Cardiovascular Stress in Football Referees

Urhausen A 1, 3, 4; Vivas JP 1 ; Lambert C 2 ; Weiler B 1

1 - CENTRE HOSPITALIER DE LUXEMBOURG, Sports Clinic , Luxembourg, Luxembourg

2 - UNIVERSITY OF WITTEN/HERDECKE, Department of Trauma and Orthopedic Surgery, Cologne Merheim Medical Center, Cologne, Germany

3 - LUXEMBOURG INSTITUTE OF HEALTH, Human Motion, Orthopaedics, Sports Medicine and Digital Methods, Luxembourg, Luxembourg

4 - LUXEMBOURG INSTITUTE OF RESEARCH IN ORTHOPAEDICS, SPORTS MEDICINE AND SCIENCE, Luxembourg, Luxembourg

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Summary

Problem:

As opposed to athletes, the cardiovascular strain of referees during a competition is neither systematically explored nor included in their cardiovascular screening programs.

Methods:

Twenty-one referees from the two upper Luxemburgish football divisions were monitored during and after a match with an ambulatory Holter electrocardiogram. The results were compared to a sports cardiological check-up including a maximal incremental test on the treadmill.

Results: During the match, the referees evolved in average 17%, 32%, 34% and 17% in the “regenerative” (<80% of the HR of individual anaerobic threshold, IAT), “extensive” (80 - 87.5% IAT), “intensive” (87.6 - 102.5% IAT) and “high intensive” (>102.5% IAT) zones. During the match, the mean (154 ± 11 bpm, mean ±SD) and maximal HR (180 ± 10 bpm) were only slightly lower than at the IAT (161 ± 9 bpm) and the end of the treadmill test (183 ± 11 bpm), respectively. ECG only revealed minor arrhythmias both during Holter monitoring and ergometry on the treadmill, but a higher incidence of premature beats during the 1.5h of the match than during the 15.5h off-match period. One referee showing significant ST segment depressions during the match suffered from a sudden cardiac exercise-associated event two years later.

Conclusion:

Football referees experience significant cardiovascular strain. A systematic endurance training is indispensable for football referees. Regular health monitoring, including a maximal exercise test on a treadmill ergometer, should be recommended not only for athletes but also for football referees.