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3 August 2026

12 Pages

The Long-Term Effect of Auto-Generated Corrective Exercise Programming on Movement Literacy Among Firefighters

,
and
1
Department of Physical Therapy, Nova Southeastern University, Fort Lauderdale, FL 33428, USA
2
Palm Beach Gardens Fire Rescue, Palm Beach Gardens, FL 33410, USA
3
School of Fire, Construction & Emergency Management, Oklahoma State University, Stillwater, OK 74078, USA
4
School of Kinesiology and Physical Therapy, University of Central Florida, Orlando, FL 32816, USA
Fire2026, 9(8), 322;https://doi.org/10.3390/fire9080322
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Abstract

Introduction: Approximately 50% of firefighter injuries occur in the musculoskeletal system and poor movement quality increases injury risk. Previous research suggests that corrective exercise interventions with integrated movements improve movement literacy; however, the long-term benefit of corrective exercise programming has not been established among firefighters. Purpose: To investigate, as a continuation of a previously published short-term (mean—267 days) outcome pilot study, the long-term effectiveness of auto-generated corrective exercise programming on movement literacy scores among firefighters with lower baseline scores. Methods: Nine male firefighters (mean age +/− standard deviation 40 (12)) with baseline Functional Movement System (FMS™) scores less than 14/21 were initially recruited from October 2021 to September 2022. Baseline FMS™ assessments included detailed explanations of the seven movement screens as well as five clearing procedures and scoring criteria. A certified FMS™ professional performed each test first, prior to scoring, to demonstrate what was expected and firefighters were permitted to attempt each test for a total of three times with the highest score retained. Scores ranged from 0 to 3 for each of the seven movement screens with a maximum composite score of 21. Upon completing the screenings, test scores were reviewed and a detailed report was provided to each firefighter through the FMS™PRO APP. Additionally, each participant received an auto-generated corrective exercise program from the FMS™PRO APP with exercise figures, descriptions, and videos to be performed prior to routine conditioning programs. Participants were re-evaluated an average of 813 days after baseline for the long-term follow-up (F2). Pairwise comparisons from baseline to F2, as well as from a previously reported short-term follow-up (F1) to F2, were evaluated using the Friedman and Wilcoxon signed-rank tests. A Bonferroni correction resulted in an adjusted alpha of p = 0.025. Results: Composite FMS™ scores improved from a baseline mean of 11.3/21 to 14.7/21 at F2. When F2 was compared to the F1 scores from the previously published data set, scores declined by a mean of 1.4 points. Compared with baseline, scores at F2 were significantly improved (p = 0.013) with a large effect size (r = 0.83). In contrast, score declines (r = −0.73) from F1 to F2 were not statistically significant after Bonferroni correction (p = 0.028). Conclusions: An auto-generated corrective exercise program combined with a detailed explanation of baseline performance was effective in improving overall movement literacy in a standardized movement assessment tool in a long-term follow-up exceeding 2 years. The composite score change exceeded the threshold of error based on a previously established minimal detectable change (MDC) of 2.5/21, indicating true change occurred from baseline to F2. The decline from F1 to F2 did not exceed the threshold of error based on the MDC and may represent a regression to the mean and participant acknowledgement of marginal adherence after F1. Long-term adherence to programming is necessary to prevent the tapering of improvements seen in this study. The absence of a comparison or control group is a study limitation.

