Fitness and First Responders

Being a first responder (Police, Firefighters, and Paramedics) is a noble profession.  It is a profession of service.  It is also a profession that takes a unique toll on the body.  First responders are repeatedly put in high stress situations causing a release of certain hormones and neurotransmitters and the suppression of others. This is to prepare the body and mind for the challenge they are facing.  One of the biggest issues is that these situations are not sustained.  They often last only minutes and then the body is left with a cascade of chemicals and no way to express them.   Sometimes the events last for hours and then then body suffers parasympathetic backlash.  When you have been in a high stress situation for so long after it is over the body and mind are fatigued beyond description.  These events repeated over time wreak havoc on the endocrine system.  Often, first responders live with sustained elevated levels of cortisol, systemic inflammation, and reduced levels of vital hormones such as testosterone.

Cardiovascular disease (CVD) is the leading cause of on-duty death among firefighters (45% of on-duty fatalities) and a major cause of morbidity.(1) Previous studies have found police officers to have higher rates of Cardiovascular disease risk factors and cardiovascular disease morbidity than other groups.(2)

Lack of sleep also plays a role in the reduced well-being, lack of energy, and chronic disease development many first responders become accustomed to.   First responders often work shift work which has been shown to have a negative impact both on physical and mental health.(3)  Studies suggest that first responders get less sleep than the average population. One study concluded “Among a group of North American police officers, sleep disorders were common and were significantly associated with increased risk of self-reported adverse health, performance, and safety outcomes.”(4)  Another study suggested that EMS workers are sleep deprived and fatigued.(5)  I recognize that any first responder who is reading this doesn’t need a study to tell them what they already know.  First responders live in a state of sleep deprivation and fatigue.  Sadly, many come to think of it as normal.  Lack of sleep suppresses testosterone levels during the day and can lead to low testosterone.(6)

Stress is common to most first responders.  Evidence suggests that the stress police officers face can result in multiple health problems,(7) including increasing the risk of developing cardiovascular risk factors and cardiovascular disease.(8)  This likely holds true for all first responders.  I know for myself that when working as a firefighter and then as a flight medic I was repeatedly put in stressful situations. 

Often this repeated stress results in changes in mood.  Depression is more common in police than the average population: “Firefighters represent an occupational group at increased suicide risk.” (9)  A study performed on paramedics “found significantly higher levels of fatigue, depression, anxiety, and stress, and significantly poorer sleep quality than reference samples.” (10)

There is no comparison of whose job is more difficult.  All first responders have difficult, stressful, and dangerous jobs often requiring work on little sleep and repeated stressful events.  It takes its toll.  Any first responder reading this knows exactly what I am talking about.  The day after your shift when you just feel run down, tired, many times in a bad mood and the only explanation is the beating your shift took on you the day before.

Sadly, many men come to believe that this is just a part of growing older and must be accepted as a part of life.  But this couldn’t be further from the truth.  The problems can be treated and reversed through changes in diet and lifestyle as well as treatments such a testosterone replacement.

The problem is many physicians do not understand the unique problems first responders face.  They often just want to write a few prescriptions and treat them just like they would the average population.  Generally, this results in little improvement.  Sometimes one’s labs look better but they do not feel better.  Looking better on paper but still feeling bad is not real help. 

When a first responder seeks treatment what he needs is someone who completely understands the unique challenges of being a first responder.  I was a firefighter for 10 years, worked for a private EMS service on a 911 ambulance, and flew as a critical care flight paramedic.  This gives me insight into the profession and the significant issues the lifestyle causes.  I took that experience and read books, studies, research papers, etc.  I talked to other first responders in all 3 professions to see things from others’ points of view.  I did everything I could to thoroughly understand the profession and treatments individuals may require.

We have had a lot of success treating first responders.  Here are a few reviews from first responders on our Facebook page:

“Great initial visit! Dr. Lunow is really focused on taking complete care of Men’s health issues. It was a very informative visit, with an exciting plan to put you on track for better health. They understand the issues that men deal with through personal experience with the same issues they have dealt with themselves”

“Superior to all other low T clinics. Dr. Lunow is very thorough in his assessment and tailoring treatments to your specific needs. He is genuinely interested in your health and invested in his patients. Highly recommended.”

 “Great first visit. Dr. Lunow was very focused on what I thought was important. My overall health. He went through a detailed plan with me during the visit. I'm glad I made the switch.”

At Apex Health, we take the profession seriously and approach it with respect.  Men who serve diligently ought to age with dignity.  We do everything we can to help first responders reverse the issues their profession and lifestyle has caused.  We work with them to help them make changes that will lead to long term health and well being and ward off the chronic diseases that often develop.

  1. Cardiol Rev. 2011 Jul-Aug;19(4):202-15. doi: 10.1097/CRD.0b013e318215c105. Cardiovascular disease in US firefighters: a systematic review. Soteriades ES1, Smith DL, Tsismenakis AJ, Baur DM, Kales SN.

  2. Int J Emerg Ment Health. 2011; 13(4): 211–220. Health Disparities in Police Officers: Comparisons to the U.S. General Population Tara A. Hartley, Cecil M. Burchfiel, Desta Fekedulegn, Michael E. Andrew, and John M. Violanti

  3. Paramedics and the effects of shift work on sleep: a literature review. Sofianopoulos S1, Williams B, Archer F.

  4. 2011 Dec 21;306(23):2567-78. doi: 10.1001/jama.2011.1851. Sleep disorders, health, and safety in police officers. Rajaratnam SM1, Barger LK, Lockley SW, Shea SA, Wang W, Landrigan CP, O'Brien CS, Qadri S, Sullivan JP, Cade BE, Epstein LJ, White DP, Czeisler CA;

  5. Prehosp Emerg Care. 2010 Apr 6; 14(2): 187–193. Sleep Quality and Fatigue Among Prehospital Provider P. Daniel Patterson, PhD, MPH, Brian P. Suffoletto, MD, Douglas F. Kupas, MD, Matthew D. Weaver, NREMT-P, and David Hostler, PhD

  6. 2011 Jun 1; 305(21): 2173–2174. Effect of 1 Week of Sleep Restriction on Testosterone Levels in Young Healthy MenFREE chel Leproult, PhD and Eve Van Cauter, PhD

  7. J Occup Environ Med. 2002 Feb;44(2):160-7. Work stress in aging police officers. Gershon RR1, Lin S, Li X.

  8. J Occup Environ Med. 2002 Dec;44(12):1182-9. Relationship between cardiovascular disease morbidity, risk factors, and stress in a law enforcement cohort.  Franke WD1, Ramey SL, Shelley MC 2nd.

  9. /j.comppsych.2018.03.014. Epub 2018 Apr 7. Anxiety sensitivity and suicide risk among firefighters: A test of the depression-distress amplification model.  Stanley IH1, Smith LJ2, Boffa JW1, Tran JK3, Schmidt NB1, Joiner TE1, Vujanovic AA4.

  10. Caring for the country: fatigue, sleep and mental health in Australian rural paramedic shiftworkers. Courtney JA1, Francis AJ, Paxton SJ.