{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T19:43:09Z","timestamp":1788118989674,"version":"build-2803163510"},"reference-count":132,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T00:00:00Z","timestamp":1754438400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Northern Arizona University","award":["U54MD012388"],"award-info":[{"award-number":["U54MD012388"]}]},{"name":"National Institute on Minority Health and Health Disparities of the National Institutes of Health (NIH)","award":["U54MD012388"],"award-info":[{"award-number":["U54MD012388"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Almost one in three firefighters develop mental health disorders at some point during their careers, a rate double that in the general population. Frequent exposures to potentially traumatic situations can contribute to symptoms of these disorders, two of the most common being depression and post-traumatic stress disorder (PTSD). While various psychological interventions have been implemented among this group, reports of their effectiveness include mixed results. To this end, the current study endeavored to test the effectiveness of a 12-week intervention combining occupationally-tailored high-intensity functional training (HIFT) and psychological resilience training (RES) in reducing depressive and post-traumatic stress symptoms (PTSSs), as well as increasing psychological resilience and mental wellbeing, in career firefighters. Thirty career firefighters completed four mental health measurements over 17 weeks while anthropometrics and physical performance (i.e., number of stations completed in 20 min during an eight-station simulated job-task circuit workout [T-CAC]) were measured pre- and post-intervention. Pre to post comparisons were made via repeated-measures t-tests. Significant mean differences were observed for T-CAC stations completed, PTSSs, and psychological resilience between pre- and post-intervention. In future interventions, researchers should actively engage firefighters, maximize integration with daily operations, and employ culturally-relevant practices to explore the links between physical and mental health.<\/jats:p>","DOI":"10.3390\/ijerph22081227","type":"journal-article","created":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T13:25:11Z","timestamp":1754486711000},"page":"1227","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Effectiveness of a Mind\u2013Body Intervention at Improving Mental Health and Performance Among Career Firefighters"],"prefix":"10.3390","volume":"22","author":[{"given":"Anthony C.","family":"Santos","sequence":"first","affiliation":[{"name":"Department of Health Sciences, Northern Arizona University, Flagstaff, AZ 86011, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seth","family":"Long","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy and Athletic Training, Northern Arizona University, Flagstaff, AZ 86011, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher P.","family":"Moreno","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Northern Arizona University, Flagstaff, AZ 86011, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dierdra","family":"Bycura","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Northern Arizona University, Flagstaff, AZ 86011, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,6]]},"reference":[{"key":"ref_1","unstructured":"Substance Abuse and Mental Health Services Administration (2025, April 07). Disaster Technical Assistance Center Supplemental Research Bulletin First Responders: Behavioral Health Concerns, Emergency Response, and Trauma; Rockville, MD, 2018, Available online: https:\/\/www.samhsa.gov\/sites\/default\/files\/dtac\/supplementalresearchbulletin-firstresponders-may2018.pdf."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s13728-016-0049-x","article-title":"Chronic Occupational Exposures Can Influence the Rate of PTSD and Depressive Disorders in First Responders and Military Personnel","volume":"5","author":"Walker","year":"2016","journal-title":"Extrem. Physiol. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1037\/pro0000266","article-title":"Enhancing Mental Health Treatment for the Firefighter Population: Understanding Fire Culture, Treatment Barriers, Practice Implications, and Research Directions","volume":"51","author":"Johnson","year":"2020","journal-title":"Prof. Psychol. Res. Pract."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1177\/1359105312443402","article-title":"Mental Health Conditions, Individual and Job Characteristics and Sleep Disturbances among Firefighters","volume":"18","author":"Saitz","year":"2013","journal-title":"J. Health Psychol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1016\/j.psychres.2016.11.037","article-title":"Differences in Psychiatric Symptoms and Barriers to Mental Health Care between Volunteer and Career Firefighters","volume":"247","author":"Stanley","year":"2017","journal-title":"Psychiatry Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1037\/ser0000222","article-title":"Behavioral Health Programs in Fire Service: Surveying Access and Preferences","volume":"16","author":"Gulliver","year":"2019","journal-title":"Psychol. Serv."