1. Introduction

Firefighters operate in environments requiring a level of physical conditioning comparable to competitive sports, lending to their classification as tactical athletes [1]. Unlike sporting athletes who have seasonal demands, firefighters operate on a year-round training schedule [1], with many departments using 24 h work shifts. In addition to time demands, firefighters operate under extreme temperatures with a heavy load carriage, unpredictable deployment, interrupted sleep, and inconsistent feeding schedules [1]. These demands elevate their physical and mental job demands. With regard to deployments, firefighters respond to fireground activity as well as medical rescues, which require high-level movement quality, stability, and muscle performance to protect themselves from injury and meet task requirements. From a fitness perspective, firefighters are required to transfer, carry and drag heavy patients of varying body mass, climb stairs with a heavy load carriage, and breach entry into building and vehicles [1]. These tasks are potentially performed with limited visibility, extreme temperature, and unpredictable terrain [1]. Their demanding work conditions increase injury risk, and impose considerable demands on the body, which over time escalates degenerative changes and impaired functional movement.
In 2022, an estimated 65,650 firefighters were injured in the line of duty, which was an increase of 8 percent from 2021 [2]. A majority of the reported incidents occurred at the fireground, with musculoskeletal sprains, strains, and muscle injuries comprising 36% of injuries. Of the non-fireground incidents that occurred, sprains, strains, and muscular injuries accounted for 56% of the reports. Regarding non-fireground injuries, resistance training has been reported as a prominent mechanism, with evidence obtained from healthcare providers indicating that reduced movement proficiency and poor technique are key risk factors [3].
From a prevalence perspective, a meta-analysis of musculoskeletal disorders among firefighters identified an injury prevalence of 46%, with the lower back, neck, shoulder, and knees reported as the most common sites of injury [4]. Similarly, Ziaei et al. reported an overall work-related musculoskeletal disorder lifetime prevalence of 52% with 49% of the firefighters reporting a musculoskeletal issue in more than one body region [5]. Moreover, evidence from one study of 309 firefighters indicates that approximately 73% report experiencing discomfort 1–2 times a week that interfered with their ability to work [6].
From a job performance perspective, essential firefighter activities such as crawling, transferring patients, kneeling while operating a hoseline, lifting equipment, and working in confined environments require physical mobility and stability beyond that of the general population. Furthermore, firefighters may be required to wear turnout gear and a self-contained breathing apparatus (SCBA) which further increases the physical demand of the job. Although firefighters train with weighted vests or other gear to become accustomed to the constraints of their gear and ensure proper task performance, research has found that the SCBA specifically hinders firefighters’ upper trunk and neck movement, and that firefighting boots obstruct ankle mobility [7]. Given the occupational mobility demands of firefighters, regular assessments of stability and mobility with corrective interventions are necessary to meet job-related demands. One such assessment tool with corrective interventions is the Functional Movement System (FMSTM).
The FMSTM is a validated screening tool with assessments of both mobility and stability (including balance) that also includes screenings for joint pain. The tool screens individuals in a dynamic functional capacity that emulates many tasks specific to firefighter requirements [8]. The FMSTM comprises seven movement screening tests and four joint pain screening tests which produce a maximum composite score of twenty-one [9,10]. Evidence suggests that firefighters with a history of work-related musculoskeletal disorders are 76.3% more likely to achieve a score of ≤14 on the FMSTM than a score of >14 [5].
Lower FMSTM scores may be used to identify movement literacy impairments and, when combined with other factors, predict injury. In terms of identifying injury risk, a meta-analysis found that the odds of injury were greatest for tactical operators (e.g., law enforcement and firefighters) when the FMSTM composite score was less than or equal to 14 [11]. Another meta-analysis using a mixed population reported the odds of injury were 2.74 times more likely when there was a composite score less than or equal to 14/21 [12]. Additionally, a systematic review with meta-analysis found that individuals with scores lower than thirteen were 51% more likely to be affected by injury than those classified as low-risk via higher scores; however, firefighters were not part of the groups studied [13]. In the aforementioned analysis it should be noted that cut-off scores ranged from 13 to 17, with a score ≤13 having a higher likelihood of injury than a cut-off score of 17. Other