First Responders are expected to maintain high-performance levels and make the right decisions under extreme conditions. However, exposure to violence, human suffering, and aspects of the job itself, such as physical work demands and unpredictable schedules, are demanding, taking a heavy toll on these frontline workers.
These demands can lead to stress, anxiety, trauma, suicide-ideation, and post-traumatic stress disorder (PTSD) – resulting in physical health problems and poor job performance. Without sufficient support and resources, these demands often cause first responders to be trapped in a vicious cycle that typically includes occupational trauma, stress, and maladaptive coping skills. For example, in police officers, stress manifests as increased absenteeism, turnover, and declines in performance, including slower reaction time, poorer decision-making ability, and increased complaints and misconduct allegations (Rineer, J., 2018).
In this article, we focus on two groups of first responders, police officers and firefighters. We discuss why resiliency is necessary for these frontline workers and how trauma impacts resilience on emotional, mental, and physical levels. We also highlight the latest research showing how exercise produces positive impacts on symptoms of PTSD, increases resilience, and mitigates the physiological and psychological effects of trauma. Increasing resilience not only offers first responders the tools they need to do their job, but this intervention gives them what they deserve to live a better life – allowing them to continue to answer the call of duty.
How Trauma Impacts Resilience in Police Officers & Firefighters
Police officers are often expected to respond to and resolve extreme situations. However, officers are also called upon to save and protect victims of crimes and be compassionate heroes (Kostintino, P. & Tuttle, B.M., 2018). These two sides are challenging to navigate. Additionally, police officers are exposed to traumatic events and extreme stress throughout their careers. According to a police psychologist with the New York City Police Department, police officers may be exposed to at least 900 potentially traumatic incidents throughout their career (Rudofossi, D., 2009). While research has shown that officers show more resilience than the general population, the chronic exposure to potentially traumatic incidents, loss, and extreme pressure may come at the cost of police officers’ health and well-being.
One study, by John Violanti with the School of Public Health at SUNY Buffalo, concluded that police shiftwork not only increases stress but also leads to sleep problems, obesity, heart problems, and sleep apnea. The study also found a link between PTSD and increased rates of depression and suicide. “Mediation of brain processes due to sleep deprivation and fatigue may also impact suicidal thinking” (Violanti, J.M., 2012). Other research has shown that exposure to stressful life events in the general population can also change brain structure, resulting in decreases in gray matter volume in the bilateral anterior cingulate and the hippocampi (Violanti, J.M. et al., 2017). When it comes to firefighters, the nature of their work, including repeated exposure to painful and dangerous experiences and erratic sleep schedules, can pose a significant risk to their mental health. One report found, over 50 percent of firefighter deaths are due to stress, trauma, and exhaustion. A study investigating the suicidality of firefighters reported markedly elevated levels of post-traumatic stress in volunteer firefighters, while career firefighters reported higher levels of PTSD (Stanley, I.H. et al., 2017).
Firefighters must be physically fit so they can perform their duties. Unfortunately, many firefighters are at risk of cardiac disease and injury due to chronic stress, disrupted sleep, strenuous physical activity, and sedentary work environments (Lovejoy, S. et al., 2015). Even when firefighters keep up with their fitness routines, their bodies can still experience short or long-term physical stress. Short-term physical stress responses include headaches, stomach upset, and fatigue. Long-term stress responses often include insomnia, clumsiness, and change in performance. These stress responses are dangerous and need to be reduced or eliminated to protect firefighters from illness, injury, and disease (Lovejoy, S. et al., 2015).
Why is Resilience Necessary in First Responders?
Resilience, or the ability to successfully adapt to stressors, maintaining psychological well-being in the face of adversity, acts as a protective factor against many mental and behavioral health issues. (Haglund, M.E. et al., 2007). Why is maintaining resiliency necessary in first responders? In a cohort of police officers followed after Hurricane Katrina, resilience, satisfaction with life, and gratitude helped mitigate symptoms of PTSD (McCanlies, E.C. et al., 2014). In a study about emergency service retirees, those who reported higher resilience levels had better quality of life scores than those with low resilience (Bracken-Scally, M. et al., 2014). Some people have higher resilience, but others can be trained to increase their resiliency, improving their odds of not developing conditions like PTSD or depression.