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.jad.2015.08.007","article-title":"Career Prevalence and Correlates of Suicidal Thoughts and Behaviors among Firefighters","volume":"187","author":"Stanley","year":"2015","journal-title":"J. Affect. Disord."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1037\/pro0000072","article-title":"Firefighter Suicide: Understanding Cultural Challenges for Mental Health Professionals","volume":"47","author":"Henderson","year":"2016","journal-title":"Prof. Psychol. Res. Pract."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1002\/jts.22180","article-title":"Duty-Related Trauma Exposure and Posttraumatic Stress Symptoms in Professional Firefighters","volume":"30","author":"Lee","year":"2017","journal-title":"J. Trauma. Stress"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1037\/tra0000980","article-title":"A Prospective Study of Firefighters\u2019 PTSD and Depression Symptoms: The First 3 Years of Service","volume":"13","author":"Gulliver","year":"2021","journal-title":"Psychol. Trauma Theory, Res. Pract. Policy"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Wolffe, T.A.M., Robinson, A., Clinton, A., Turrell, L., and Stec, A.A. (2023). Mental Health of UK Firefighters. Sci. Rep., 13.","DOI":"10.1038\/s41598-022-24834-x"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"R315","DOI":"10.1152\/ajpregu.00343.2014","article-title":"Autonomic and Inflammatory Consequences of Posttraumatic Stress Disorder and the Link to Cardiovascular Disease","volume":"309","author":"Brudey","year":"2015","journal-title":"Am. J. Physiol. Regul. Integr. Comp. Physiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.biopsych.2015.01.005","article-title":"Diagnostic Biomarkers for Posttraumatic Stress Disorder (PTSD): Promising Horizons from Translational Neuroscience Research","volume":"78","author":"Michopoulos","year":"2015","journal-title":"Biol. Psychol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association. [5th ed.].","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2349","DOI":"10.1001\/archinte.159.19.2349","article-title":"Effects of Exercise Training on Older Patients with Major Depression","volume":"159","author":"Blumenthal","year":"1999","journal-title":"Arch. Intern. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"741","DOI":"10.2165\/00007256-200232120-00001","article-title":"Exercise and the Treatment of Clinical Depression in Adults: Recent Findings and Future Directions","volume":"32","author":"Brosse","year":"2002","journal-title":"Sport. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1111\/j.1468-2850.2006.00021.x","article-title":"Exercise Interventions for Mental Health: A Quantitative and Qualitative Review","volume":"13","author":"Stathopoulou","year":"2006","journal-title":"Clin. Psychol. Sci. Pract."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"491","DOI":"10.2165\/00007256-200939060-00004","article-title":"The Antidepressive Effects of Exercise: A Meta-Analysis of Randomized Trials","volume":"39","author":"Rethorst","year":"2009","journal-title":"Sport. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.jsams.2013.03.010","article-title":"Exercise and the Treatment of Depression: A Review of the Exercise Program Variables","volume":"17","author":"Stanton","year":"2014","journal-title":"J. Sci. Med. Sport"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.jpsychires.2016.02.023","article-title":"Exercise as a Treatment for Depression: A Meta-Analysis Adjusting for Publication Bias","volume":"77","author":"Schuch","year":"2016","journal-title":"J. Psychiatr. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.neubiorev.2015.11.012","article-title":"Neurobiological Effects of Exercise on Major Depressive Disorder: A Systematic Review","volume":"61","author":"Schuch","year":"2016","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1249\/01.FIT.0000416000.09526.eb","article-title":"Is Exercise a Viable Treatment for Depression?","volume":"16","author":"Blumenthal","year":"2012","journal-title":"ACSM\u2019s Health Fit. J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.1249\/MSS.0b013e318213fefb","article-title":"Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in Apparently Healthy Adults: Guidance for Prescribing Exercise","volume":"43","author":"Garber","year":"2011","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Netz, Y. (2017). Is the Comparison between Exercise and Pharmacologic Treatment of Depression in the Clinical Practice Guideline of the American College of Physicians Evidence-Based?. Front. Pharmacol., 8.","DOI":"10.3389\/fphar.2017.00257"},{"key":"ref_25","unstructured":"Magyari, P., Lite, R., Killpatrick, M.W., and Schoffstall, J.E. (2018). ACSM\u2019s Resources for the Exercise Physiologist, Wolters Kluwer. [2nd ed.]