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Systematic review of randomised control trial health promotion intervention studies in the fire services: study characteristics, intervention design and impacts on health
  1. Freya MacMillan,
  2. Gregory S Kolt,
  3. April Le,
  4. Emma S George
  1. School of Health Sciences, Western Sydney University, Penrith South, New South Wales, Australia
  1. Correspondence to Professor Gregory S Kolt, Western Sydney University, Penrith South, NSW 2751, Australia; G.Kolt{at}


The objective of this study was to systematically review health promotion interventions in the fire services. Four databases were searched for articles reporting on health promotion interventions for firefighters evaluated in randomised controlled trials (RCT) and measuring efficacy on health or lifestyle behaviour outcomes. Data were extracted to create a narrative synthesis regarding study design, intervention characteristics and impact on outcomes. Risk of bias was assessed using a 13-item tool. Of 448 papers identified, after removal of duplicates, 209 were excluded based on title/abstract screening. A further 60 papers were excluded, mostly due to studies not being RCTs, not including a lifestyle behaviour intervention, or not focusing on health or lifestyle behaviour outcomes. Ten studies (reported in 11 papers) were eligible for inclusion. Six studies compared an intervention to usual practice, one compared a full intervention to a minimal intervention, one compared two exercise programmes and two compared two interventions to usual practice. Four studies evaluated structured physical activity interventions. Five studies evaluated physical activity and diet-focused behaviour change programmes, and one study included a mindfulness programme. When assessing risk of bias, three studies had low risk ratings for >8/13 items, leaving seven studies with high-risk ratings for ≥5/13 items. Eight of the 10 studies reported improvements in at least 1 outcome from baseline to final follow-up in the intervention group over a comparison group. The majority of lifestyle behaviour interventions targeted physical activity and/or diet. Findings from included studies suggest that programmes for firefighters initiated in the workplace can improve some health outcomes.

  • health promotion
  • fire fighters

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  • Contributors All authors were involved in the conception of this systematic review, reviewed the search strategy and provided feedback on full drafts of the paper. AL ran searches and screened all papers. AL extracted data initially and conducted risk of bias ratings, and GSK, EG and FM checked a portion of the data extraction and provided independent risk of bias ratings for a subset of studies. AL wrote the first draft of the paper, with all authors contributing to feedback prior to submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.