Why High-Stress Workers Need a Different Recovery Strategy

Standard wellness advice wasn't built for people who can't control their stress exposure. Here's what to do instead.

If you're a first responder — firefighter, paramedic, law enforcement officer, or anyone else in a high-stakes profession — you've probably heard some version of the generic advice to reduce your stress. Maybe from a well-meaning doctor looking at your blood pressure. Or an wearable app that notices your sleep score dropping.

The advice isn't wrong, exactly. Chronic stress does damage the body. But for people in high-stress occupations, the standard playbook doesn't apply. Eliminating the stressor isn’t a variable you can control. The nature of the job is the stressor — and you chose it for a reason.

What you can do is get ahead of the damage. And that requires a different approach to health and recovery — one that's proactive rather than reactive, and one that's grounded in objective data rather than waiting for symptoms to appear.

Reactive Care

Most healthcare operates on a reactive model: something breaks, you fix it. But for high-stress professions, that model has a fundamental flaw. By the time symptoms show up — fatigue that won't lift, blood pressure that keeps climbing, recovery that takes longer than it used to — the cumulative damage has been building for months, if not years.

The numbers tell the story.

According to a systematic review and meta-analysis, cardiovascular disease risk factors are significantly and inversely associated with cardiorespiratory fitness among firefighters — and approximately 45% of on-duty firefighter fatalities are related to sudden cardiac death.

A study in the Journal of the American Heart Association examined autopsy data from duty-related firefighter deaths and found that 82% had both coronary heart disease and increased heart mass — conditions that develop over time and could potentially be detected earlier with targeted screening.

These aren't sudden events that come out of nowhere. They're the end result of cumulative physiological strain that was building long before it became visible.

How High-Stress Occupations Differ

Most stress research focuses on office workers with demanding jobs. But the stress profile of a first responder is fundamentally different — and so is what you need to do about it.

1. Shift work disrupts circadian rhythms

A study of firefighters published in the International Journal of Environmental Research and Public Health found that cortisol levels varied significantly based on shift cycle, with some shift schedules allowing full recovery of circadian rhythm while others did not. Firefighters on 6-day and 21-day shift cycles showed delayed cortisol recovery compared to those on 9-day cycles.

Why does this matter? Because cortisol isn't just a "stress hormone" — it's a circadian marker. When your cortisol rhythm is disrupted, it affects sleep quality, metabolic function, immune response, and cardiovascular health. And unlike someone who can "just sleep more," shift workers often can't control when they need to be alert and when they can rest. 

What to track: Compare your HRV and resting heart rate across different shift cycles. You may find that some rotations allow full recovery while others consistently leave you in a deficit. If your metrics tank on certain schedules, that's objective data — useful for understanding your own patterns, and potentially worth raising in conversations about scheduling or recovery time.

2. Acute exposures create immediate physiological load

Research showed that even a 12-minute live-fire drill significantly increased heart rate, core body temperature, blood coagulability, leukocyte count, and cortisol levels. These acute spikes aren't inherently harmful — but when they happen repeatedly without adequate recovery, the cumulative effect compounds.

A separate study comparing firefighters and law enforcement officers found that firefighters had higher cortisol levels, higher oxidative stress markers, and higher cardiovascular risk biomarker concentrations — suggesting that occupation-specific stressors create measurably different physiological profiles. 

What to track: Notice how long it takes your resting heart rate and HRV to return to baseline after high-intensity shifts. If recovery is taking longer than it used to — or longer than it takes your peers — that's a signal your system may be carrying more cumulative load than you realize.

3. Cumulative trauma exposure takes a psychological and physical toll

Research on repeated exposure to trauma in firefighters has documented the cumulative psychological toll: desensitization, flashbacks, irritability, and increased risk of PTSD and substance use. But the effects aren't just psychological. Chronic psychological stress creates chronic physiological stress—elevated inflammatory markers, suppressed immune function, and impaired recovery capacity.

