TO THE EDITOR:
We appreciate the supportive letter “Obesity and Treadmill Exercise Duration in Hazmat Candidates” by Dr Raymond (1) with regard to our recent publication. We demonstrated a high prevalence of overweight and obesity among firefighter and ambulance recruits and that increasing BMI was strongly associated with adverse effects on common measures of health and fitness. Dr Raymond's findings in a sample of somewhat older hazardous material response candidates are in strong agreement with ours: both show a strong inverse relationship between increasing BMI and maximal exercise capacity.
Dr Raymond also correctly points out the need for investigations that prospectively evaluate the relationship between excess weight and reduced exercise capacity in emergency responders and the ability to safely perform their duties. We are currently collecting baseline data to examine this question in a multicenter study. However, several lines of biologically plausible evidence already support the hypothesis that obesity and exercise tolerance are independent predictors of health and employment outcomes in emergency responders. Emergency response work consists of long periods of relative inactivity, interspersed with brief periods of very physically and psychologically stressful work. Such periods of irregular physical activity have been shown to markedly increase the risk for cardiovascular events (2,3), which account for nearly half of on-duty deaths in firefighters (3). On the other hand, regular physical exertion, which increases exercise tolerance, is protective (2). Additionally, general population studies have consistently demonstrated an inverse relationship between physical fitness and cardiovascular disease risk, as well as all-cause mortality (4). Furthermore, a prospective firefighter study by our group has demonstrated a higher risk of job disability among obese firefighters (5). Therefore, we agree with Dr Raymond regarding the need for improved fitness among emergency responders. Such a goal will be difficult to achieve without directly and frankly addressing the problem of epidemic obesity among emergency responders.