The hazards of watching football — are Australians at risk?

Sudden stress or anger may trigger cardiac events or sudden death. Increased rates of these events have been noted during war or after earthquakes1,2 and also immediately following stressful national and international sporting events.3 Football, particularly soccer, is the most noteworthy and oft-reported cause of such acute population stress, indignation and anger. These responses may be induced by close matches, by national pride, or by referee errors regarding the “offside rule”; one study showed the rate of referee errors to be as high as 26%.4 In a Swiss study, sudden cardiac deaths increased around the time of the 1998 and 2002 World Cup matches.5,6 In England, a 25% increase in hospital admissions from cardiovascular causes was noted in the 2 days following the 1998 World Cup penalty shoot-out between England and Argentina,3 when the match was decided in Argentina’s favour (4–3). Another study has shown similar soccer-related cardiac risks in the Netherlands during the 1996 European championship.7

We assessed these risks in Australian populations, specifically New South Wales residents, during two stressful sporting events in 2005: the Sydney Swans’ appearance in the 2005 Australian Football League (AFL) Grand Final, and Australia’s World Cup soccer qualifying match against Uruguay. Our central hypothesis was that Australian Sports Spectator Behaviour (ASSB) would protect spectators from risks induced by sport-related stress.

Biologically, it does not appear likely that Australian populations are less prone to vascular hypercoagulability and haemodynamic changes (thought to be the mechanism linking major emotional turmoil and thrombogenesis3) than European spectators. Identifying spectator-protective genetic markers may be a useful research endeavour, to ascertain why Australian lounge chair-adherent enthusiasts have a selective advantage, compared with their European counterparts.

A recent report in the BMJ8 described a newly Australian-discovered condition, motivational deficiency disorder (MoDeD), that is characterised by pervasive psychosocial and physical inertia. This condition has only been described by Australian scientists.8 Our data provide some indirect validity of MoDeD’s existence. However, instead of costing millions of dollars in associated health care costs, the prevalent syndrome in the sport-spectator population may actually protect against acute sport-watching-related cardiovascular events. Further, this syndrome, that has been dismissed by many,9 may be part of a cluster of diseases previously described as “hypokinetic disorders”,10 which includes other conditions such as the “couch potato syndrome”, also known as SeDS (sedentary death syndrome).10 Treatment with Indolebant is recommended for MoDeD,8 and Brazilian physicians have prescribed Agitol or Exercil for treatment* of SeDS.11 However, during times of acute sporting stress, we suggest that these medications be discontinued as the cardioprotective benefits may be lost.

An alternative explanation may lie in cultural practices that ameliorate adverse emotional responses, especially seen as part of ASSB. Incomplete concentration or lack of full engagement with the sporting event may be produced by extremely frequent exposure to sports telecasts; by aggravation caused by rapid channel changing; and by transitional blurring induced by alcohol consumption and large comfortable chairs. Other potential confounders that might mask any apparent relationship include temperature and weather differentials (it doesn’t get cold enough in Australia to induce myocardial stress), and language and cultural differences (it’s more stressful to barrack in a Yorkshire accent, or in Dutch); these factors should be considered in future research.

A final possible explanation might be characterised as “Winners are Grinners”, where the adverse health effects in stressful sporting events seem to be confined to supporters of the losing teams. If this hypothesis is proven, it could result in increased financial investment in teams that do well and in sports where Australia is likely to win, as this may confer public health advantages as well as stimulating sporting nationalism. Following the French victory in the 1998 soccer World Cup, heart attack rates were, if anything, lower than usual in France.12 As both of the matches we studied ended in victory for the local supporters, this could be the protective factor in our study. This theory can now be empirically tested, when data from the period following the 2006 AFL Grand Final are available: identical teams but a reversed result. Another Antipodean factor is that the national sporting interest is spread across four football codes, which could dilute the acute code-specific population risk. Euro-soccer fanaticism, directed at a single dominant code, may induce the increased risk demonstrated in European studies.

Overall, it is probably safe for the Australian population to watch telly over the Christmas break — even to watch the Ashes Test series — with minimal increased cardiac risk. We are likely to win, anyway. No worries, mate.