."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Box, A.G., Feito, Y., Brown, C., Heinrich, K.M., and Petruzzello, S.J. (2019). High Intensity Functional Training (HIFT) and Competitions: How Motives Differ by Length of Participation. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0213812"},{"key":"ref_27","first-page":"151","article-title":"The Importance of Enjoyment to Adherence and Psychological Benefits from Physical Activity","volume":"24","author":"Wankel","year":"1993","journal-title":"Int. J. Sport Psychol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1136\/bjsports-2022-106195","article-title":"Effectiveness of Physical Activity Interventions for Improving Depression, Anxiety and Distress: An Overview of Systematic Reviews","volume":"57","author":"Singh","year":"2023","journal-title":"Br. J. Sports Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1176\/appi.ajp.2018.17111194","article-title":"Physical Activity and Incident Depression: A Meta-Analysis of Prospective Cohort Studies","volume":"175","author":"Schuch","year":"2018","journal-title":"Am. J. Psychiatry"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.maturitas.2017.09.003","article-title":"Exercise and Mental Health","volume":"106","author":"Mikkelsen","year":"2017","journal-title":"Maturitas"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1176\/appi.focus.20170026","article-title":"Integrative Therapy Approaches for Posttraumatic Stress Disorder: A Special Focus on Treating Veterans","volume":"15","author":"Sornborger","year":"2017","journal-title":"Focus (Madison)"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.genhosppsych.2017.06.012","article-title":"Direct and Indirect Effects of Exercise on Posttraumatic Stress Disorder Symptoms: A Longitudinal Study","volume":"49","author":"Whitworth","year":"2017","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.jad.2021.01.029","article-title":"Symptoms of Depression, Anxiety, and Post-Traumatic Stress Disorder and Their Relationship to Health-Related Behaviors in over 12,000 US Military Personnel: Bi-Directional Associations","volume":"283","author":"Hruby","year":"2021","journal-title":"J. Affect. Disord."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1016\/j.pmedr.2015.04.023","article-title":"The Use of Periodization in Exercise Prescriptions for Inactive Adults: A Systematic Review","volume":"2","author":"Strohacker","year":"2015","journal-title":"Prev. Med. Reports"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2196\/23432","article-title":"A Mental Health\u2013Informed Physical Activity Intervention for First Responders and Their Partners Delivered Using Facebook: Mixed Methods Pilot Study","volume":"5","author":"McKeon","year":"2021","journal-title":"JMIR Form. Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1111\/acps.12371","article-title":"Exercise Augmentation Compared with Usual Care for Post-Traumatic Stress Disorder: A Randomized Controlled Trial","volume":"131","author":"Rosenbaum","year":"2015","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1007\/s40279-019-01187-6","article-title":"Exercise as Medicine for Mental and Substance Use Disorders: A Meta-Review of the Benefits for Neuropsychiatric and Cognitive Outcomes","volume":"50","author":"Firth","year":"2020","journal-title":"Sport. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.psychres.2015.10.017","article-title":"Physical Activity in the Treatment of Post-Traumatic Stress Disorder: A Systematic Review and Meta-Analysis","volume":"230","author":"Rosenbaum","year":"2015","journal-title":"Psychiatry Res."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Feito, Y., Heinrich, K.M., Butcher, S.J., and Poston, W.S.C. (2018). High-Intensity Functional Training (HIFT): Definition and Research Implications for Improved Fitness. Sports, 6.","DOI":"10.3390\/sports6030076"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"447","DOI":"10.34297\/AJBSR.2019.03.000715","article-title":"Training Implications for Firefighters through Objective Measurement of the Physiological Demands of Firefighter Job Tasks","volume":"3","author":"Bycura","year":"2019","journal-title":"Am. J. Biomed. Sci. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e1508","DOI":"10.7205\/MILMED-D-15-00503","article-title":"The Benefits of High Intensity Functional Training (HIFT) Fitness Programs for Military Personnel","volume":"181","author":"Haddock","year":"2016","journal-title":"Mil. