Effect of Rapid Heat Stress on Firefighters Musculoskeletal Injury Risk
NCT ID: NCT06442956
Last Updated: 2025-03-07
Study Results
Results pending
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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Recruitment Status
RECRUITING
Clinical Phase
NA
Total Enrollment
28 participants
Study Classification
INTERVENTIONAL
Study Start Date
2025-01-07
Study Completion Date
2026-05-31
Brief Summary
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This study will examine the effect of heat stress on factors that influence musculoskeletal injury risk in firefighters. Participants will attend 4 data collection sessions. 1: informed consent, screening, and familiarization. 2: pre-tests (strength, balance, and movement quality). 3: heat stress (rapid or gradual) followed by post-tests (strength, balance, and movement quality). 4: heat stress (rapid or gradual) followed by post-tests.
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Detailed Description
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This study utilizes a crossover design, with participants acting as their own controls and participating in both the control (gradual uncompensable heat) and experimental (rapid heat stress (RHS)) conditions. The independent variable is the type of heat stress (uncompensable or rapid). The dependent variables are: peak concentric muscle torque (hip abductors, hip adductors, knee flexors, knee extensors), dynamic balance (Y-Balance Test, Firefighter-Specific Functional-Balance Test (FFSFBT)), and frontal plane movement quality (Forward-Step-Down Test (FSDT)). These will be measured three times, once during pre-testing and twice during post-testing as described below.
The study will consist of four visits. Visit one will be the informed consent and familiarization to the outcome measures. Participants will be educated on filling out the 24-hour food/drink diary, and asked to standardize their diet as close as possible to this record the 24 hours before visits 2, 3, and 4. Injury history and demographic data will be collected at visit 1.
Visit two will be the pre-test data collection, which will occur at approximately 22°C. Participants will complete all outcome measures (torque, balance, movement quality measures). Body composition will also be measured in the BodPod at this time.
Before visits 2, 3, and 4, participants will follow the safety guidelines outlined below to ensure proper hydration:
* 48 hours before: no heat stress (will contact participant to determine if they have been called out to a live fire. Data collection will be postponed if so)
* 24 hours before: no alcohol consumption, no energy drink consumption (normal coffee/tea is allowed)
* 24 hours before: no physical activity (exercise or vigorous play)
* 24 hours before: drink 3.7L of total water to make sure to be well-hydrated
* 2 hours before: eat last meal
Visits three and four will consist of a steady-state treadmill protocol inside the environmental chamber (37-38°C, 50% humidity) followed by post-test measures. During either session three or four, the participant will don his/her firefighting gear (jacket, pants, hood, boots, gloves) and perform the treadmill test with the gear on. This is the RHS trial and will be denoted GEAR. In the other session, the participant will wear exercise clothes (shirt and shorts) plus a weighted backpack to replicate the weight of the gear. This is the gradual uncompensable heat stress trial and will be denoted NOGEAR. The order of the GEAR and NOGEAR sessions will be randomized and counterbalanced to prevent crossover effects.
Upon arrival for the pre-testing visit (session two), participants will be measured for height using a stadiometer and weight. Body composition will be measured once with the BodPod (Cosmed, USA). They will warm up for five minutes on an exercise bike or treadmill then proceed with taking the outcome measures.
Upon arrival for visits three and four, participants will be weighed again. A urine sample will be collected to assess hydration status. They will swallow the core temperature (Tc) capsule 40-45 minutes prior to the start of the session using a small amount of 20°C water, with no further water ingestion throughout the protocol to avoid artificially lowering Tc. Participants will be fit with the Equivital EQLife Monitor (Equivital, NY) system to record heartrate (HR) and Tc. They will then perform the treadmill protocol, and post-test measures will be completed immediately following the cessation of the treadmill test with removal of their gear. They will be weighed following exercise to determine changes in body weight due to sweating.
Sessions three and four will be separated by at least seven days to reduce the influence of heat acclimatization and fatigue. Continuous monitoring of Tc and HR will help ensure participant safety.
