Worksite Exercise Interventions for Low Back Injury Prevention in Firefighters
Worksite Exercise Interventions for Low Back Injury Prevention in Firefighters
Purpose and Aims: The purpose of this study is to assess the clinical effectiveness of back
 and core exercise interventions for low back injury prevention in firefighters. Aim 1.
 Compare the effectiveness of 2 worksite exercise interventions (supervised, web-based)
 relative to control to reduce lost work days related to low back injury and illness in
 firefighters.

 Relevance: Low back injury is one of the most common and disabling disorders in firefighters.
 Thus, novel interventions are needed to counteract the adverse consequences of this disorder
 and its impact on firefighter safety.

 Methods: A cluster randomized controlled trial will be conducted in career, full active duty
 firefighters (n = 345) who will be randomly assigned (by fire station) to 1 of 3 intervention
 groups - 1) supervised exercise (n = 115), 2) web-based exercise (n = 115), or 3) control (n
 = 115). Participants in the supervised and web-based exercise groups will perform back and
 core exercises previously tested in our recent FEMA-funded grant (EMW-2009-FP-00418), twice
 per week for 12 months while on duty, in addition to their usual physical fitness routine -
 The supervised group will perform exercise under direct supervision of certified exercise
 specialists, and the web-based group will utilize a web-based exercise system. The control
 group will not perform back and core exercises, but will continue their usual physical
 fitness routine and receive brief education on general exercise and physical activity
 principles. Outcome measures include low back injury and illness data obtained and
 cross-checked from various sources, other standard clinical outcome measures for low back
 pain and disability, and validated physical fitness tests.

 Anticipated Outcomes: We hypothesize that the supervised and web-based interventions will
 reduce lost work days related to low back injury and illness by 40% compared with control.
 Assuming positive results, this study will deliver an evidence-based exercise intervention
 for low back injury prevention specifically designed for firefighters and assessed in a
 full-scale randomized controlled trial.
Low back injury is one of the most common and disabling disorders in firefighters (IAFF,
 2008). Thus, novel interventions are needed to counteract the adverse consequences of this
 disorder and its impact on firefighter safety. Our long-term research objective is to develop
 and test interventions to reduce the incidence, morbidity, economic, and other adverse
 consequences of low back injury and illness in firefighters. Our previous studies funded by
 the FEMA Assistance to Firefighters Grant Program demonstrated that: 1) a relationship exists
 between poor back muscular endurance and increased prevalence of low back pain in
 firefighters (Verna, 2010); and 2) a worksite intervention including back and core exercise
 training is safe and effective in improving back and core muscular endurance in firefighters
 (Mayer, 2015). The purpose of the current study, which builds upon our previous work, is to
 assess the clinical effectiveness of back and core exercise interventions for low back injury
 prevention in firefighters.

 Specific Aims (Purpose) Aim 1. Compare the effectiveness of 2 worksite exercise interventions
 (supervised, web-based) relative to control to reduce lost work days related to low back
 injury and illness in firefighters.

 Hypotheses: Primary - The supervised exercise intervention will reduce the number of lost
 work days related to low back injury and illness over the 12-month intervention period by 40%
 compared with control. Secondary - The web-based exercise intervention will reduce the number
 of lost work days related to low back injury and illness over the 12-month intervention
 period by 40% compared with control. No difference between the supervised and web-based
 exercise interventions in lost work days will be observed.

 To test the hypotheses, a 3-arm, cluster randomized controlled trial will be conducted in
 career, full active duty firefighters from 76 stations of 3 fire rescue departments in the
 Tampa Bay region of Florida. Firefighters (n = 345) will be randomly assigned (by fire
 station) to 1 of 3 exercise intervention groups - 1) supervised, (n = 115), 2) web-based (n =
 115), or 3) control (n = 115). Participants in the supervised and web-based exercise groups
 will perform back and core exercises previously tested in our recent FEMA-funded grant
 (EMW-2009-FP-00418), twice per week for 12 months, in addition to their usual physical
 fitness routine. All participants at a given fire station will receive the same intervention
 and interventions will be completed during normal shift hours at the fire station. The
 supervised group will perform back and core exercises with on-site, 1-on-1, direct
 supervision by certified exercise specialists (e.g. peer fitness trainers from the partner
 fire departments) for each exercise session using an identical strategy as our previous
 study. The web-based group will be provided an interactive web-based delivery, guidance, and
 monitoring system for back and core exercises using technology developed by our group and
 partners, along with remote interaction with and guidance from exercise specialists. The
 control group will not perform back and core exercises, but will continue their usual
 physical fitness routine and receive brief education on general exercise and physical
 activity principles.

 Outcome measures to test these hypotheses include low back injury and illness data obtained
 and cross-checked from various sources, including administrative data (primary outcome), such
 as reports from the fire departments and workers' compensation data, and participant
 self-reported questionnaires in accordance with departmental, Occupational Safety and Health
 Administration (OSHA), and fire service standards. Numerous other clinically relevant
 measures for low back pain injury and illness, comorbidities, risk factors, and prognosis
 will also be collected and analyzed, such as incidence, frequency, severity,
 chronicity/duration, physical function, psychological measures (e.g. fear avoidance), back
 and core muscular endurance, body mass index, Functional Movement Screen, physical activity
 and exercise measures, and cost-effectiveness. In order to inform implementation efforts
 throughout the fire service, we will conduct a health economic analysis, such as cost
 effectiveness, and collect data to gain a better understanding of the context for
 implementation of the exercise interventions.

 Potential impact on firefighter health and safety. The proposed study will provide pivotal
 evidence for dissemination and implementation throughout the fire service. Assuming positive
 results, this study will deliver an evidence-based exercise intervention for low back injury
 prevention specifically for firefighters and assessed in a full-scale randomized controlled
 trial.. The innovative, efficient, and effective exercise intervention will reduce the
 adverse consequences of low back injury and illness in firefighters, and will be ready for
 national implementation throughout the fire service for fire departments with similar
 characteristics as those tested. If successfully implemented, this low back injury prevention
 program will improve firefighter safety and health in order to enhance resilience and
 preparedness, so they can more effectively carry out their duties to protect the community.
 Further, this low back injury prevention program will help improve off-duty and long-term
 quality of life for firefighters.

 Unique contribution to body of knowledge. Knowledge gaps exist in evidence-based approaches
 for low back injury prevention in firefighters, particularly regarding interventions for
 clinical effectiveness, costs, and implementation. The proposed study will assess such an
 intervention, and is responsive to 4 health and wellness priorities of the 2011 National Fire
 Service Research Agenda (NFFF, 2011): 1.0: Health and disease related to firefighter wellness
 and fitness; 3.0: Implementation / translational research; 7.0: Optimization of performance
 and reducing risk; and 8.0: Cost effectiveness of health and safety systems.
Inclusion Criteria:

 -  Age 18 years or older.

 -  Full duty, regular service, career firefighter housed at a standard fire station from
 Hillsborough County Fire Rescue, St. Petersburg Fire & Rescue, or Tampa Fire Rescue.

 Exclusion Criteria:

 -  Current workers' compensation or personal injury case or litigation

 -  Research personnel (e.g. firefighter peer fitness trainers).

 -  Participant in the exercise intervention group of our previous FEMA-funded study
 (EMW-2009-FP-00418).