In Firefighter Trainees, ‘Mediterranean Lifestyle’ Linked to Lower Health Risks

Young firefighter recruits who follow a ‘Mediterranean lifestyle’ are less likely to have hypertension (high blood pressure) and more likely to have good aerobic fitness, reports a study in the July Journal of Occupational and Environmental Medicine.

With further study, promoting a Mediterranean diet and other lifestyle changes might be a useful new approach to reducing the high rates of sudden cardiac death and other cardiovascular events among firefighters, according to the new research by Stefanos N. Kales, MD, MPH, of Harvard University T.H. Chan School of Public Health and colleagues.

The study included 92 recruits — mainly men, average age 25.6 years — at two firefighting academies. Recruits filled out the MEDI-Lifestyle questionnaire, which assessed seven healthy characteristics: no obesity, no smoking, a Mediterranean diet, being physically active, low television watching (less than 2 hours per day), adequate sleep (7 to 8 hours), and taking afternoon naps. Each item was worth one point; health outcomes were compared for recruits with high (5 to 7 points) versus low (0 to 2 points) MEDI-Lifestyle scores.

Higher scores were associated with increased physical fitness and decreased body fat. On adjustment analysis, recruits with high scores were less likely to have hypertension: for each extra point, the risk of hypertension decreased by 36 percent.

Recruits with a high MEDI-Lifestyle score were also more likely to have high aerobic capacity: for each one-point increase, the odds of high aerobic capacity doubled. Greater physical activity and adequate sleep were also linked to high aerobic capacity.

Firefighters are at high risk of cardiovascular disease, including sudden cardiac death. While these adverse events may be brought on by strenuous work duties, they are strongly related to conventional risk factors like obesity and high blood pressure.

Various approaches have been suggested to promote healthy behaviors among firefighters. With further research, a Mediterranean lifestyle might be one way to lower cardiovascular risk factors in firefighter trainees at the start of their careers.

“Our results suggest that fire academy interventions designed to increase healthy lifestyle habits overall could add additional benefits to the physical fitness training traditionally provided in academy settings,” Dr. Kales and coauthors conclude. They note that efforts to reduce hypertension — already present in more than one-third of the recruits in their study — might be especially important in reducing long-term cardiovascular risks.
About the Author
Dr. Kales may be contacted for interviews at
ACOEM (, an international society of 4,000 occupational physicians and other health care professionals, provides leadership to promote optimal health and safety of workers, workplaces, and environments.
About the Journal of Occupational and Environmental Medicine
The Journal of Occupational and Environmental Medicine ( is the official journal of the American College of Occupational and Environmental Medicine. Edited to serve as a guide for physicians, nurses, and researchers, the clinically oriented research articles are an excellent source for new ideas, concepts, techniques, and procedures that can be readily applied in the industrial or commercial employment setting.


Lan F-Y, Fernandez-Montero A, Yiannakou I, et al. A Mediterranean lifestyle is associated with lower hypertension prevalence and better aerobic capacity among New England firefighter recruits. J Occup Environ Med. 2020;62(7):466-71.