studies have noted that athletes with total FMSTM scores less than or equal to 14 had an 11-times-increased risk of serious injury and a 51% probability of sustaining a serious injury over the course of one competitive season [14]. Furthermore, an individual study that specifically evaluated firefighter academy injury risk determined that a cut-off score of less than or equal to 14 was able to discriminate between those at a greater risk of injury, and that the trunk stability push-up and deep squat were most predictive [15]. While a body of evidence on injury prediction among firefighters identifies specific scoring thresholds, the evidence is not completely clear, as one study of 581 firefighters found that FMSTM scores were not predictive of a future workers’ compensation claim [16]. While this finding does potentially challenge the predictability of using the FMSTM as an injury predictive tool, it is well recognized that injury in the fire service is not always associated with a workers’ compensation claim.
In addition to composite scoring, joint pain during the clearing tests and asymmetry on the bilateral tests have been identified as predictive risk factors for injury. Among military recruits, pain reports on the FMSTM increased injury risk to a predictive level greater than a composite score of less than or equal to 14 (relative risk of 1.62 versus 1.58) [17]. Moreover, evidence suggests that pain reports or a score of less than or equal to 1 on any test increases injury risk and that individuals with asymmetry on any test are up to 2.7 times more likely to sustain an injury [18,19].
The effect of corrective exercise programs designed to improve FMSTM scores has been investigated with promising results in mixed populations [5,20,21,22]. However, many of the studies assessed shorter-term follow-ups or used interventions that may not be practical in terms of scheduling demand and time constraints. Furthermore, some studies provided interventions that were not individualized based on each firefighter’s needs. In one systematic review of six studies, interventions used to improve functional movement based on FMSTM scores were assessed among high-risk athletes. Results were promising in that programming inclusive of corrective interventions performed 1–4 times a week over an average of 6–8 weeks was effective with an average FMSTM composite score improvement of 3.28 points despite variations in programming [20]. In a firefighter-specific study [21], an intervention consisting of twenty-one seminars of 3 h each—focused on education, back school, postural training, core strengthening, and fire task-specific training—reduced lost time to injuries by 62% and the number of injuries by 42% over a 12-month period compared to a historical control group [22]. provided automated corrective exercise programming to firefighters using the FMSTM PRO App (version 2)and reported a significant increase in scores from 12.09 to 13.66 over an 8-week period [22]. Although the results indicated significant improvement, changes did not exceed the previously reported threshold of error based on a minimum detectable change (MDC) = 2.5 points [23]. In another study, individuals who scored less than 14 on the FMS were randomly assigned to either a corrective exercise program or were allowed to continue their usual routine for a period of 8 weeks. The results from the study indicated significant improvements in FMS scores (69%) for the group receiving the corrective exercise programming compared to self-selected exercise, which only showed a 3% improvement [24]. Moreover, when considering movement quality changes from interventions, it is important to consider expected changes in scores due to site-specific training policies. For example, evidence has shown an increase in FMSTM scores from the start of the academy to completion and to completion of probationary status, suggesting that firefighter-specific training can enhance functional movement competencies [25]. While a body of evidence supports the efficacy of interventions to improve movement literacy and reduce injury, there is a paucity of long-term data to determine the sustainability of interventions.
Given the time demands of firefighter schedules and potentially limited resources, there is a need to identify individualized corrective interventions that reduce a firefighter’s injury risk profile and improve functional movement and stability in the long term. Currently, there is a paucity of long-term data to determine the efficacy of automated exercise programming among firefighters. Thus, the purpose of this pilot study was to determine the long-term effect of automated corrective exercise programming utilizing the FMSTM PRO App on firefighters who scored less than 14 on the updated FMSTM assessment tool. It was hypothesized that automated programming individualized to firefighters’ FMSTM scoring impairments would produce significant improvements when re-evaluated in a long-term (mean +/− SD 813 (47) days) follow-up. Furthermore, this study sought to determine the sustainability of previously reported short-term (6–9-month) FMSTM composite score improvements in the same cohort [26].

