BALANCE ABILITIES OF WORKERS IN PHYSICALLY DEMANDING JOBS: WITH
SPECIAL REFERENCE TO FIREFIGHTERS OF DIFFERENT AGES*
dissertation presented on the 5th November 2004 at the Large Lecture
Hall of the Haartman Institute, Helsinki, Finland by permission
of Faculty of Medicine of the University of Kuopio, Finland.
Department of Physiology, University of Kuopio, Department of Physiology,
Finnish Institute of Occupational Health, Kuopio, Finland
© Journal of Sports Science
and Medicine (2005) 4, Suppl.8, 1 - 47
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review is based on the following original publications, which will be referred
to in the text as Studies 1-5:
Punakallio, A. (2003) Balance abilities of different-aged workers
in physically demanding Jobs. Journal of Occupational Rehabilitation 13,
Punakallio, A., Lusa, S. and Luukkonen, R. (2003) Protective equipment
affects balance abilities differently in younger and older firefighters.
Aviation, Space, and Environmental Medicine 74, 1151-1156.
Punakallio, A., Hirvonen, M. and Grönqvist, R. Slip and fall risk among
firefighters in relation to balance, muscular capacities and age. Safety
Punakallio, A., Lusa, S. and Luukkonen, R. (2004) Functional, postural
and perceived balance for predicting the work ability of firefighters.
International Archives of Occupational and Environmental Health 77, 482-490
5. Punakallio, A. (2004) Trial-to-trial reproducibility and test-retest
stability of two dynamic balance tests among male firefighters. International
Journal of Sports Medicine 25, 163-169.
objectives of the present study were to investigate the associations
between balance abilities and age, occupation and the use of fire-protective
equipment (FPE) in different visual conditions, and the associations
of slip and fall risk with balance abilities among workers in physically
demanding jobs, especially among workers in fire and rescue work.
The reliability and predictive values of balance tests in respect
to perceived work ability were also studied. The professional firefighters
aged 30 to 56-years (n = 29-135), construction workers (n = 52),
home care workers (n = 66) and nursing workers (n = 51) aged 23
to 61 years participated in this study. The data were obtained with
balance tests with the use of a force platform, functional balance
tests, slipping tests and questionnaires. In one study the balance
tests were carried out with and without FPE. The slipping tests
with FPE were carried out on a straight 8-m long path that had one
area covered by water and detergent or glycerol. Perceived work
ability at baseline and after a 3-year follow-up was determined
with the use of the work ability index (WAI). In the reliability
study, the dynamic balance tests were repeated six times in two
testing periods at an interval of 2 months. The results indicated
that the balance abilities of firefighters over 49 years of age
were significantly poorer than those of firefighters in the age
groups of <40 and 40-49 years. The decline of balance abilities
among construction, home care and nursing workers was not as consistent.
Postural balance was also more harmfully affected among the older
firefighters (43-56 years) than among the younger ones (33-38 years)
by the use of FPE without visual input. Self-contained breathing
apparatus was the most significant single piece of FPE to impair
balance in both groups. Furthermore, fast and controlled performance
in the dynamic stability test based on visual feedback was related
to smaller slip and fall risk with FPE in both age groups. The older
firefighters tended to have longer and more serious slips than the
younger ones. In addition, the construction workers were significantly
faster and made fewer errors than the firefighters in the functional
balance test. Among the firefighters, poor performance on the balance
tests significantly predicted a reduced WAI after a follow-up of
3 years. The dynamic stability and functional balance tests showed
reasonable reliability, especially when the reliability was estimated
from the best of at least three repeated trials. The present results
suggest that balance abilities should be taken into account in follow-ups
of the work ability of firefighters, as well as in the organization
of work tasks and the development of the characteristics of FPE.
It is also essential to provide ample balance training opportunities
for firefighters with and without FPE. The balance assessments of
the present study can be included when prerequisites of work ability
are evaluated and followed-up for firefighters.
WORDS: Musculoskeletal equilibrium, posture, aging, occupations,
rescue work, protective devices, risk factors, occupational exposure,
comparative study, cross-sectional studies, follow-up studies, reproducibility