A study in Occupational Medicine found that cumulative trauma exposure moderated the relationship between stress and PTSD symptoms—the more cumulative exposure, the greater the impact of each additional incident. 

What to track: Psychological stress shows up in physiological markers. If you're noticing increased irritability, sleep disruption, or emotional blunting, it's worth looking at your inflammatory markers (hs-CRP), HRV trends, and sleep architecture. Sometimes the body signals overload before the mind fully registers it.

Why Standard Recovery Advice Doesn't Work

The health and wellness industry's standard recommendations — sleep 8 hours, manage stress, exercise regularly, eat whole foods — aren't wrong. They're just incomplete for those that can't control their exposure.

• "Sleep 8 hours" doesn't account for interrupted sleep from calls, circadian disruption from shift work, or the hypervigilance that makes it hard to wind down after high-intensity incidents.

• "Exercise regularly" doesn't account for the physical demands already placed on the body during duty — demands that might mean you need more recovery, not more training stimulus.

• "Reduce stress" isn't actionable when the stress is structural. You're not going to stop responding to emergencies.

What high-stress workers need isn't generic wellness advice. It's a way to see what's actually happening inside their bodies, so they can intervene strategically where it matters most.

Proactive Health Monitoring

If you can't eliminate the stress, you need to get ahead of its effects. That means shifting from reactive health care (wait until something breaks) to proactive monitoring (track what's happening and intervene early).

Here's what that looks like in practice — with specific markers worth paying attention to.

1. Track biomarkers that show cumulative stress load

Your body keeps the score, even when you feel fine. Inflammatory markers like high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6) rise with chronic stress. Metabolic markers like fasting glucose and triglycerides can shift before you develop clinical conditions. Cardiovascular markers — blood pressure trends, lipid profiles, and heart rate variability — can reveal strain that hasn't yet become symptomatic.

The key isn't focusing on any single marker — it's the patterns over time. Having slightly elevated hs-CRP in isolation might not mean much. But combine it with elevated cortisol, declining HRV, and creeping blood pressure, and you're looking at a system under strain.

What to track:

• Inflammation: hs-CRP, IL-6

• Metabolic: Glucose, HbA1c, Triglycerides

• Cardiovascular: lipid panel, blood pressure

• Hormones: Cortisol, Testosterone, DHEA-S

• Nervous System: HRV (via wearable)

The goal isn't to obsess over every number — it's to establish your baseline and watch for trends that suggest your system is under more strain than it can handle.

2. Use wearable data to understand recovery capacity

Wearables can show you what traditional annual physicals miss: how your body is actually recovering day to day. Heart rate variability, resting heart rate trends, sleep architecture, and respiratory rate all provide insight into the state of your autonomic nervous system.

For shift workers especially, this data is invaluable. You can see how different shift cycles affect your recovery. You can identify patterns — maybe your HRV tanks after back-to-back 24-hour shifts, or your resting heart rate stays elevated after particularly intense calls.

What to look for in your wearable data:

• HRV trends over 7-14 days — more useful than any single reading. A downward trend suggests accumulating strain.

• Resting heart rate (RHR) — should drop during sleep. If it stays elevated overnight, your nervous system isn't fully recovering.

• Sleep architecture — deep sleep percentage matters more than total time. Aim for 15-20% in deep stages.

• Recovery after high-intensity shifts — how many days until your metrics return to baseline? If it's taking longer than it used to, that's a signal.

This isn't about adding another thing to worry about. It's about using information you're already collecting to make better decisions about when to push and when to prioritize recovery.

3. Connect the dots between different data sources

The real power isn't in any single data point — it's in seeing how different indicators relate to each other. Your wearable might show declining sleep quality. Your labs might show rising inflammatory markers. Your blood pressure might be trending up. Individually, each of these might seem like minor fluctuations. Together, they tell a more complete story about a system that's under more strain than it can handle.

