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Official Journal of Northwestern Center for Public Safety

The Key

A New, Fit Year: The Why & How of Planning a Wellness Program for Your Police Agency

by Caroline Paulison Andrew

The responsibility for officer wellness and screening lies within the training academy, the agency, and the individual officer . . . [It is] absolutely vital that law enforcement agencies recognize this risk and develop wellness and screening programs to keep their officers healthy, effective, and safe.”

Dr. Jonathan Sheinberg,
board-certified cardiologist & sworn officer in Cedar Park, TX

"Police officers exhibit some of the poorest cardiovascular disease health profiles of any occupation, including higher rates of cardiovascular disease risk factors, overt cardiovascular disease, and on-duty cardiovascular events," states Tara A. Hartley of the Biostatistics and Epidemiology branch of the National Institute for Occupational Safety and Health. Despite dire statistics, though, the process of developing much-needed agency wellness programs has been slow. Compared to 2017, on-duty fatal heart attacks are up 20% in 2018. (ODMP) As the year comes to a close, now is a good time for police department executive teams to consider how they can begin leading their agencies to increased wellness in the new year.

Reversible Statistics

Cardiac events consistently rank in the annual top three causes of line-of-duty deaths, generally surpassed only by automobile crashes and gun-fire deaths.1 A 2014 study led by researchers from the Harvard School of Public Health found that out of 4,500 line-of-duty deaths between 1984 to 2010, 441 were caused by sudden cardiac death. (Varvarigou) According to Dr. Jonathan Sheinberg, a board-certified cardiologist and a sworn officer in Cedar Park, Texas, the average age of an officer’s first heart attack is 49, compared to age 67 in the general US population. In fact, the 2011-12 fatal heart attack rate of 15 to 16 officers per 100,000 was about 3 to 5 times higher than the national average among private sector employees. (Varvarigou)

The Harvard study also reported that while physically restraining a suspect or being involved in a physical altercation involve about 1% to 2% of an officer’s annual work time, these events accounted for 25% of on-duty sudden cardiac deaths2. Therefore, restraints and altercations are associated with a sudden cardiac death risk about 30 to 50 times higher than routine/non-emergency duties. (Varvarigou)

25%of fatal, on-duty sudden cardiac deaths

occur while restraining or subduing suspects

66%of 2018 sudden cardiac deaths occurred during certification or training courses

Foot pursuits of suspects comprise less than 2% of on-duty time but are associated with 12% of sudden cardiac deaths as well as risks that are 30 to 50 times higher than routine / non-emergency duties. The most likely explanation for these findings is “a sudden increase in cardiovascular demand due to a combination of physical exertion and psychological stress, consistent with ‘fight or flight’ physiology,” (Varvarigou) that triggers a heart attack or cardiac arrest.

Police training programs also can include intense physical activity, which involves higher cardiac risks. The Harvard study found that out of the 441 sudden cardiac deaths, 20% occurred during physical training. (Varvarigou) However, during the first nine months of 2018, 66% of on-duty, sudden cardiac deaths occurred during training or certification courses.3 (ODMP)

Jurisdiction size matters: population seems to correlate with cardiac statistics. Officers in agencies serving populations of less than 10,000 people are at a substantially higher risk of sudden cardiac death while restraining a suspect or in a physical altercation than officers in agencies serving more than 100,000 people, when compared to routine/non-emergency duties.4(Varvarigou) 

Law Enforcement & Cardiovascular Risk Factors

General risk factors for cardiovascular disease are well known but worth repeating. They include: (Zimmerman)

  • high blood pressure,
  • high overall cholesterol — or high LDL cholesterol and low HDL cholesterol,
  • type 2 diabetes,
  • obesity,
  • smoking,
  • metabolic syndrome, and
  • sedentary lifestyle.

Among these risk factors, police officers have a significantly lower rate of blood sugar-related risk factors. Only 3% of officers Type 2 diabetes, compared to 11% of the US population. (Zimmerman) In fact, only 23.6% of law enforcement tests positive for glucose intolerance, compared to 32.4% of civilians. (Hartley)

Unfortunately, officers struggle with a greater rate of obesity and metabolic syndrome5 (Hartley): more than 40% of US officers have a BMI >= 30, compared to 32% of the US adult population;6
26.7% of officers suffer from metabolic syndrome, compared to 18.7% of the general population.

Police officers also are exposed to occupationally-specific cardiac risk factors, including: (Zimmerman)

  • sudden intense physical activity that may occur during an otherwise sedentary shift;
  • acute and chronic stress from such sources as sudden peril, trauma, agency pressures, chronic fatigue, and shift work; and,
  • shift work itself, which may increase insomnia and chronic fatigue, family stress, obesity, and poor eating habits.

