squad of sailors in dress whites formed up a alley. Everyone, and I mean everyone, stood and started clapping and kept clapping as though each of these grizzled and some stooped figures were a member of our own families. Hundreds of travelers came together and proudly gave every aged veteran their undivided attention. Travelers were wiping tears from their eyes at the incredible sight.

Statistics about WWII vet mortality are bantered about, like 30,000 WWII vets are dying every month. Just a few months ago, Frank Buckles, the last surviving WWI veteran passed away at the age of 110. Based on that model, statistically, there will still be a few more WWII vets left for some years to come (a GI of 17 in the last year of the war, 1945- living to be 110 would die in 2038).

All paid for by private donations, the honor flight contingent would be loaded onto buses and taken to Washington, DC to view the WWII Memorial, the Korean War Memorial and the Vietnam Memorial. Then, they would be flown home to stay in their own beds. Many of these heroes were in wheelchairs. I noticed that the captain of the SWA flight ferried several of the vets off the flight. We all forgot about the fact that the plane was about 90 minutes late due to mechanical problems. That minor distraction quickly paled in comparison to the awesome experience of watching these venerable warriors embracing the experience. The smiles on their faces, the waves and salutes were rewarded with more intense clapping, cheering, whistling and flag waving.

This episode seemed in so many ways, foreign to cacophony of partisan politics and all the divisive vitriol that spews daily from TV, print media and zinger emails. For a short half hour of the day, we shared common values and a sense of pride for what these veterans had done for us.

It made me very proud to be an American and the son of a now deceased WWII submariner. I just wished that Dad could have been there.

Ah, Rest!

After slogging on for an unprecedented 12-week, no break stint, Time Off! Some of you Challenge addicts might be in withdrawal, but the hard-working members of the Crüe welcome the time of respite.

One of the most overlooked components of physical training is rest. It’s an integral part of the General Adaption Syndrome (GAS). I continue to believe that a large number of our die-hards still adhere to the adage: No Pain, No Gain. No one ever got fit without sweat. There is no magic pill or plug-in the wall thing that’s going to take the place of the Work Out. But muscles require rest to recover.

Pain is nature’s way of telling you to back off. DOMS (delayed onset of muscle soreness) comes from microscopic tears in the cellular fabric of muscle cells. Leakage follows with edema, putting pressure on nerve cell endings. Extreme workouts can give rise to rhabdomyolsis, a potentially lethal condition where protein leaks out of the cells and interferes with the ability of the kidneys to process urea. We’ll talk more about rhabdo in an upcoming Blog.

But, back to the rest thing. Periodization is the process of allowing certain muscle groups to recover between workouts. For a muscle to gain strength, it must be stressed beyond the usual daily loading. Power, not to be confused with strength quickly becomes refractory to improvements after fatigue. Depending upon the severity of the workout, one day might not be enough. With advancing age, your recovery curve becomes a lot longer. Ah, the benefits of youth.

Regrettably, without the ability to look at blood serum enzymes, it’s difficult to know where you are. Staleness has some subjective cues, like “how do you feel?” Listening to your body takes some time. If you’re rolling out of the rack in the AM and feel sore and stiff, you’re not ready to pound your body into some kind of submission.

The major risk of overtraining is a susceptibility to connective tissue injury. Muscles can also tear, but because they’re heavily vascularized, they heal quickly, especially if you help out with rest and ice. Anti-inflammatories like Motrin are effective. Tendons and ligaments take a lot longer to repair because they have very little blood flow.

I think it would be interesting to look at our injury rates for this sport and compare them to say, softball. I think that we’re well ahead of that cohort. But it does trouble me when I hear of injuries to our competitors, regardless of where the injury took place. Sometimes its doing an innocuous activity that you would never guess had any risk- like walking up stairs.

The Sportsmedicine model of active rest and light range of motion activity has been proven to greatly accelerate the recovery period. No one who’s doing anything active is going to escape musculoskeletal injuries. We just want to be smart about it and remember that rest is the missing variable in a lot of workout routines.

From Whence Came the Challenge?

For the uninitiate (a person unfamiliar with a specific topic or subject) upon first seeing the Scott Firefighter Combat Challenge, the likely question: “What is this and where did it come from?“ Good questions, both.

