While protecting our communities, firefighters often respond to dangerous situations that put them at risk of adverse health events. Firefighting as an occupation is associated with elevated risk of injuries and diseases including certain cancers,^1,2 and cardiac events which are a major contributor to line-of-duty fatalities among firefighters.^3–5 Physical activity and fitness can reduce the risk of these adverse conditions,^6–9 and are critical to ensure firefighter safety, and improve firefighting response capacity.

Volunteer firefighters, constituting the majority (65%) of the United States (US) fire service,¹⁰ have a higher prevalence of insufficient cardiorespiratory fitness necessary for essential firefighting tasks while wearing firefighting personal protective equipment and self-contained breathing apparatus (SCBA).^11–13 They also have a higher prevalence of overweight and obesity compared to career firefighters.^11,12 In 2020, 71% of volunteer departments lacked basic firefighter fitness programs compared to 27% of career departments, accounting for the population size served by the departments. Similarly, 58% of volunteer departments did not provide medical or physical evaluations to their members, compared to 22% of career departments.¹⁴ Fire department-offered fitness support can be beneficial to firefighters.

A US-based study comparing career firefighters from ten departments with fitness programs (annual physical exams, access to fitness coordinators and trainers, and time allotted for fitness activities) with career firefighters from ten departments without such program reported that firefighters from departments with fitness programs had lower odds of being obese, had five times greater odds of meeting cardiorespiratory fitness benchmark, and generally had higher mean cardiorespiratory fitness than firefighters in departments which did not have fitness programs.¹⁵ However, fitness challenges specific to volunteer firefighters have rarely been studied in this already understudied majority of the US fire service.

Commonly reported barriers to fitness among career firefighters, which volunteers may also face, include inadequate rest or sleep and concern of fatigue due to exercising before a fire call.^16–18 Additionally, a qualitative study exploring challenges to healthy behaviors among volunteer firefighters found that being on call and not having a set schedule, were barriers to maintaining healthy behaviors like healthy eating and physical activity.¹⁹ Improving fitness is a priority for volunteer departments and their leadership are often interested in fire department-offered fitness programs and exercise education.²⁰

US volunteer fire departments face barriers in offering their volunteers fitness-related support.¹⁴ The 2020 US Fire Departments Needs Assessment conducted by the National Fire Protection Association (NFPA),²¹ a non-profit organization that develops firefighter health and safety standards, identified that most volunteer fire departments did not provide their membership with a basic firefighter fitness program or with periodic medical or physical evaluations.¹⁴ This inability may be attributed to financial challenges among volunteer departments to implement health promotion and prevention practices.²² While career firefighters may benefit from dedicated exercise spaces, health and fitness programs and regular health examinations at the fire station during their shifts,^15,17,23 these resources may not be as readily available to volunteer firefighters through their fire department.

The US Fire Administration and the National Volunteer Fire Council identified firefighting culture, recruitment and retention challenges, funding limitations, expanding roles of firefighters, personal health, and the adoption of safety protocols as the most critical health and safety-related issues for volunteer fire departments and their firefighters.²⁴ They suggest routine health screenings and the promotion of positive lifestyle behaviors, including fitness assessments and programming, can address and manage volunteer firefighter health and safety issues.²⁴ However, limited research explores the unique barriers to physical fitness among volunteer firefighters which may change with their age and years of firefighting service.²⁵

To better understand these factors and address the health and safety issues faced by the volunteer fire service from their own perspectives, this qualitative study explored perceived individual- and fire department-level barriers and promoters of physical activity and fitness among US volunteer firefighters.

Between June 2021 and December 2022, 28 CAPS participants were interviewed as the majority of the 569 incumbent CAPS volunteer firefighters (83.9%) were enrolled in 2021 or later. Among the interviewed participants, 7 were in the fire service for less than 10 years, 11 were in the service for 10 to less than 30 years, and 10 were in the service for 30 years or more (Table 2). Just under two-thirds (64.3%) of the interviewed participants were members of New Jersey volunteer fire departments. New Jersey volunteer firefighters comprised 41.5% of the overall CAPS sample. The remainder of the interviewed participants were from Connecticut, Maine, Maryland, and Tennessee.

The interviewed participants were incumbent members of their departments and were predominantly male (96.4%), non-Hispanic white (85.7%), and half (50%) were 50 years or older. More than half (53.5%) of interviewees held non-leadership roles at their fire departments. Most interviewees (92.3%) were employed in jobs other than being a volunteer firefighter and were married or partnered (71.4%). Only 25% met the NFPA cardiorespiratory fitness recommendation, based on their questionnaire responses. With respect to other fitness characteristics, 53.6% were obese, while 35.7% reported routine vigorous physical activity in the past month (Table 3).

The purpose of this study was to explore the firefighter- and fire department-level barriers and promoters of physical activity and fitness among US volunteer firefighters across different years of firefighting service. The interviewed firefighters underscored the significance of fitness for both their firefighting performance and overall health. A notable obstacle to firefighters’ engagement in physical activity was identified as competing time commitments stemming from trying to balance firefighting responsibilities, employment, and personal commitments. Volunteer firefighters also emphasized that fire training drills, as well as having fitness advocates within their department, play crucial roles in promoting physical fitness. Variations in perspectives towards the promoters or barriers to physical activity and fitness were observed based on years of firefighting. These variations were not contradictory but rather led to similar and expanded conclusions. For example, while most firefighters acknowledged their fire departments’ role in influencing their fitness, those with more years of service also suggested that promoting physical activity and fitness would require a collective effort involving the department, volunteers, and the community.