2. Methods

The study was approved by the Institutional Review Board at Nova Southeastern University. Records were retrieved of full-time firefighters who completed the FMSTM as part of their yearly physical examination between February 2021 and February 2024 at a city fire department accredited by the Commission on Fire Accreditation International (CFAI), and holding an Insurance Services Office (ISO) Public Protection Classification of 1. The department operates on a 48 h work schedule consisting of 24 h on duty followed by 48 h off duty, with an additional scheduled shift off duty every 21 days to reduce average work hours. All firefighters included in the assessment were certified Emergency Medical Technicians (EMTs) or Paramedics and were assigned to unrestricted duty during the study period. In accordance with department policy, firefighters are required to complete a structured physical training program each shift, selecting from a library of workouts developed by a Doctor of Physical Therapy and designed to support firefighter-specific functional fitness.

2.1. Participants

One hundred and ten full-time firefighters (100 men) completed the FMSTM assessment during a single on-duty session between February 2021 and September 2022. Assessments were conducted in an air-conditioned facility, and participants wore a t-shirt, duty boots, and duty uniform pants. Testing was performed during the first 8 h of their shift. Firefighters were scored by the same researcher, who holds a certification in the FMSTM tool, and is a board-certified orthopedic physical therapist and tactical strength and conditioning specialist. Eleven of the 110 firefighters, who scored less than 14/21, received a corrective exercise program and were previously scheduled for a follow-up 6–9 months from the initial assessment date. These results have been previously published [26]. Following this short-term assessment period, the same firefighters were scheduled for a long-term follow-up during the 2024 assessment year. Two of the initial 11 firefighters retired as planned, leaving nine firefighters who were re-evaluated an average of 813 days (min-max 763–875 days) from the initial assessment. Inclusion criteria for participation included active unrestricted duty and a score <14/21 on the FMSTM. Exclusion criteria included firefighters on restricted duty.

2.2. Procedures

Each firefighter, as part of their biennial physical, performed the FMSTM. The FMSTM has been shown to possess good-to-excellent intrarater reliability among both experienced and inexperienced testers with intraclass correlation coefficient (ICC) values of 0.95 and 0.77 respectively when tested 1 week apart [27]. Among a group inclusive of tactical athletes, the intrarater and interrater reliability ICC and MDC have been reported at 0.76 (2.5) and 0.74 (2.1) respectively [23]. With incorporation of updated scoring criteria and tests, the interrater reliability remains excellent, with a reported ICC of 0.95 among trained testers for composite scoring [28]. The interrater reliability of the updated rotary stability test had an ICC of 0.96 and the ankle clearing tests had an ICC ≥0.92 for pain and ≥0.63 for mobility [28].
Prior to performance of the FMSTM, each firefighter was provided with a verbal explanation of the test and scoring, and the researcher demonstrated the expected test. Evidence suggests that explanations of testing improve scoring [29]. Participants completed the 7 components and 4 clearing tests of the FMSTM tool in a single session, based on previously established guidelines and updates to the tool which were implemented in 2020 [9,10,30], in an order specified within the FMSTMPRO App. The FMSTMPRO is an application which allows entry of individual FMSTM item test scores and calculates a total score which may then be used to auto-generate a program. The FMSTM assessment included the overhead deep squat, hurdle step, inline lunge, ankle clearing, shoulder mobility, shoulder clearing, active straight-leg raise, trunk stability push-up, extension clearing, rotary stability, and flexion clearing. Changes to the FMSTM implemented in 2020 include the addition of an ankle clearing test for both pain and mobility as well as alternative scoring for the rotary stability test [30]. Each component test was scored on an ordinal scale (0 to 3 points), resulting in a composite score ranging from 0 to 21 points. A score of zero represents the presence of pain during an individual component test or during a screening test, a score of 1 is given if the individual cannot perform the movement pattern without compensation or mobility falls below a set threshold, a score of 2 is given when the participant can perform the movement but utilizes poor mechanics or compensatory movements, and a score of 3 is related to a patient having normal movement patterns according to established criteria [9,28]. Pain during any of the clearing tests resulted in a score of 0 for the respective composite test (e.g., pain during ankle clearing would result in a score of 0 for the inline lunge). Additionally, 4 of the 7 component tests are bilateral and participants received the lowest scores for each test. For any test with a score lower than 3, participants were provided with 2 additional opportunities to obtain a higher score, with the highest score retained. Once scoring was completed and entered on the FMSTMPRO App, which is a subscription app available to FMSTM-certified practitioners, the researcher reviewed results with participants on an individual basis.
Of the firefighters who completed the assessment, eleven who scored less than 14/21 were provided with an individualized corrective exercise program using the FMSTMPRO App and were scheduled for a short- and long-term follow-up. The FMSTMPRO App provides a detailed explanation of scoring along with a document detailing the individualized exercises to be performed, their frequency, as well as a video of the exercises. On average, the automated program provides 5–6 corrective exercises, which, based on dosing, is completed in 20–30 min.
Firefighters were advised to perform the exercises prior to their shift-required fitness program, which was approximately 2–3 times per week. Additionally, firefighters were required to perform their standard fitness routines without modification. Firefighters were not required to document adherence to the program. A follow-up e-mail was sent to each firefighter within 1 week of the initial assessment with a reminder of the programming. Based on their schedules, firefighters were requested to follow up on a short-term basis of 6–9 months from the initial assessment and a long-term basis of 25–29 months to determine the efficacy of the program. In each of the follow-up testing sessions a discussion of adherence was carried out and documented on the testing report. The short-term results have previously been published [26]; thus, the primary purpose of this study is to determine the long-term efficacy of the program compared to baseline for the nine active-duty firefighters. The secondary purpose was to determine the sustainability of improvements when compared to the previously published short-term follow-up on the nine specific firefighters who remain on active duty. Short-term improvements have previously been reported; thus, scores will only be used as a means of determining the sustainability of improvements.