The treadmill exercise protocol begins with a graded approach to reach aerobic steady state. The treadmill protocol includes an initial five-minute stage at 3 miles per hour and a 0% grade, followed by increases in percent grade of 4% at minute 5 and 8% at minute 10 and continued throughout the test. Following the final planned incremental increase in treadmill incline, the incline will then be adjusted to ensure that the subject remains at steady-state for the duration of the protocol, defined by a respiratory exchange ratio between 0.9-0.99 using the lab's metabolic cart (Parvomedics, USA). HR, rating of perceived exertion (RPE), thermal comfort, and thermal sensation will be recorded at each 0.5°C interval. The treadmill test will be stopped when participants either reach a Tc of 39°C or a volitional maximum (participant is unable to continue exercise). The investigators will also halt the test if signs of excessive heat stress are present (unsteady gait, confusion, dizziness, slurred speech, etc.) Should the participant not meet either termination criteria, there will be a 50 minute time limit for the treadmill protocol for the GEAR condition and 2 hour limit for the NOGEAR condition. Both GEAR and NOGEAR sessions will begin with the same treadmill test.
Following the treadmill test, the participants will complete the post-test outcome measures. These consist of isokinetic torque of the hip abductors and adductors, isokinetic torque of the knee flexors and extensors, the Y-Balance Test, the FFSFBT, and FSDT. Participants will doff their gear immediately following cession of the treadmill test. For unilateral tests, the dominant leg will be recorded and used for these tests; this is the leg used to kick a ball. Outcome measure order will be standardized for each participant with testing order based on primary outcomes and difficulty of each test. The FSDT will be performed first, as this is the primary outcome and previous research showed that recovery after a maximal exertion stimulus happens quickly. The FFSFBT will be performed next, followed by the Y-Balance Test. Isokinetic testing will be last due to the fatiguing nature of this testing. Hip muscles will be tested first, followed by thigh muscles. Three minutes will be allotted for rest and instruction between each outcome measure. Five minutes of rest will be given between isokinetic tests to allow for machine set-up and instructions. One minute of rest will be given between each isokinetic speed, with three speeds tested for the hip (30°, 60°, and 120° per second) and knee (60°, 180°, and 300° per second) muscles.
Participants will be followed for 2 years, with 6-month follow-up calls to track injury status. Details on type of injury, location of injury, and time lost to work will be collected.
The study will consist of four visits. Visit one will be the informed consent and familiarization to the outcome measures. Participants will be educated on filling out the 24-hour food/drink diary, and asked to standardize their diet as close as possible to this record the 24 hours before visits 2, 3, and 4. Injury history and demographic data will be collected at visit 1.
Visit two will be the pre-test data collection, which will occur at approximately 22°C. Participants will complete all outcome measures (torque, balance, movement quality measures). Body composition will also be measured in the BodPod at this time.
Before visits 2, 3, and 4, participants will follow the safety guidelines outlined below to ensure proper hydration:
* 48 hours before: no heat stress (will contact participant to determine if they have been called out to a live fire. Data collection will be postponed if so)
* 24 hours before: no alcohol consumption, no energy drink consumption (normal coffee/tea is allowed)
* 24 hours before: no physical activity (exercise or vigorous play)
* 24 hours before: drink 3.7L of total water to make sure to be well-hydrated
* 2 hours before: eat last meal
Visits three and four will consist of a steady-state treadmill protocol inside the environmental chamber (37-38°C, 50% humidity) followed by post-test measures. During either session three or four, the participant will don his/her firefighting gear (jacket, pants, hood, boots, gloves) and perform the treadmill test with the gear on. This is the RHS trial and will be denoted GEAR. In the other session, the participant will wear exercise clothes (shirt and shorts) plus a weighted backpack to replicate the weight of the gear. This is the gradual uncompensable heat stress trial and will be denoted NOGEAR. The order of the GEAR and NOGEAR sessions will be randomized and counterbalanced to prevent crossover effects.
Upon arrival for the pre-testing visit (session two), participants will be measured for height using a stadiometer and weight. Body composition will be measured once with the BodPod (Cosmed, USA). They will warm up for five minutes on an exercise bike or treadmill then proceed with taking the outcome measures.