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1249\/JSR.0b013e31821a9fec","article-title":"Firefighter Fitness: Improving Performance and Preventing Injuries and Fatalities","volume":"10","author":"Smith","year":"2011","journal-title":"Curr. Sports Med. Rep."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"3151","DOI":"10.1519\/JSC.0000000000002683","article-title":"Efficacy of a Goal Setting and Implementation Planning Intervention on Firefighters\u2019 Cardiorespiratory Fitness","volume":"33","author":"Bycura","year":"2019","journal-title":"J. Strength Cond. Res."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1037\/a0025189","article-title":"Mindfulness Is Associated with Fewer PTSD Symptoms, Depressive Symptoms, Physical Symptoms, and Alcohol Problems in Urban Firefighters","volume":"79","author":"Smith","year":"2011","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Skeffington, P.M., Rees, C.S., Mazzucchelli, T.G., and Kane, R.T. (2016). The Primary Prevention of PTSD in Firefighters: Preliminary Results of an RCT with 12-Month Follow-Up. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0155873"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.jpsychires.2016.10.014","article-title":"PTSD Symptoms and Suicidal Thoughts and Behaviors among Firefighters","volume":"84","author":"Boffa","year":"2017","journal-title":"J. Psychiatr. Res."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1017\/S0954579407000430","article-title":"Psychobiological Mechanisms of Resilience: Relevance to Prevention and Treatment of Stress-Related Psychopathology","volume":"19","author":"Haglund","year":"2007","journal-title":"Dev. Psychopathol."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Sch\u00e4fer, S.K., Sopp, M.R., Staginnus, M., Lass-Hennemann, J., and Michael, T. (2020). Correlates of Mental Health in Occupations at Risk for Traumatization: A Cross-Sectional Study. BMC Psychiatry, 20.","DOI":"10.1186\/s12888-020-02704-y"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Krakauer, R.L., Stelnicki, A.M., and Carleton, R.N. (2020). Examining Mental Health Knowledge, Stigma, and Service Use Intentions Among Public Safety Personnel. Front. Psychol., 11.","DOI":"10.3389\/fpsyg.2020.00949"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e10326","DOI":"10.2196\/10326","article-title":"Mindfulness-Based Resilience Training in the Workplace: Pilot Study of the Internet-Based Resilience@Work (RAW) Mindfulness Program","volume":"20","author":"Joyce","year":"2018","journal-title":"J. Med. Internet Res."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1136\/oemed-2020-106613","article-title":"Systematic Review of Randomised Control Trial Health Promotion Intervention Studies in the Fire Services: Study Characteristics, Intervention Design and Impacts on Health","volume":"78","author":"MacMillan","year":"2021","journal-title":"Occup. Environ. Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1016\/j.jad.2020.12.021","article-title":"Prospective Risk and Protective Factors for Psychopathology and Wellbeing in Civilian Emergency Services Personnel: A Systematic Review","volume":"281","author":"Kyron","year":"2021","journal-title":"J. Affect. Disord."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"2252","DOI":"10.1002\/jcop.22403","article-title":"Social Support as a Mediator of Occupational Stressors and Mental Health Outcomes in First Responders","volume":"48","author":"Kshtriya","year":"2020","journal-title":"J. Community Psychol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1016\/j.psychres.2018.06.020","article-title":"Understanding Mental Health among Military Veterans in the Fire Service","volume":"267","author":"Bartlett","year":"2018","journal-title":"Psychiatry Res."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1080\/16506073.2019.1575900","article-title":"Mental Health Training, Attitudes toward Support, and Screening Positive for Mental Disorders","volume":"49","author":"Carleton","year":"2020","journal-title":"Cogn. Behav. Ther."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1093\/occmed\/kqx056","article-title":"Designing Smartphone Mental Health Applications for Emergency Service Workers","volume":"67","author":"Deady","year":"2017","journal-title":"Occup. Med."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"112794","DOI":"10.1016\/j.psychres.2020.112794","article-title":"Is Resilience Trainable? An Initial Study Comparing Mindfulness and Relaxation Training in Firefighters","volume":"285","author":"Denkova","year":"2020","journal-title":"Psychiatry Res."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1080\/15555240.2017.1369885","article-title":"Posttraumatic Stress Disorder (PTSD) Symptoms among Firefighters: Roles of Resilience and Locus of Control","volume":"32","author":"Onyedire","year":"2017","journal-title":"J. Workplace Behav. Health"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1016\/j.ijdrr.2017.10.020","article-title":"Psychological Impacts of Disaster on Rescue Workers: A Review of the Literature","volume":"27","author":"Mao","year":"2018","journal-title":"Int. J. Disaster Risk Reduct."