2.3. Statistical Analysis

Data was entered into the SPSS version 27 for Windows software program (IBM SPSS, Armonk, New York, NY, USA) for analysis. Descriptive data and outcome measure scores were calculated as appropriate using frequency counts and means +/− standard deviation (SD). For the outcome measures, averages were reported as mean values, as opposed to median values, based on standard clinical and field application for scoring and interpreting change scores using the MDC. Outcome measure comparison points were analyzed as non-parametric data with a Friedman test initially to compare overall differences between baseline, short- (F1) and long-term (F2) follow-ups. Wilcoxon signed-rank tests were then used to compare differences between baseline and F2 as well as F1 to F2 with a Bonferroni adjustment and a significance level set at p < 0.025. Effect sizes were calculated using Z scores from the Wilcoxon signed-rank test using the formula r = Z/√N, where N = the number of observations on which Z is based [31,32]. Interpretation of effect sizes was based on recommendations for non-parametric tests, such that a large effect was 0.5 or greater, a medium effect size was 0.3, and a small effect size was 0.1 [32,33].

3. Results

Nine male firefighters, with a mean age (+/− standard deviation) of 40 (12.1) years, presented for follow-up testing. Firefighters on average (mean) followed up after 832 +/− 45.2 days for the long-term re-assessment (F2), which was conducted by the same researcher who performed the initial assessment in the same location. Mean composite scores significantly improved (p = 0.013) from 11.3 at baseline to 14.7/21 at F2 with a large effect size (r = 0.83). Individual item scores significantly improved for the deep overhead squat and left hurdle step (p ≤ 0.025) with effect sizes of r = 0.75–0.77. Significant changes were not observed for the inline lunge, right hurdle step, active straight-leg raise, shoulder mobility, rotary stability, and trunk stability push-up (p ≥ 0.102). Positive clearance scoring tests (pain during clearance test), which result in a zero score for the associated test, were documented on five occasions during baseline testing compared to one and two occasions in the short- and long-term follow-up respectively. Ankle dorsiflexion mobility, an ordinal measurement ranked on three criteria, is not a component of the composite score and did not show significant changes between baseline and F2 (p ≥ 0.655).
Asymmetry was assessed for the hurdle test, inline lunge, ankle mobility, active straight-leg raise, shoulder mobility test, and rotary stability tests with p-values ranging from 0.046 to 0.564 from baseline to F2, and 0.046–1.0 from F1–F2, indicating no significant differences at either time point.
Composite scores at F1 and F2 were 16.1 and 14.7 respectively, with score reductions being non-significant (p = 0.028). Individual item scores all had marginal reductions but were non-significant (p ≥ 0.083). A positive clearance scoring tests (pain during clearance test), which resulted in a zero score for the associated test, was documented on one occasion during short-term testing compared to two occasions in long-term follow-up. Ankle dorsiflexion mobility did not show significant changes between F1 and F2 (p ≥ 0.564).
Of the nine participants who completed the long-term study, all remained on active duty and there were no workers’ compensation injuries reported. Furthermore, none of the nine participants communicated an injury to the health and wellness coordinator during the assessment periods.
A post hoc power analysis was conducted using the final sample size of nine participants, the baseline-to-long-term follow-up effect, and the Bonferroni alpha level of 0.025. The results of this analysis showed a power of 0.67.
Table 1 presents change scores and probability analysis of FMS composite and individual item test scores from baseline to F2, and Table 2 presents change scores and probability analysis of FMS composite and individual item test scores from F1 to F2. Effect size estimates for FMS composite scores between assessment periods are presented in Table 3.
Table 1. Functional Movement System change score from baseline to long-term follow-up.
Table 2. Functional Movement System change score from short-term to long-term follow-up.
Table 3. Effect size estimates for Functional Movement System change scores.