Back in the dark ages of personnel selection, fire chiefs believed that big(ger) people tended to excel at the avocation. Ergo, there were minimum height and weight standards. No one considered that women would ever want a career in this most male of occupations. Disparate impact was an unfamiliar term in those days. So, in 1975, Chief David Gratz who was the director of fire-rescue service for Montgomery County (MD) and Dr. Leonard Marks paid us a visit at the Sports Medicine Center of the University of Maryland’s School of Public Health, Department of Kinesiology. They wanted to know if there was a way to measure what it took to, for example, climb a ladder and chop a hole in a roof. “Sure,” we remarked.

FEMA was still a distant gleam in someone’s eye, but the formation of what would become the National Fire Administration was gaining some traction. This new agency under the Department of Commerce would have money to fund research. A research proposal was cobbled together and submitted with the backing of our US Senator, J. Glen Beall. For the modest sum of $87,216 we embarked on a project that would become the first study to link empirically physical performance constructs with simulated job tasks for structural firefighters.

One-hundred greater Washington area firefighters were randomly selected by age and political jurisdiction strata and underwent laboratory-based tests for aerobic and anaerobic kinetics as well as other demographic data. The results were correlated against performance on a series of linked fire ground evolutions. Technically, we used mutliple-regresson and canonical correlation to create a model of success. In other words, a profile of fitness that could predict performance on frequently performed, non-skill dependent, arduous fire suppression tasks.

The Criterion Tasks were nominated by the Training Officers subcommittee of the COG Fire Chiefs Committee. These tasks were corroborated through surveys and have been replicated in numerous jurisdictions across the US. The objective was to focus on a core of Essential Functions that were ubiquitous to the fire service, much like hanging a door would be for carpentry. Local jurisdictions might feel strongly that they would want to add logical accessories such as the ability to swim where water was a part of the first due equation.

Morphing into what would ultimately become the Essential Functions Test (EFT), hundreds of fire departments across the nation in the early 90’s were signing on for the use of the “Combat Test” as a selection, or in some cases, retention test. In 1991 we held our first Washington, DC Council of Governments (COG) sponsored competition at the Maryland Fire-Rescue Institute. Never intended as a race, but rather as a personnel selection instrument, the EFT received kudos as being age and sex neutral (in other words, age and sex were not factors in scoring). But, you know how firefighters can be and speed to completion ignited a game.

The general premise in personnel selection is that your natural abilities can take you wherever you wish to go. The Constitution of the United States affords you with equal opportunity. The results are on you. This called the Merit System- the novel idea of hiring people based upon objective data.

With the rapidly ascending popularity of the Scott Firefighter Combat Challenge, the major focus of our efforts became the fine tuning of an International Sports competition. For several years, the great unanswered question was, “Can someone actually do this under 2:00?” Mind you, most firefighters would walk through the course in around five minutes. The very practical application of the EFT has been overshadowed by the 10-year run on ESPN, and the 20-years of a 24-stop annual US tour. There are still departments that require their personnel to walk through the course each year. The measurable benefits are increased safety by reducing line-of-duty musculo-skeletal injuries by fielding a fit workforce. Sounds like a plan to me. No one in our shop ever thought that these insane times would become the de rigueur.

Hopefully, this little tutorial might clear up some misconceptions that continue to linger on the still current and compelling need for physically fit firefighters.

Bottoms Up

The number of heat records set this summer have shattered many that have stood for decades. It’s estimated that over 200M people were affected this year. All the while, the mighty Scott Firefighter Combat Challenge has bravely soldiered on. On a positive note, we’ve had one transport- an individual who admitted self medicating with Creatine.

I hear a lot of comments from spectators that it must be brutal wearing all that gear. And it is- if you had to wear it for periods longer than a few minutes. Fortunately, the time on the course does not add appreciably to the thermal load. The body has an amazing thermoregulatory system. Within a few minutes of maximum muscular contractions, core temperature can climb 1°C. We all know about the heat-injury-illness paradigm. Core temperatures of 104°F are consistent with heat stroke- except when it isn’t. Like in well conditioned athletes who can tolerate running a marathon with this range of core temperature without any consequences.

There is, however, a critical part of the equation: hydration. Your water on board has more to do with maintaining homeostasis than anything else. Even a well-conditioned athlete can’t make it without replacement. Another adaptation is retaining electrolytes. Well fit athletes lose less electrolytes than do unconditioned people.

Sports drinks such as Gatorade provide essential electrolytes as well as fuel. But these are poorly tolerated in the presence of arduous physical activity. I continually remind people that the thirst mechanism is about 20 minutes behind the power curve. In other words, but the time you’re thirsty, it’s too late. Sports drinks should be taken at least an hour before, and not again until the event is well over.