Upon arrival for visits three and four, participants will be weighed again. A urine sample will be collected to assess hydration status. They will swallow the core temperature (Tc) capsule 40-45 minutes prior to the start of the session using a small amount of 20°C water, with no further water ingestion throughout the protocol to avoid artificially lowering Tc. Participants will be fit with the Equivital EQLife Monitor (Equivital, NY) system to record heartrate (HR) and Tc. They will then perform the treadmill protocol, and post-test measures will be completed immediately following the cessation of the treadmill test with removal of their gear. They will be weighed following exercise to determine changes in body weight due to sweating.
Sessions three and four will be separated by at least seven days to reduce the influence of heat acclimatization and fatigue. Continuous monitoring of Tc and HR will help ensure participant safety.
The treadmill exercise protocol begins with a graded approach to reach aerobic steady state. The treadmill protocol includes an initial five-minute stage at 3 miles per hour and a 0% grade, followed by increases in percent grade of 4% at minute 5 and 8% at minute 10 and continued throughout the test. Following the final planned incremental increase in treadmill incline, the incline will then be adjusted to ensure that the subject remains at steady-state for the duration of the protocol, defined by a respiratory exchange ratio between 0.9-0.99 using the lab's metabolic cart (Parvomedics, USA). HR, rating of perceived exertion (RPE), thermal comfort, and thermal sensation will be recorded at each 0.5°C interval. The treadmill test will be stopped when participants either reach a Tc of 39°C or a volitional maximum (participant is unable to continue exercise). The investigators will also halt the test if signs of excessive heat stress are present (unsteady gait, confusion, dizziness, slurred speech, etc.) Should the participant not meet either termination criteria, there will be a 50 minute time limit for the treadmill protocol for the GEAR condition and 2 hour limit for the NOGEAR condition. Both GEAR and NOGEAR sessions will begin with the same treadmill test.
Following the treadmill test, the participants will complete the post-test outcome measures. These consist of isokinetic torque of the hip abductors and adductors, isokinetic torque of the knee flexors and extensors, the Y-Balance Test, the FFSFBT, and FSDT. Participants will doff their gear immediately following cession of the treadmill test. For unilateral tests, the dominant leg will be recorded and used for these tests; this is the leg used to kick a ball. Outcome measure order will be standardized for each participant with testing order based on primary outcomes and difficulty of each test. The FSDT will be performed first, as this is the primary outcome and previous research showed that recovery after a maximal exertion stimulus happens quickly. The FFSFBT will be performed next, followed by the Y-Balance Test. Isokinetic testing will be last due to the fatiguing nature of this testing. Hip muscles will be tested first, followed by thigh muscles. Three minutes will be allotted for rest and instruction between each outcome measure. Five minutes of rest will be given between isokinetic tests to allow for machine set-up and instructions. One minute of rest will be given between each isokinetic speed, with three speeds tested for the hip (30°, 60°, and 120° per second) and knee (60°, 180°, and 300° per second) muscles.
Participants will be followed for 2 years, with 6-month follow-up calls to track injury status. Details on type of injury, location of injury, and time lost to work will be collected.
Conditions
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Occupational Injuries
Heat Stress
Leg Injury
Back Injuries
Study Design
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Allocation Method
RANDOMIZED
Intervention Model
CROSSOVER
randomized crossover
Primary Study Purpose
PREVENTION
Blinding Strategy
NONE
Study Groups
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Rapid Heat Stress
Participants in the rapid heat stress arm will perform an exercise protocol on a treadmill in a hot, humid environment while wearing firefighter protective gear. This results in an uncompensable heat environment with a rapid increase in core temperature.
Group Type
EXPERIMENTAL
Rapid Heat Condition
Intervention Type
OTHER
The heat condition is the intervention. Personal protective equipment will be used to create the rapid heat stress condition, resulting in a rapid rise in core temperature. This will be in combination with the physiological heat produced by the treadmill protocol.