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1037\/ser0000240","article-title":"Perceptions of Belongingness and Social Support Attenuate PTSD Symptom Severity Among Firefighters: A Multistudy Investigation","volume":"16","author":"Stanley","year":"2019","journal-title":"Psychol. Serv."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1002\/jts.22632","article-title":"Negative Emotionality Interacts with Trauma Exposure to Prospectively Predict Posttraumatic Stress Disorder Symptoms During Firefighters\u2019 First 3 Years of Service","volume":"34","author":"Meyer","year":"2021","journal-title":"J. Trauma. Stress"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"173","DOI":"10.5055\/jem.2018.0366","article-title":"Individual and Organizational Factors Associated with Professional Quality of Life in Florida Fire Personnel","volume":"16","author":"Miller","year":"2018","journal-title":"J. Emerg. Manag."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"543","DOI":"10.12740\/PP\/73837","article-title":"Stress Coping Styles in Firemen Exposed to Severe Stress","volume":"52","author":"Witt","year":"2018","journal-title":"Psychiatr. Pol."},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Counson, I., Hosemans, D., Lal, T.J., Mott, B., Harvey, S.B., and Joyce, S. (2019). Mental Health and Mindfulness amongst Australian Fire Fighters. BMC Psychol., 7.","DOI":"10.1186\/s40359-019-0311-2"},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Hegberg, N.J., Hayes, J.P., and Hayes, S.M. (2019). Exercise Intervention in PTSD: A Narrative Review and Rationale for Implementation. Front. Psychiatry, 10.","DOI":"10.3389\/fpsyt.2019.00133"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"953","DOI":"10.7205\/MILMED-D-15-00488","article-title":"Exercise and Post-Traumatic Stress Disorder in Military Veterans: A Systematic Review","volume":"181","author":"Whitworth","year":"2016","journal-title":"Mil. Med."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1111\/joop.12120","article-title":"Resilience Training in the Workplace from 2003 to 2014: A Systematic Review","volume":"88","author":"Robertson","year":"2015","journal-title":"J. Occup. Organ. Psychol."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Leppin, A.L., Bora, P.R., Tilburt, J.C., Gionfriddo, M.R., Zeballos-Palacios, C., Dulohery, M.M., Sood, A., Erwin, P.J., Brito, J.P., and Boehmer, K.R. (2014). The Efficacy of Resiliency Training Programs: A Systematic Review and Meta-Analysis of Randomized Trials. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0111420"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s12995-019-0232-2","article-title":"Examining a Novel Firefighter Exercise Training Program on Simulated Fire Ground Test Performance, Cardiorespiratory Endurance, and Strength: A Pilot Investigation","volume":"14","author":"Hollerbach","year":"2019","journal-title":"J. Occup. Med. Toxicol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1097\/JOM.0000000000001685","article-title":"Occupationally Tailored, Web-Based, Nutrition and Physical Activity Program for Firefighters: Cluster Randomized Trial and Weight Outcome","volume":"61","author":"Day","year":"2019","journal-title":"J. Occup. Environ. Med."},{"key":"ref_71","unstructured":"The First Twenty (2021, January 28). The First 20 Academy. Available online: https:\/\/www.thefirsttwenty.org\/programming\/."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research Electronic Data Capture (REDCap)-A Metadata-Driven Methodology and Workflow Process for Providing Translational Research Informatics Support","volume":"42","author":"Harris","year":"2009","journal-title":"J. Biomed. Inform."},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Harris, P.A., Taylor, R., Minor, B.L., Elliott, V., Fernandez, M., O\u2019Neal, L., McLeod, L., Delacqua, G., Delacqua, F., and Kirby, J. (2019). The REDCap Consortium: Building an International Community of Software Platform Partners. J. Biomed. Inform., 95.","DOI":"10.1016\/j.jbi.2019.103208"},{"key":"ref_74","unstructured":"International Association of Fire Fighters (2007). The Fire Service Joint Labor Management Wellness-Fitness Initiative Candidate Physical Ability Test, Fire Service Joint Labor Management Wellness-Fitness Initiative. [2nd ed.]."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1001\/jama.282.18.1737","article-title":"Validation and Utility of a Self-Report Version of PRIME-MD: The PHQ Primary Care Study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire","volume":"282","author":"Spitzer","year":"1999","journal-title":"JAMA"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1016\/0005-7967(96)00033-2","article-title":"Psychometric Properties of the PTSD Checklist (PCL)","volume":"34","author":"Blanchard","year":"1996","journal-title":"Behav. Res. Ther."