4. Discussion

Identifying “high-injury-risk” firefighters with a low-cost, time-efficient, and low-physical-risk screening tool could decrease medical costs, the number of injuries, and time lost to injury. The FMSTM provides valuable information needed for early detection of injury-prone firefighters who may benefit from corrective interventions, and provides automated software to generate individualized exercises using the FMSTMPRO App. Programming that links movement assessment scores to individualized exercises provides the advantage of corrective exercise specificity and meets the efficiency demands of a firefighter’s schedule. In this pilot study, this system was used to determine the long-term efficacy of the automated programming app on a cohort of firefighters who were deemed to be at risk of a musculoskeletal injury based on a threshold composite score of less than 14. Additionally, the secondary purpose was to determine the sustainability of improvements in the long term compared to a previously published short-term follow-up on nine of the original 11 firefighters in the pilot study, with two retiring prior to the scheduled long-term follow-up.
Although a composite score threshold of less than or equal to 14/21 on the FMSTM scoring system has been used most often in the literature, the justification for this cut-off point is not definitively clear and should draw questions from researchers. In a study of junior Australian football players, the authors reported the predictive injury risk of players using different FMSTM score thresholds [34]. The composite score thresholds were compared based on an FMSTM score with and without consideration of a prior musculoskeletal injury. When comparing a composite score threshold of ≤13 to ≤14, the odds ratio of an injury that season was 1.26 and 1.0 respectively. When a prior injury was incorporated into the analysis, the odds ratio for an injury increased to 2.16 and 1.89 respectively, indicating the superior predictability of a cut-off score threshold of less than or equal to 13 and supporting the decision to use it in this study. With regard to sensitivity and specificity, the authors in the aforementioned study reported that using a cut-off score of less than or equal to 13 led to more false negative predictions (athletes classified as not at risk who had an injury during the season) than a cut-off score of less than or equal to 14, but fewer false positive predictions [34]. Bardenett et al. compared composite threshold scores of 11–17 in a study of high-school athletes based on a prospective injury during a season [35]. As expected, lower composite threshold scores have a greater positive likelihood ratio for injury prediction; however, higher composite threshold scores were more likely to produce false positive results (classifying an athlete with a positive injury risk despite no injury during the season) [35]. Interestingly, a composite threshold score of 13 or less was the threshold where probability favored the onset of an injury during the season. Importantly, published studies to date have not used the updated scoring system as we have; when used, this may ultimately lead to lower scores than previous reference values, ultimately causing a shift in thresholds for injury prediction. Given the updated scoring changes, which should theoretically lower reference values, and the evidence for increased predictability when using a lower composite score threshold, a decision to use a score of less than or equal to 13 was made for this study.
A paucity of evidence exists to determine optimal programming for at-risk firefighters with lower FMS scores. While evidence indicates that any corrective intervention may be of benefit, shift demands and challenging work schedules make more elaborate programs challenging. Furthermore, many fire departments, particularly smaller or resource-constrained agencies, may lack access to qualified professionals with the expertise to develop individualized corrective exercise programs. As part of a daily routine, firefighters may be required to engage in physical training; thus, a program that can be integrated into existing exercise routines would theoretically meet the time demands and scheduling challenges of firefighters. While evidence from one study indicated that automated programming using the FMSTM PRO App was beneficial, the study had only a short-term follow-up of 6–8 weeks, and the average change score did not meet the threshold of error which has been determined at 2.5 points. When comparing exercise programming to mitigate movement dysfunction based on scoring from the FMS, evidence does indicate greater improvements in FMS scoring for corrective exercise programs designed by qualified professionals compared to the usual self-selected training program [24]. As part of our previously published study [26], the short-term benefit over a time period of 6–9 months, which exceeds previous studies, included a significant improvement in composite scoring from 11.3 to 16.1 with a large effect size (r = 0.89). It should be noted that the aforementioned changes reflect the nine individuals retained for the long-term investigation.
While significant improvements were recorded from baseline to the short- and long-term follow-up time periods, score declines were recorded in both composite scores and individual tests when comparing the short-term score improvements to long-term scores. Arguably, the change in composite scoring from the short to the long term may have represented a regression to the mean; however, non-significant score declines were present for individualized tests. From a statistical perspective the composite score declines did not reach the MDC of 2.5 so may very well represent a regression to the mean or variability in intrarater scoring. Nevertheless, program performance was not documented in the long term and marginal adherence in the long term was acknowledged. Specifically, all participants communicated strict adherence in the initial short-term follow-up; however, at F2, all firefighters communicated continued albeit inconsistent performance. Of particular interest is the number of reported positive clearance tests. Positive clearing tests are recorded when participants experience pain during the clearance tests. Scoring protocols require a positive clearance test to reduce the score of its associated mobility test to zero, which, in a small cohort, can have considerable score implications. As expected from composite scores the initial baseline testing had four positive reports compared to one and two respectively for F1 and F2. One clear finding was the lack of overall improvements in the mobility testing, which included active straight-leg raise, shoulder mobility, and the ankle dorsiflexion test. The reasoning for the lack of mobility changes is not clear; however, for shoulder mobility, the issue may reside in the automated programming exercises. Specifically, the program lacks passive flexibility exercises (hand to back and hand to neck) that would improve the specific testing motions.
Additional factors that may have contributed to the tapering of scores in the long term include the age of participants, as the study was conducted on average 813 days after the baseline assessment. While all participants passed yearly fitness performance tests, this does not necessarily imply stable functional movement scores. Furthermore, call volume and fluctuation in duty load may have impacted testing sessions as this was not standardized.
A limitation of our study is the small sample size of nine; however, we were limited to data collected from one large city fire department which only had an eligibility of 9/110 for the long-term evaluation based on the selected composite scoring threshold. While we acknowledge that the study is underpowered, we do recognize this is the nature of a pilot study. Nevertheless, the low power recommends cautious interpretation of the findings. Additional considerations that may reflect limitations of the study include the exclusion of female firefighters; thus, the results can only be generalized to men. Other limitations include the fact that the automated program was not monitored beyond initial communications and those that occurred during follow-up testing sessions. This is a limitation to any study providing interventions for individuals to perform independently; however, as with any intervention, there will be adherence issues and the outcomes are ultimately what determines efficacy. This reflects real-world implementation conditions within an operational fire service environment, where formal adherence tracking may not be feasible due to varying schedules and the unpredictable nature of emergency calls. Lastly, the results of the study would have greater application if characteristics such as anthropometrics, rank, and prior injuries were included in the discussion. Future studies should employ a comparison group to determine if there is a superiority of interventions in improving functional movement quality.