Gradual Heat Stress
Participants in the rapid heat stress arm will perform an exercise protocol on a treadmill in a hot, humid environment while wearing light exercise clothing. This results in an uncompensable heat environment but with a gradual increase in core temperature.
Group Type
ACTIVE_COMPARATOR
Gradual Heat Condition
Intervention Type
OTHER
The gradual heat condition is the control. Physiological heat will be produced by exercise on a treadmill, and light exercise clothing will help moderate the rise in core temperature.
Interventions
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Rapid Heat Condition
The heat condition is the intervention. Personal protective equipment will be used to create the rapid heat stress condition, resulting in a rapid rise in core temperature. This will be in combination with the physiological heat produced by the treadmill protocol.
Intervention Type
OTHER
Gradual Heat Condition
The gradual heat condition is the control. Physiological heat will be produced by exercise on a treadmill, and light exercise clothing will help moderate the rise in core temperature.
Intervention Type
OTHER
Eligibility Criteria
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Inclusion Criteria
* professional firefighter
* healthy per the Physical Activity Readiness Questionnaire+ screening
* healthy per the Physical Activity Readiness Questionnaire+ screening
Exclusion Criteria
* unable to swallow core temperature capsule
* unable to follow pre-testing hydration criteria
* musculoskeletal injury in the past 3 months that limits ability to perform outcome measures
* females with known pregnancy (risk of hyperthermia to fetus)
* unable to follow pre-testing hydration criteria
* musculoskeletal injury in the past 3 months that limits ability to perform outcome measures
* females with known pregnancy (risk of hyperthermia to fetus)
Minimum Eligible Age
18 Years
Maximum Eligible Age
57 Years
Eligible Sex
ALL
Accepts Healthy Volunteers
Yes
Sponsors
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Louisiana State University Health Sciences Center Shreveport
OTHER
Sponsor Role
lead
Responsible Party
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Responsibility Role
SPONSOR
Principal Investigators
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Erin McCallister, DPT
Role: PRINCIPAL_INVESTIGATOR
LSUHSC-Shreveport
Locations
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LSUHSC-Shreveport
Shreveport, Louisiana, United States
Site Status
RECRUITING
Countries
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United States
Central Contacts
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Facility Contacts
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References
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Coehoorn CJ, Neary JP, Krigolson OE, Service TW, Stuart-Hill LA. Firefighter salivary cortisol responses following rapid heat stress. J Therm Biol. 2022 Aug;108:103305. doi: 10.1016/j.jtherbio.2022.103305. Epub 2022 Aug 7.
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BACKGROUND
Coehoorn CJ, Patrick Neary J, Krigolson OE, Stuart-Hill LA. Firefighter pre-frontal cortex oxygenation and hemodynamics during rapid heat stress. Brain Res. 2023 Jan 1;1798:148156. doi: 10.1016/j.brainres.2022.148156. Epub 2022 Nov 4.
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Hewett TE, Ford KR, Hoogenboom BJ, Myer GD. Understanding and preventing acl injuries: current biomechanical and epidemiologic considerations - update 2010. N Am J Sports Phys Ther. 2010 Dec;5(4):234-51.
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BACKGROUND
Coehoorn, C. J., Stuart-Hill, L. A., Abimbola, W., Neary, J. P., & Krigolson, O. E. Firefighter neural function and decision-making following rapid heat stress. Fire Safety Journal, 2020; 118. https://doi.org/10.1016/j.firesaf.2020.103240
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Games, K. E., Winkelmann, Z. K., & Eberman, L. E. Physical Exertion Diminishes Static and Dynamic Balance in Firefighters. International Journal of Athletic Therapy and Training. 2020; 25(6), 318-322. https://doi.org/10.1123/ijatt.2019-0063
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Gokeler A, Welling W, Zaffagnini S, Seil R, Padua D. Development of a test battery to enhance safe return to sports after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2017 Jan;25(1):192-199. doi: 10.1007/s00167-016-4246-3. Epub 2016 Jul 16.
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Reference Type
BACKGROUND
Other Identifiers
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STUDY00002549
Identifier Type: -
Identifier Source: org_study_id
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