It’s rewarding to watch all the Challenge athletes walking around with their gallons of water. Proper hydration needs planning and you need to start the day before the event. Urine color is the best indices of your status. There is a risk of overdoing it and creating a condition of hyponatremia- where you’re losing electrolytes because you’re overwhelming your kidneys. While a rare phenomena, it can have grave consequences.

Staying out of the sun, ingesting about one pint per hour (to make up for insensitive fluid loss) is the preferred pre-race preparation. Training in the heat is the fastest way to become acclimatized to heat. But, the old adage: “everything in moderation” works every time. Oh yeah; and on the point of beer, it is not a good hydration source. You do not buy beer, you rent it. Alcohol will dehydrate you- before AND after the Challenge.

What Motivates You?

I’ve been doing the Tuesday Night lecture thing at the National Fire Academy in Emmitsburg, MD since the beginning of this year. If you’re not familiar with the EFO (Executive Fire Officer) program, check it out at http://www.usfa.dhs.gov/nfa/efop/

In this week’s lecture, I discussed fitness (of course) and the practical reality of maintaining a fit workforce when we really only have control over employees 10 days per month. Of course, the people reading this post are the very ones that “get it.” They understand that personal fitness is a personal responsibility and that duty extends beyond just the days that they’re clocked in.

As a card-carrying member and Fellow of the American College of Sports Medicine, I’m rightfully proud of the body of literature that has been amassed over the last five-plus decades. Thousands, perhaps hundreds of thousands of peer-reviewed research studies on how to get fit, stay fit; benefits of being fit. But, from a practical perspective, we probably don’t apply 10% of what we know. What we’re missing is that link, the trigger that creates the desire to be all that you can be. To know that you have the physical capabilities to get the job done. The self-confidence that comes from knowing yourself.

Ayn Rand wrote: “A creative man is motivated by the desire to achieve, not by the desire to beat others." I would submit that this adage was never more in evidence than at the Scott Firefighter Combat Challenge. People who are unfamiliar with our sport marvel at the camaraderie. Now, if we could just somehow figure out how to bottle this stuff and vaccinate the rest of the fire service- now that would be something.

Up In the Air

After World Challenge XIX, we administered a survey to all attendees and an unprecedented 400+ responses were received. I read every single comment and am now responding to a minority, but important concern about costs to attend.

Since the critiques were not specific, I can only adjudge that complaints about expenses were driven by airfares, since lodging prices were ridiculously cheap. Mike Medeiros and I did a little study, looking at R/T airfares from several major cities. Myrtle Beach was a very reasonable destination with round trip fares less than $300 from a number of cities.

The caveat is, “when?”

Answer, “Now.” By that I mean that if you have qualified, or are pretty sure that you are going to qualify, this is a good time to start shopping for airplane tickets.

As a member of a number of airline award programs with over 4 million miles on one airline alone, I know a little bit about how these tariffs work. The idea is to fill every seat on the plane before departure. Once the plane leaves the gate, that seat is now worthless. Airlines have very sophisticated software programs that track sales for every flight. A 737 might carry 140 people, with very few of the passengers paying the same price for any given seat.

What we know is that typically, the lowest price point is a couple of months ahead of departure. The closer you get to departure, the more expensive the ticket. For example, we saw a price bump on a flight jump 400% over night. Apparently there was a push after we checked the fare and the next thing we knew, the demand had pushed the price through the roof. There are exceptions. For example, if a flight is not filling up and departure is within a day or so, they may drop the price. If you purchased a ticket for more than the cheaper price, you are entitled to a refund of the difference (on most airlines like Southwest).

Where all the carriers get you is for changes (except Southwest). So, be reasonably sure of your dates. I realize that this presents a bit of a risk. Cancellations on non-refundable tickets are exactly that: nothing. But you are allowed in most cases to rebook, at a “modest” fee of more than $100. (Except Southwest.) And, of course, they nick you for checked luggage. (Except Southwest.) This is why we are partial to a particular airline (Southwest).

Speaking of this airline, they fly to Charleston. And, you can rent cars and drive to M.B. Just one suggestion on how to make your bucks go further. We want everyone to optimize their cash by getting as far out ahead of World Challenge XX as possible- at the lowest possible price.

I hope this has been helpful. I’d like to hear of any deals, thoughts or suggestions you might have that can be shared with everyone. See you in Myrtle Beach this November.