EMT and paramedic rehab: Get off your butt and move
Research shows sitting is the new smoking and for EMS providers who sit a lot more movement is needed
By Bruce Evans
Firefighter rehab has traditionally focused on firefighters physically exerting themselves in suppression or mitigation efforts. The fire service now understands that those stresses are both physical and mental.
Recently, while at a chiefs' meeting at a neighboring department, I noticed several offices being converted to the desk that elevate. It started the wheels turning to as to whether this was trendy and eclectic or a legitimate health issue with real benefits.
Many a command officer has been trained to sit in a command vehicle and run the scene. Simulations reinforce this and the 360-degree sprint around the building is left to the first-due captain.
There are many advantages in command sequencing to being in the vehicle. Being insulated from the noises of the incident and having the benefit of a 25-watt vehicle radio verses a 5-watt handheld to clearly receive and transmit orders make an incident commander more effective.
Often the command officer is not seen as a person who should cycle through the rehab sector. The stresses and physiological changes of having personnel in hazardous situations are not to be discounted. While clearly a risk, there may be more long-term risk from sitting both at the desk and in the command vehicle.
"Sitting is the new smoking," according to research from Ohio State University's Wexner Medical Center. Looking at the evidence from studies that evaluated sitting and smoking, Ohio State researchers cited an Australian study published in October 2012 in the British Journal of Sports Medicine that compared two activities.
That study showed that every hour people watch TV, presumably while sitting, cuts about 22 minutes from their life. In contrast, it's estimated that smokers shorten their lives by about 11 minutes for every cigarette.
The researchers found that adults who spend an average of six hours in front of the TV will reduce their life expectancy by just under 5 years, compared with someone who does not watch TV.
Enough studies now exist to satisfy the scientific community that prolonged sitting will reduce your lifespan by promoting dozens of chronic diseases, even if you exercise regularly. For example, prolonged sitting increases your risk of heart disease, diabetes, obesity and the risk for a blood clot.
This places an entirely new perspective on TV time in the average fire station.
The Mayo Clinic and Arizona State University found that within 90 seconds of standing up, the muscles and cells that process blood sugar, triglycerides, insulin and cholesterol are stimulated. All of these molecular effects are activated simply by carrying your own bodyweight.
Sitting has a significant impact on your body's ability to respond to insulin. Just one day of excess sitting leads your pancreas to produce increased amounts of insulin. Sitting for more than eight hours a day has also been associated with a 90 percent increased risk of Type 2 diabetes.
NFPA 1582 identifies diabetes as a Category A medical condition disqualifying a firefighter when it is treated with insulin or diabetes not treated by insulin, which is not controlled as evidenced by hemoglobin A1C levels.
Cardiovascular damage also can be accelerated from prolonged sitting. Blood flows slower and muscles burn less fat, which makes it easier for fatty acids to clog blood vessels.
Research published in the Journal of the American College of Cardiology showed that people who sit for 10 or more hours a day may have a significantly greater risk of developing heart disease than those who sit for five hours or less.
Evidence now shows excessive sitting may increase your risk of colon, breast, and endometrial cancers. Researched indicates that excess insulin production may be the culprit. Insulin encourages both good and bad cell growth.
Sitting has been found to increase lung cancer by 54 percent, uterine cancer by 66 percent and colon cancer by 30 percent. Another reason for this increased cancer risk is thought to be weight gain, which is associated with inflammation. Inflammation promotes and can be the trigger for cancer.
In contrast, regular movement boost antioxidant production in your body that may eliminate potentially cancer-causing free radicals generated within the body and encountered in a modern structure fire.
A pain in the …
Long periods of sitting also have profound orthopedic effects resulting in strain on the neck and shoulders. It's common to hold your neck and head forward while working at a computer or cradling a phone to your ear.
Sitting puts more pressure on your spine than standing, and the toll on your back health is even worse sitting hunched in front of a computer. It's estimated that 40 percent of people with back pain have spent long hours at their computer each day.
The disks in your back are meant to expand and contract as you move, which allows them to absorb blood and nutrients. When you sit, the disks are compressed and can lose flexibility over time. Sitting excessively can also increase the risk of herniated disks.
There is also significant muscle and joint degeneration that occurs with sitting. Abdominal muscles go unused and hip problems become more significant from prolonged sitting. In fact, all of the joints become tight or atrophied, and that limits range of motion.
Sitting also does nothing good for your buttocks muscles, which when weakened affects your stability and power for standing or lifting. Weakness in those muscles and decreased hip mobility is a contributing factor to falls.
Sitting leads to poor circulation in your legs, which can cause swelling in your ankles, varicose veins, and blood clots known as deep vein thrombosis.
Technology can have an impact. The use of a Fitbit, pedometer or other device that monitors your activity can help by notifying you to get up and move.
The goal should be to take a minimum of 250 steps each hour — this can be accomplished with two to three minutes of walking. And avoid sitting in a vehicle more than an hour at a time.
The Center for Disease Control and Prevention recommends adults get about 150 minutes of moderate activity per week. That equates to about 8,000 steps per day. This simple count can go a long way toward getting more movement and less sitting.
For officers, one way to increase your physical movement is to organize the layout of your office space so that you have to stand up to reach often used files, the telephone or printer. Reverse the trend to have everything within easy reach.
You can also use a standing desk. And if you're a battalion chief or shift commander, avoid sitting during station visits.
The body is designed for regular movement and most command or chief officers spend the bulk of their day sitting. Most can benefit by simply getting more non-exercise movement into their daily routine.
On average, a U.S. adult spends nine to 10 hours each day sitting. These 10 hours or more are easily accumulated on four 10s, 24-hour or 48/96 shift schedules, requiring a deliberate routine to counter the sitting.
While a brief period of sitting is natural, long periods of sitting day-in and day-out can seriously impact your health and shorten your life.
About the author
Chief Evans is the fire chief and a paramedic at the Upper Pine River Fire Protection District in Bayfield, Colo. He is on the board of directors at the National Association of EMT's, a National Fire Academy instructor and sits on the National Academy of Science's Institute of Medicine's Preparedness Committee. He has a master's degree in public administration and bachelor's degree in science from the University of Nevada, Las Vegas. You can reach him at Bruce.Evans@FireRescue1.com