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1002\/jts.20271","article-title":"Psychometric Analysis and Refinement of the Connor\u2013Davidson Resilience Scale (CD-RISC): Validation of a 10-Item Measure of Resilience","volume":"20","author":"Stein","year":"2007","journal-title":"J. Trauma. Stress"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1186\/1477-7525-5-63","article-title":"The Warwick-Edinburgh Mental Well-Being Scale (WEMWBS): Development and UK Validation","volume":"5","author":"Tennant","year":"2007","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The Patient Health Questionnaire PHQ-9: Validity of a Brief Depression Severity Measure","volume":"16","author":"Kroenke","year":"2001","journal-title":"J. Gen. Intern. Med."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1023\/A:1023796007788","article-title":"Sensitivity and Specificity of the PTSD Checklist in Detecting PTSD in Female Veterans in Primary Care","volume":"16","author":"Lang","year":"2003","journal-title":"J. Trauma. Stress"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1002\/jts.22438","article-title":"An Empirical Crosswalk for the PTSD Checklist: Translating DSM-IV to DSM-5 Using a Veteran Sample","volume":"32","author":"Moshier","year":"2019","journal-title":"J. Trauma. Stress"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"23","DOI":"10.9790\/487X-1904032333","article-title":"A Critical Review of Scales Used in Resilience Research","volume":"19","author":"Salisu","year":"2017","journal-title":"IOSR J. Bus. Manag."},{"key":"ref_83","unstructured":"Davidson, J.R.T. (Connor-Davidson Resilience Scale (CD-RISC) \u00a9 Manual, 2020). Connor-Davidson Resilience Scale (CD-RISC) \u00a9 Manual, unpublished."},{"key":"ref_84","unstructured":"Connor, K.M., and Davidson, J.R.T. (2021, June 30). Scoring and Interpretation of the Connor-Davidson Resilience Scale (CD-RISC\u00a9), Available online: https:\/\/www.connordavidson-resiliencescale.com\/CD-RISC%20Manual%2008-19-18.pdf."},{"key":"ref_85","unstructured":"Connor, K.M., and Davidson, J.R.T. (2021, June 30). The Connor-Davidson Resilience Scale. Available online: http:\/\/www.connordavidson-resiliencescale.com\/about.php."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/1477-7525-7-15","article-title":"Internal Construct Validity of the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS): A Rasch Analysis Using Data from the Scottish Health Education Population Survey","volume":"7","author":"Tennant","year":"2009","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1186\/1477-7525-10-156","article-title":"Evaluating the Responsiveness of the Warwick Edinburgh Mental Well-Being Scale (WEMWBS): Group and Individual Level Analysis","volume":"10","author":"Maheswaran","year":"2012","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_88","unstructured":"(2015). Warwick-Edinburgh Mental Well-Being Scale (WEMWBS): User Guide\u2014Version 2, NHS Health Scotland. [2nd ed.]."},{"key":"ref_89","unstructured":"Haff, G.G., and Triplett, N.T. (2016). Essentials of Strength Training and Conditioning, Human Kinetics. [4th ed.]."},{"key":"ref_90","unstructured":"Microsoft Corporation (2018). Microsoft Excel, Microsoft Corporation."},{"key":"ref_91","unstructured":"IBM Corp (2021). IBM SPSS Statistics for Windows, IBM Corp."},{"key":"ref_92","unstructured":"Glen, S. (2025, April 06). Hedges\u2019 g: Definition, Formula. Statistics How To.com: Elementary Statistics for the Rest of Us!, Available online: https:\/\/www.statisticshowto.com\/hedges-g\/."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"igz036","DOI":"10.1093\/geroni\/igz036","article-title":"Effect Size Guidelines, Sample Size Calculations, and Statistical Power in Gerontology","volume":"3","author":"Brydges","year":"2019","journal-title":"Innov. Aging"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1111\/psyp.12798","article-title":"Statistical Considerations for Reporting and Planning Heart Rate Variability Case-Control Studies","volume":"54","author":"Quintana","year":"2017","journal-title":"Psychophysiology"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1002\/ejsp.2752","article-title":"Empirically Derived Guidelines for Effect Size Interpretation in Social Psychology","volume":"51","author":"Lovakov","year":"2021","journal-title":"Eur. J. Soc. Psychol."},{"key":"ref_96","unstructured":"National Institute of Standards and Technology (2025, July 06). Hedge\u2019s g Statistic, Available online: https:\/\/www.itl.nist.gov\/div898\/software\/dataplot\/refman2\/auxillar\/hedgeg.htm."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1037\/a0024338","article-title":"Effect Size Estimates: Current Use, Calculations, and Interpretation","volume":"141","author":"Fritz","year":"2012","journal-title":"J. Exp. Psychol. Gen."