Cardiovascular stress in football referees

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.