Physical activity guidelines for firefighters with coronary heart disease and multiple health risk behaviours: A modified Delphi study

Abstract

Firefighters encounter unique occupational demands that increase their risk of coronary heart disease (CHD) and various health risk behaviors (HRBs). Although physical activity (PA) is known to reduce these risks, there are no specific guidelines tailored for this group. This study aimed to develop consensus-based PA guidelines for firefighters with CHD and HRBs. A two-round modified Delphi technique was used with 50 invited experts, of whom 21 participated. Round 1 gathered qualitative input on the design, implementation, and evaluation of PA programmes, which was thematically analysed into draft guideline statements. In Round 2, experts rated statements using a 4-point Likert scale. Consensus was defined as ≥70% agreement with a median score above 3.25. Consensus was reached on thirty-two guidelines across seven programme categories: aerobic, strength, flexibility, balance, neuromotor, mind–body, and functional movement training. Key recommendations included 2–3 sessions of PA per week, monitoring intensity via VO₂ max or Borg’s RPE, and provision of professional oversight by biokineticists and sports scientists. This study uniquely presents tailored physical activity guidelines for firefighters with coronary heart disease and health-risk behaviours. The evidence-based recommendations are intended to improve cardiovascular health, support operational effectiveness, and reduce duty-related mortality. Further research is required to examine the feasibility and applicability of these guidelines in practice.