5. Conclusions

An automated corrective exercise program using the FMSTM PRO App was effective for improving FMSTM scores in firefighters who initially were deemed at risk for injury based on scoring less than or equal to 13. Improvements were sustained in the long term with marginal reductions over time. While initial improvements were statistically significant, these improvements tapered off over time. Automated interventions that use individualized findings from FMS scores on the app itself are ideal from a time, proficiency and efficiency perspective. The convenience of exercise videos and detailed explanations of scoring results provide an optimal environment for adherence without the scheduling demands of in-person training. More frequent follow-up assessments combined with measures to ensure adherence are potential options to sustain short-term improvements. Formal compliance measures would allow a better understanding of the factors that may have influenced score changes from the first to second follow-up periods. Understanding specific causes provides a stronger opportunity to improve and maintain optimal movement quality over time. The implications for this study include the need to conduct periodic movement assessments; while short-term improvements were considerable using exercise prescription, the lack of long-term monitoring may lead to the tapering of improvements.

Author Contributions

Conceptualization, M.J.K., J.N.I. and W.J.H.; methodology, M.J.K.; software, M.J.K.; validation, M.J.K., W.J.H. and J.N.I.; formal analysis, M.J.K.; investigation, M.J.K.; resources, M.J.K. and J.N.I.; data curation, M.J.K.; writing—original draft preparation, M.J.K., W.J.H. and J.N.I.; writing—review and editing, M.J.K., W.J.H. and J.N.I.; visualization, M.J.K., W.J.H. and J.N.I.; supervision, M.J.K.; project administration, M.J.K. All authors have read and agreed to the published version of the manuscript.

Funding

The authors did not receive funding to complete this study.

Data Availability Statement

No new data were created or analyzed in this study. Data sharing is not applicable to this article.

Conflicts of Interest

The authors declare no conflicts of interest.

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