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"175","DOI":"10.3758\/BF03193146","article-title":"G*Power 3: A Flexible Statistical Power Analysis Program for the Social, Behavioral, and Biomedical Sciences","volume":"39","author":"Faul","year":"2007","journal-title":"Behav. Res. Methods"},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.3758\/BRM.41.4.1149","article-title":"Statistical Power Analyses Using G*Power 3.1: Tests for Correlation and Regression Analyses","volume":"41","author":"Faul","year":"2009","journal-title":"Behav. Res. Methods"},{"key":"ref_100","unstructured":"(2015). Etymologia: Bonferroni Correction. Emerg. Infect. Dis., 21, 289."},{"key":"ref_101","unstructured":"SAS Institute Inc (2016). SAS for Windows, SAS Institute Inc."},{"key":"ref_102","doi-asserted-by":"crossref","unstructured":"Singer, J.D., and Willett, J.B. (2003). Applied Longitudinal Data Analysis: Modeling Change and Event Occurrence, Oxford University Press, Inc.","DOI":"10.1093\/acprof:oso\/9780195152968.001.0001"},{"key":"ref_103","unstructured":"Hoffman, L. (2015). Longitudinal Analysis: Modeling Within-Person Fluctuation and Change, Taylor & Francis."},{"key":"ref_104","unstructured":"Borg, G. (1998). Borg\u2019s Perceived Exertion and Pain Scales, Human Kinetics."},{"key":"ref_105","doi-asserted-by":"crossref","unstructured":"Lakens, D. (2013). Calculating and Reporting Effect Sizes to Facilitate Cumulative Science: A Practical Primer for t-Tests and ANOVAs. Front. Psychol., 4.","DOI":"10.3389\/fpsyg.2013.00863"},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"316","DOI":"10.3928\/01484834-20230415-02","article-title":"Cohen\u2019s and Hedges\u2019 G","volume":"62","author":"Taylor","year":"2023","journal-title":"J. Nurs. Educ."},{"key":"ref_107","unstructured":"National Center for PTSD (2021, June 30). Using the PTSD Checklist for DSM-IV (PCL), Available online: https:\/\/www.ptsd.va.gov\/professional\/assessment\/documents\/PCL_handoutDSM4.pdf."},{"key":"ref_108","unstructured":"Prime-md (2005). Patient Health Questionnaire (PHQ-9), Pfizer Inc."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1037\/ser0000572","article-title":"Reducing the Impacts of Exposure to Potentially Traumatic Events on the Mental Health of Public Safety Personnel: A Rapid Systematic Scoping Review","volume":"19","author":"Genest","year":"2022","journal-title":"Psychol. Serv."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1080\/15555240.2014.898568","article-title":"Behavioral Health Interventions in the Fire Service: Stories from the Firehouse","volume":"29","author":"Jahnke","year":"2014","journal-title":"J. Workplace Behav. Health"},{"key":"ref_111","doi-asserted-by":"crossref","unstructured":"Lentz, L., Smith-Macdonald, L., Malloy, D.C., Anderson, G.S., Beshai, S., Ricciardelli, R., Br\u00e9mault-Phillips, S., and Carleton, R.N. (2022). A Qualitative Analysis of the Mental Health Training and Educational Needs of Firefighters, Paramedics, and Public Safety Communicators in Canada. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19126972"},{"key":"ref_112","unstructured":"Tabachnick, B.G., and Fidell, L.S. (2013). Using Multivariate Statistics, Pearson Education, Inc.. [6th ed.]."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1519\/SSC.0000000000000659","article-title":"High-Intensity Functional Training for Firefighters","volume":"44","author":"Sempf","year":"2022","journal-title":"Strength Cond. J."},{"key":"ref_114","doi-asserted-by":"crossref","unstructured":"Stratton, E., Lampit, A., Choi, I., Calvo, R.A., Harvey, S.B., and Glozier, N. (2017). Effectiveness of EHealth Interventions for Reducing Mental Health Conditions in Employees: A Systematic Review and Meta-Analysis. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0189904"},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"e12219","DOI":"10.1002\/1348-9585.12219","article-title":"Health Outcomes of Psychosocial Stress within Firefighters: A Systematic Review of the Research Landscape","volume":"63","author":"Igboanugo","year":"2021","journal-title":"J. Occup. Health"},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1146\/annurev-orgpsych-032117-104640","article-title":"Conservation of Resources in the Organizational Context: The Reality of Resources and Their Consequences","volume":"5","author":"Hobfoll","year":"2018","journal-title":"Annu. Rev. Organ. Psychol. Organ. Behav."