Just as agencies regularly assess first responder safety initiatives, they should continuously evaluate their wellness programs’ effectiveness. Interventional strategies such as support groups, incident debriefing, psychological crisis intervention, and annual wellness checks are necessary for first responders’ physical and psychological health. However, one area that is often discussed but not enforced could be the key to mitigating first responders’ mental and physical health challenges – the power of exercise.
How Exercise Helps Build Mental, Cognitive, & Physical Resilience
According to the American Psychiatric Association (APA), symptoms of PTSD include re-experiencing trauma, avoidance, negative cognitions and mood, and arousal often manifested by aggressiveness, sleep problems, recklessness, or self-destructive behavior (Violanti, J.M. et al., 2017.) Individuals with PTSD symptoms, or those who report having experienced trauma, are more likely to have conditions such as gastrointestinal disorders and autoimmune disorders, as well as experience many comorbid psychological conditions, including depression, suicidal ideation, and substance use disorders (McCanlies, E.C. et al., 2014).
How can exercise help mitigate the symptoms of trauma and PTSD? One study found that exercise and fitness can help foster a healthy and thriving police workforce that takes fewer sick leaves and feels better prepared to cope with chronic stress (Gerber, M. et al., 2010). Another study investigated the efficacy of 16 weeks of exercise training as an intervention to reduce firefighters’ psychophysiological response to stress. The result? Exercise-trained participants reacted with a significantly lower pulse and mean arterial pressure than the control condition. Exercise participants also reported significantly less stress-related state anxiety and negative affect (Throne, L.C. et al., 2000).
Other studies show that exercise can help exert positive cognitive and psychological impacts, including exposure and desensitization to internal arousal cues, enhanced cognitive function, exercise-induced neuroplasticity, hypothalamic-pituitary axis (HPA) function balance, and reductions in inflammatory markers (Hegberg, N.J. et al., 2019). Below we take a deep dive into each of these impacts.
Exposure & Desensitization
One symptom of PTSD is hyperarousal, which results in sensitivity to physiological arousal cues. It occurs when a person’s body suddenly kicks into high alert due to thinking about their trauma. Research suggests that repeated exposure to these cues, such as rapid heartbeat, during exercise may increase tolerance of and facilitate desensitization to the physiological sensations (Whitworth, J.W. et al., 2017). In other words, vigorous activity, which by definition causes the greatest increase in physiological arousal cues, is a means of exposure. This activity eventually reduces the individuals’ heightened response to these cues in other daily settings (Hegberg, N.J. et al., 2019).
Enhance Cognitive Function
Another symptom of PTSD is disrupted cognitive function or control, resulting in issues with attention, memory, problem-solving, and emotional processing. This impairment may contribute to the maintenance of PTSD symptoms, such as hypervigilance and avoidance (Weierich, M.R. et al., 2008). PTSD-related cognitive impairment and symptoms may be alleviated by improvements in cognition associated with aerobic exercise. For example, research among older adults suggests that cardiorespiratory fitness positively affects executive function and memory (Hegberg, N.J. et al., 2019). John J. Ratey MD, an associate clinical professor of psychiatry at Harvard Medical School and author of the book Spark: The Revolutionary New Science of Exercise and the Brain, states, “Exercise prompts the brain cells to send out growth factors like BDNF (brain-derived neurotrophic factor), helping to rebuild new and stronger connections between cells. This activity promotes brain cell growth and cognitive performance. BDNF is like ‘miracle-gro’ for the brain (Ratey, 2008).”