This is especially important for those of us to whom standard reference ranges might not apply. A "normal" blood pressure for a sedentary office worker might be elevated for someone with high cardiovascular fitness. Context matters — and having all your data in one place makes that context visible.

A Note on "Normal" Ranges

Standard lab reference ranges are built for general populations — not people with high cardiovascular fitness or chronic occupational stress.

Where context matters:

• Resting heart rate: A "normal" RHR of 70 bpm might be elevated for someone with high cardiovascular fitness, where 50-55 would be more typical.

• Cortisol: A "normal" total cortisol level might mask a blunted diurnal rhythm — where your morning spike is flat and evening levels stay elevated. The pattern matters more than the number.

• Blood pressure: Cardiovascularly fit individuals often run lower. What's "normal" for a sedentary person might represent elevated strain for you.

• HRV: Highly individual. Your baseline is more meaningful than any population average. Track your own trends.

This is why single-point-in-time annual physicals often miss what's actually happening. And why tracking trends over time — with a provider who understands your occupation — is more valuable than any single test result.

What You Can Actually Control

You can't eliminate occupational stress. But you can optimize everything around it. Here's where the data becomes actionable:

Recovery windows

When you can't control your stress exposure, protecting your recovery windows becomes critical. Research suggests that recovery between high-intensity exposures matters more than total rest time. The question isn't just "did I rest?" — it's "did my system actually recover?"

How to tell: Track which days your HRV rebounds to baseline versus stays suppressed. If you're doing all the "right" recovery things and your metrics aren't moving, the strategy isn't working — even if it feels good. Experiment with different approaches (more sleep vs. active recovery vs. full rest days) and let the data tell you what actually restores your system.

Nutrition timing

A randomized controlled trial on firefighters found that 10-hour time-restricted eating improved cardiometabolic markers — even without changing what they ate. For shift workers whose schedules make consistent meals impossible, when you eat may matter more than perfect food choices. 

Practical application: If you can't control meal timing perfectly, focus on two things: (1) a consistent eating window on your days off to support circadian rhythm, and (2) avoiding large meals in the 2-3 hours before sleep, which can impair sleep architecture. Track how your glucose, inflammatory markers, and sleep quality respond to different eating patterns — and adjust based on what the data shows. 

Sleep protection

You can't always control when you sleep. But you can control the 30-60 minutes before — and the environment you sleep in.

Research shows that pre-sleep interventions that downregulate the nervous system (heat exposure, compression, breathwork) can improve sleep architecture more than additional sleep time alone. For shift workers dealing with hypervigilance after high-intensity calls, the goal is helping your nervous system shift out of threat-detection mode.

Practical application: Track which nights your deep sleep percentage is highest — and reverse-engineer what you did differently. Was it a hot shower? Compression boots? No screen time? A specific wind-down routine? Your wearable data can reveal which strategies actually improve your sleep quality, not just your time in bed.

Early intervention

When you can see biomarkers trending in the wrong direction, you can intervene before they become clinical problems — and before symptoms show up.

What early intervention might look like:

• HRV declining over 2-3 weeks: Temporarily reduce training load, prioritize sleep, increase recovery modalities

• hs-CRP creeping up: Look at sleep quality, stress load, and recent illness; consider anti-inflammatory nutrition strategies

• Blood pressure trending higher: Check sleep, sodium intake, recovery adequacy; flag for provider if sustained

• Resting heart rate elevated: Often a sign of accumulated fatigue, incomplete recovery, or impending illness; back off intensity

The goal isn't to self-diagnose. It's to have data that helps you make better decisions — and to walk into your doctor's office with trends, not just symptoms.

Key Takeaway

High-stress occupations demand more from the body than most other jobs. The standard "reduce your stress" advice doesn't acknowledge that reality. What does work is getting ahead of the damage — tracking objective markers of strain, understanding how your body is actually recovering, and intervening early when things start trending in the wrong direction.