},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1023\/A:1020138022300","article-title":"Hurricane Georges: A Cross-National Study Examining Preparedness, Resource Loss, and Psychological Distress in the U.S. Virgin Islands, Puerto Rico, Dominican Republic, and the United States","volume":"15","author":"Sattler","year":"2002","journal-title":"J. Trauma. Stress"},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1002\/smi.2608","article-title":"Trauma-Exposed Firefighters: Relationships among Posttraumatic Growth, Posttraumatic Stress, Resource Availability, Coping and Critical Incident Stress Debriefing Experience","volume":"30","author":"Sattler","year":"2014","journal-title":"Stress Health"},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"e12894","DOI":"10.2196\/12894","article-title":"Resilience@Work Mindfulness Program: Results from a Cluster Randomized Controlled Trial with First Responders","volume":"21","author":"Joyce","year":"2019","journal-title":"J. Med. Internet Res."},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.psychres.2018.03.059","article-title":"Mindfulness-Based Resilience Training to Reduce Health Risk, Stress Reactivity, and Aggression among Law Enforcement Officers: A Feasibility and Preliminary Efficacy Trial","volume":"264","author":"Christopher","year":"2018","journal-title":"Psychiatry Res."},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1007\/s00420-012-0748-6","article-title":"Assessment of a Prevention Program for Work-Related Stress among Urban Police Officers","volume":"86","author":"Arnetz","year":"2013","journal-title":"Int. Arch. Occup. Environ. Health"},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"e34951","DOI":"10.2196\/34951","article-title":"Feasibility, Acceptability, and Preliminary Efficacy of an App-Based Meditation Intervention to Decrease Firefighter Psychological Distress and Burnout: A One-Group Pilot Study","volume":"6","author":"Pace","year":"2022","journal-title":"JMIR Form. Res."},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1002\/hpja.656","article-title":"A Pragmatic Strength and Conditioning Intervention for Firefighters: Feasibility of the Tactical Athlete Resilience Program (TARP)","volume":"34","author":"Sharp","year":"2023","journal-title":"Health Promot. J. Aust."},{"key":"ref_124","first-page":"1546","article-title":"Building Resilience in Firefighters: A Systematic Review","volume":"51","author":"Heydari","year":"2022","journal-title":"Iran. J. Public Health"},{"key":"ref_125","first-page":"1999","article-title":"Vocational Rehabilitation for Emergency Services Personnel: A Scoping Review","volume":"17","author":"Alexander","year":"2019","journal-title":"JBI Evid. Synth."},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"13","DOI":"10.5993\/AJHB.28.1.2","article-title":"The PHLAME Firefighters\u2019 Study: Feasibility and Findings","volume":"28","author":"Elliot","year":"2004","journal-title":"Am. J. Health Behav."},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/0022-3999(90)90060-H","article-title":"The Effects of Aerobic and Anaerobic Training on Fitness, Blood Pressure, and Psychological Stress and Well-Being","volume":"34","author":"Norris","year":"1990","journal-title":"J. Psychosom. Res."},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1037\/0022-006X.61.3.520","article-title":"Psychological and Physical Benefits of Circuit Weight Training in Law Enforcement Personnel","volume":"16","author":"Norvell","year":"1993","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref_129","doi-asserted-by":"crossref","unstructured":"Lan, F.Y., Scheibler, C., Hershey, M.S., Romero-Cabrera, J.L., Gaviola, G.C., Yiannakou, I., Fernandez-Montero, A., Christophi, C.A., Christiani, D.C., and Sotos-Prieto, M. (2022). Effects of a Healthy Lifestyle Intervention and COVID-19-Adjusted Training Curriculum on Firefighter Recruits. Sci. Rep., 12.","DOI":"10.1038\/s41598-022-10979-2"},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1108\/IJES-10-2016-0020","article-title":"Firefighters and Traumatic Stress: A Review","volume":"6","author":"Wagner","year":"2017","journal-title":"Int. J. Emerg. Serv."},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1080\/15325024.2017.1284515","article-title":"Behavioral Health and Firefighters: An Intervention and Interviews with Canadian Firefighters","volume":"22","author":"Sommerfeld","year":"2017","journal-title":"J. Loss Trauma"},{"key":"ref_132","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1108\/IJES-05-2019-0021","article-title":"Resilience of Firefighters Exposed to Potentially Traumatic Events: A Literature Review","volume":"9","author":"Laureys","year":"2020","journal-title":"Int. J. Emerg. Serv."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/8\/1227\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:24:30Z","timestamp":1760034270000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/8\/1227"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,6]]},"references-count":132,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["ijerph22081227"],"URL":"https:\/\/doi.org\/10.3390\/ijerph22081227","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,6]]}}}