There is growing evidence indicating that firefighters, including volunteers, are knowledgeable and concerned about the adverse effects of firefighting on health, both acute (e.g. injuries and cardiac strain) and chronic (e.g. cancer and cardiovascular disease).^34,35 The participants in this study emphasized the connection between their physical fitness and the prevention or reduction of the burden of these health conditions. However, they also shared that discussions on physical fitness were not explicitly integrated into routine department meetings or firefighting training, despite firefighter health and safety being one of the six critical challenges recognized by the US volunteer fire service.²⁴ Incorporating fitness-related topics into these routine meetings and trainings could potentially enhance physical activity and fitness among firefighters. Participants highlighted the physically active and intense nature of their training, which could serve as a motivator to improve fitness and safety, particularly given the discussions on form and methods. It is worth noting that fire training drills may contribute to occupational physical activity which has been reported to paradoxically reduce cardiovascular health compared to leisure or recreational physical activity due to differences in intensity, duration, recovery, and related physiological responses.^36,37 Including appropriate hydration and recovery practices in firefighting training may help promote better training and fitness outcomes.

Consistent with previous evidence, volunteer firefighters in this study identified time constraints and limited availability as major obstacles to physical activity and fitness. This challenge arises from juggling personal responsibilities like family and employment, along with the commitments linked to being a volunteer firefighter.^19,24 Also, while some participants had access to fitness facilities and equipment, many reported that time constraints hindered their ability to exercise routinely. To address these challenges, in addition to incorporating exercise into fire training drills, individually tailored health programs that incorporate convenience and physical activity strategies can provide exercise options for different locations, including gyms, at-home, and the fire station.²³

Participants in this study discussed the availability of fitness resources, including workout spaces, exercise equipment, and gym memberships through their departments. However, their responses pointed to a gap between resource availability and use. Participants also highlighted the crucial role their fire departments play in helping firefighters maintain fitness, emphasizing the significance of fitness advocates within the department, such as department leaders or other engaged members. Having designated personnel in the department who can advocate for, and support fitness initiatives may motivate members to be more physically active. Evidence suggests that departments with two or more health and safety personnel may exhibit better adoption of preventive or positive health behaviors such as cancer screening activities.³⁸ As reflected by some participants in this study, fitness advocates may also motivate members to also make use of department-offered fitness resources which are generally observed to be limited among volunteer departments.¹⁴ However, identifying or recruiting this type of personnel may be a challenge for some volunteer departments as well.

There are possible limitations to this study. First, participants were mostly non-Hispanic white males, characteristics similarly observed among the national fire service demographics.¹⁰ However, physical activity and fitness influences could not be sufficiently discussed among female volunteer firefighters who may have different experiences compared to their male counterparts. Second, the perspectives of firefighters regarding physical activity and departmental fitness resources may vary based on the region of their department’s location and the level of community service and support, and most of this study’s participants were from volunteer departments in New Jersey.¹⁴ As well, we could not capture physical activity levels of the occupations the firefighters held outside their volunteer service which may affect firefighters’ perception towards their physical activity and fitness. Third, the interviews were conducted online, potentially impacting the flow of discussions compared to in-person interviews. However, the moderator received training to conduct virtual interviews and generally received active participation from all participants. Fourth, the study employed both individual and small group interviews based on participant availability, introducing potential variation in the type of discussions. However, the intentional integration of interview and focus group data may enhance data richness.³⁹ Finally, although the same interview guide was used for all participants and the influence of the COVID-19 pandemic was discussed in the early interviews, these discussions were fewer with later interviews. Therefore, the influence of the pandemic could not be sufficiently assessed in this study.

The study also has notable strengths. The semi-structured interview guide effectively probed and elicited responses from firefighters regarding perceived promoters and barriers at both individual- and fire department-levels, offering a multilevel framework for understanding volunteer firefighter fitness. Participants were strategically interviewed based on their years of firefighting service to provide varying perspectives on the influences of volunteer firefighter fitness. While individual and small group interviews were conducted, stratifying focus groups by demographic or similar characteristics may enhance saturation and provide a more comprehensive understanding of the discussed topics.⁴⁰

This study emphasizes the often-overlooked population of volunteer firefighters and their perspectives on physical activity and fitness. The findings underscore the critical role of fitness in firefighting performance and overall health, with participants expressing awareness of the potential adverse effects of firefighting on well-being. Time constraints emerged as a significant barrier to consistent physical activity, reflecting the intricate balance between firefighting duties, employment, and personal responsibilities. The study suggests that incorporating fitness discussions into routine department meetings and firefighting training, and promoting advocates for fitness within the department, could help overcome these barriers. Additionally, the study highlights the importance of addressing the gap between the availability of fitness resources and their actual use. Firefighter health researchers and fire department leadership could collaborate in exploring the impact of tailored health programs and fitness initiatives, such as incorporating fitness-related discussions into membership meetings and training sessions. Future research could also explore the identification and roles of departmental fitness advocates and assess their impact on volunteer membership fitness.