Law enforcement officers also tend to lead more sedentary lifestyles compared to the civilian population. According to a study published in Cardiology in Review, more than 66% of police officers demonstrate a “low or moderate physical fitness” level, and a “significant percentage” fail to exercise regularly. The paper cited a study that found that only 55% of tested officers could fully perform an occupationally–specific fitness test. Three separate studies found that “officers were below average in fitness compared with civilians of similar age.”7 (Zimmerman) More than 50% of early retirements can be attributed to back problems and cardiovascular issues.(Chism) Sheinberg notes that “an out-of-shape officer may resort to deadly force more quickly than his or her physically fit counterpart, as the ability to go ‘hands on’ becomes less effective.’”

In a 2016 research study on law enforcement wellness programs conducted in Chicago’s northern suburbs, most of the participants had known an area officer who suffered a fatal heart attack while in pursuit of a suspect. These officers all agreed that cardiovascular strength is important to the job. One officer explained: (Chism)

"Your body is about to go from zero to 100. [Cardiovascular wellness helps] you adapt easier to different situations. You’re not getting worn out, and you’re just able to handle the physical demand of sitting and then going to being active.”

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Figure 1: Sample Wellness Program Strategy
 
Wellness Program Basics & Benefits

Coronary artery disease is not only detectable — but when treated, it may be reversible. “The key,” Dr. Sheinberg says, “is the development of a cardiovascular screening program and an overall wellness program.” He recommends developing agency programs using a collaborative approach that includes command staff, department physicians, union representatives, fitness professionals, and police training directors. Nutritionists or dieticians should also be consulted, as well as representative patrol officers.

The benefits of voluntary department-based wellness programs that incorporate nutritional counseling, exercise, and medical screening result in fewer reported injuries, shorter recovery times, reduced use-of-force cases, less absenteeism, fewer workers’ compensation claims, and increased productivity.(Chism) In fact, wellness programs positively affect an agency’s financial bottom line, with a return on investment of two to five dollars for every one dollar spent. (Quigley)

Medical screenings are important to wellness programs because they can identify coronary artery disease before symptoms appear and before they culminate in a heart attack or cardiac arrest. Like exercise and nutritional counseling, screening reduces agency expenses before conditions escalate to costs associated with short-term disability payments and increased insurance expenses. (Sheinberg)

Program Perception & Participation
While literature abounds on the details of developing wellness programs, a significant lack of resources exist on law enforcement perceptions of agency wellness programs, with the exception of Ellen Chism’s 2016 research study, “Police Officer Perception of Wellness Programs.” The officers who participated in this study generally welcomed voluntary wellness programs and felt that agencies “should be more active in providing nutrition and exercise assistance throughout an officer’s career.”

Ninety-five percent of the study’s participants expressed an interest in a voluntary wellness program based on personal goals. In addition to understanding the physical benefits, 20% also understood that such a program would help alleviate stress. All of the officers in the study “commented on the importance of fitness throughout an officer’s career, not just when they are young and naturally in shape.” They also all agreed that fitness helps prevent injuries. “I’ve experienced when you don’t stretch, you’re tight. . . . You end up pulling a muscle. You end up injuring yourself on duty,” said one officer.

Military personnel are expected to remain in excellent physical condition, and fitness is built into their schedules. However, most US first-responders are expected to self-motivate their fitness routines. (Chism) Chism’s research revealed an overall concern about time constraints. “I would participate if it was done the right way, and they allowed you some time to work out,” said one participant. Another noted that “there is always something else to do with family and overtime details.”

One officer in Chism’s study stated that if there were no incentives involved in a wellness program, “the time and effort put forward is not worth it.” Incentives can help increase program participation. In 2001, the Chicago Police Department (CPD) implemented an annual opportunity for officers to take a physical ability test and offered a pin and a complimentary letter to those who passed. Only 200 officers participated. In 2002, CPD offered $250 for passing the test, and more than 2,000 officers participated.(Chism)

Like the CPD fitness testing, wellness programs also can make use of financial or other incentives to promote early adaptation among staff and to recognize the personal commitment required both to participate and to replace unhealthy habits with healthy ones. One 10-week study revealed that participation in a law enforcement wellness program dedicated to changing habits in relation to key barriers (e.g., lack of time and energy) resulted in improved fitness. (Chism) The officers in Chism’s study all believed they were doing “some type of fitness activity” on their own and felt that they should be held accountable with an annual test. Yet, 50% admitted they were out of shape, and 30% felt their level of fitness was only “average or good.” §

Resources:
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