You chose this work because it matters. Protecting your health isn't about stepping back from that commitment — it's about making sure you can sustain it for the long haul.

The first step is visibility. You can't optimize what you can't see.

Hundred Health + CAL FIRE Local 2881

Hundred Health is partnering with CAL FIRE Local 2881 to give first responders and their families the visibility they need into their health. By consolidating wearable data, lab results, health history, and lifestyle data into one secure system, Hundred helps high-stress workers track what matters — and catch problems before they become crises.

Dive deeper: Frequently asked questions

What biomarkers should first responders track?

Key markers include inflammatory markers (hs-CRP, IL-6), metabolic markers (fasting glucose, HbA1c, triglycerides), cardiovascular markers (lipid panel, blood pressure trends), hormonal markers (cortisol rhythm, testosterone, DHEA-S), and HRV via wearable. The goal is tracking trends over time, not obsessing over single readings.

How does shift work affect recovery?

Shift work disrupts circadian rhythms, including your cortisol pattern. Research shows different shift cycles have measurably different effects on cortisol recovery — some schedules allow full recovery while others don't. This affects sleep quality, metabolic function, immune response, and cardiovascular health.

Why doesn't standard wellness advice work for firefighters and first responders?

Standard advice like "sleep 8 hours," "exercise regularly," and "reduce stress" assumes you can control your exposure. First responders often can't — the job is the stressor. What works instead is proactive monitoring: tracking biomarkers, understanding recovery capacity, and intervening early when trends go in the wrong direction.

How often should first responders get bloodwork done?

For high-stress occupations, annual physicals often miss developing problems. Consider comprehensive bloodwork every 6 months, or quarterly if you're actively addressing concerning trends. Wearable data (HRV, resting heart rate, sleep) can be tracked continuously to fill the gaps between lab work.

References

1. Ras J, Kengne AP, Smith DL, Soteriades ES, Leach L. Association between Cardiovascular Disease Risk Factors and Cardiorespiratory Fitness in Firefighters: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2023;20(4):2816. doi:10.3390/ijerph20042816

2. Smith DL, Haller JM, Korre M, et al. Pathoanatomic Findings Associated With Duty-Related Cardiac Death in US Firefighters: A Case-Control Study. J Am Heart Assoc. 2018;7(18):e009446. doi:10.1161/JAHA.118.009446

3. Lim GY, Jang TW, Sim CS, Ahn YS, Jeong KS. Comparison of Cortisol level by Shift Cycle in Korean Firefighters. Int J Environ Res Public Health. 2020;17(13):4760. doi:10.3390/ijerph17134760

4. Burgess JL, Duncan MD, Hu C, et al. Acute cardiovascular effects of firefighting and active cooling during rehabilitation. J Occup Environ Med. 2012;54(11):1413-20. doi:10.1097/JOM.0b013e3182619018

5. Guerra BC, Martin SE, Colvin LC, et al. Firefighters Versus Law Enforcement Officers: A Comparison of Cardiovascular Disease Risk. Int J Exerc Sci. 2025;18(6):659-671. doi:10.70252/WHUP7091

6. Jahnke SA, Poston WS, Haddock CK, Murphy B. Firefighting and mental health: Experiences of repeated exposure to trauma. Work. 2016;53(4):737-44. doi:10.3233/WOR-162255

7. Pao C, Arbona C, Fan W, Tran J. Duty-related trauma and PTSD symptoms in US urban firefighters. Occup Med (Lond). 2023;73(6):324-331. doi:10.1093/occmed/kqad076

8. Manoogian ENC, Zadourian A, Lo HC, et al. Protocol for a randomised controlled trial on the feasibility and effects of 10-hour time-restricted eating on cardiometabolic disease risk among career firefighters doing 24-hour shift work. BMJ Open. 2021;11(6):e045537. doi:10.1136/bmjopen-2020-045537