Exercise is also known to increase the expression of trophic factors, or “helper molecules” that allow neurons to develop and maintain connections with their neighbors throughout the brain. Galanin is a neuromodulatory peptide and trophic factor that exerts multiple effects through its interaction with specific protein receptors. Galanin is highly expressed in the locus coeruleus (LC), which is dysregulated in stress-related disorders. However, studies have shown that galanin expression is raised in the LC by regular exercise, increasing stress resilience. For example, research on using exercise to mitigate anxiety symptoms in mice suggests that exercise may promote resilience to stress and act to mitigate the cumulative impact of repeated stressors, thus affording both preventative and therapeutic benefits (Holmes, P.V., 2014).
Exercise-Induced Neuroplasticity
There is overlap among the brain regions affected by PTSD and brain areas impacted by aerobic exercise, suggesting that exercise-induced brain changes may positively impact PTSD symptoms (Hays, S.M. et al., 2013). For instance, aerobic training studies in older adults have revealed the increased volume of prefrontal regions during aerobic training (Colcombe, S.J. et al., 2006). Another study found that increases in physical activity were associated with gray matter volume increases in the cingulate gyrus, left superior frontal gyrus, and left medial parietal cortex, among others (Ruscheweyh, R. et al., 2011). This increase in volume may be explained by exercise-associated increases in neurogenesis in the dentate gyrus subfield of the hippocampus, which negatively impacts PTSD (Hayes, J.P. et al., 2017).
Balances Hypothalamic Pituitary Adrenal Axis (HPA) Function
The HPA axis is a neuroendocrine function that regulates responses to stress. During stress, the hypothalamus releases a corticotrophin-releasing hormone (CRH), spurring the pituitary gland to release the adrenocorticotropic hormone (ACTH). Eventually, cortisol is released by the adrenal cortex, which regulates the system by providing negative feedback to the hypothalamus and pituitary gland. One review study indicated that individuals with PTSD tend to express low basal cortisol levels, which is associated with increased levels of CRH and an exaggerated HPA axis negative feedback loop (Daskalakis, N.P. et al., 2016). Regular exercise exerts positive effects on the HPA axis, promoting a reduction in PTSD symptoms. For example, studies suggest that moderate and vigorous-intensity, but not low-intensity, exercise increases cortisol levels, which might target the low basal cortisol levels seen in those with PTSD (Hill, E.E. et al., 2008).
Reduces Inflammation
The activation of the HPA axis has pro-inflammatory implications for the immune system, and evidence suggests that PTSD is characterized by increased inflammatory activity. One study found that PTSD was associated with elevations in pro-inflammatory cytokines such as interleukin-1 beta and interleukin-6 (Passos, I.C. et al., 2015). There is also evidence to suggest that there is increased c-reactive protein (CRP), decreased anti-inflammatory markers, and cell function changes related to inflammation in those with PTSD (Michopoulos, V. et al., 2017). Exercise may influence these inflammatory pathways – counteracting some PTSD symptoms.
For example, regular exercise can increase immune function and reduce pro-inflammatory signaling through the acute production of interleukin-6 (Gleeson, M. et al., 2011). There is also evidence to suggest that pro-inflammatory cytokines modulated by exercise can play a crucial role in sleep quality. For example, low concentrations of interleukin-1 are associated with enhanced non-REM sleep, whereas high levels are linked to sleep disorders (Santos, R.V. et al., 2007). Together, these favorable effects on inflammation and sleep support the idea that exercise may be an effective clinical tool for improving PTSD symptoms.
In the words of Bessel van der Kolk, M.D., founder of the Trauma Center in Massachusetts, in his book “The Body Keeps the Score,” “Nobody can ‘treat’ a war, or abuse, rape, molestation, or any other horrendous event, for that matter; what has happened cannot be undone. But what can be dealt with are the imprints of the trauma on body, mind, and soul.” Exercise can help heal both the mind and body. It is one clinical tool that first responders can use to take control of their mental, emotional, and physical health. When first responders are equipped to deal with adverse reactions to stress, this leads to more positive community contacts, fewer negative interactions, and less stress, ultimately resulting in increased job satisfaction and a higher quality work environment.
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