They are heart attacks waiting to happen. And the season has barely even started

A study reveals one in three football managers has heart trouble. By Steve Tongue and Andrew Johnson

They scream from the touchline. They tear their hair out. They rage at referees. They know that one bad result too many could cost them their job and jeopardise the future of the entire club. Failure can't be tolerated, yet the threat of it is there with every game. And the pressure doesn't go away with the final whistle. These men have to live with it every moment of their waking lives. No wonder a third of football managers are suffering heart problems.

As the new season gets under way, that is the shocking finding of a study by the body that represents managers in the Premiership and Nationwide League. The illnesses suffered in recent seasons by such high-profile managers as Gérard Houllier, Graeme Souness and Glenn Roeder were a dramatic indication of the stress of modern-day football. Now a survey of more than half of the managers of the 92 professional clubs has confirmed just how bad for your health it is.

The study, carried out by the League Managers Association (LMA), found that heart problems affected 15 of the 47 men who volunteered for testing at the Adidas Wellness Centre in Cheshire. John Barnwell, the chief executive of the LMA and a former manager of Wolverhampton Wanderers, called the figures "staggering ... frightening". He hopes that the other 45 managers of English clubs will now sign up for the programme.

"Although some clubs may give them private healthcare, they would [only] be checked at the end of the year," Barnwell says. "This scheme allows us to monitor their whole year and can become more of a preventive measure. Think back to managers like Jock Stein, Graeme Souness, Barry Fry, Gérard Houllier and Joe Kinnear. We only found out about those after the problem had got worse."

Stein, one of the greatest managers in the sport's history, died of a heart attack suffered while watching Scotland play a World Cup match against Wales 18 years ago. Fry, a self-confessed workaholic now with Peterborough United, has had three attacks. Souness needed a triple bypass after an FA Cup semi-final. Houllier, one of his successors as manager of Liverpool, collapsed at half-time during a match in October 2001 and needed 11 hours of surgery. Kinnear had a heart attack during a game between Sheffield Wednesday and Wimbledon two years earlier.

Yesterday West Ham United's Glenn Roeder was back on the touchline for his first competitive match since a life-saving operation for a brain tumour in April. Roeder, 47, does not believe that was stress-related, but his case illustrates most of the pressures facing managers. He took the job in 2001 and led the team to a highly creditable seventh place in his first season. But last season West Ham struggled throughout and Roeder became the target of abuse from some supporters. On the morning of a home game against Middlesbrough on Easter Monday, a full can of beer was thrown through the closed window of his young daughter's bedroom. It was after that match that he was taken ill, missing the rest of the season.

Dr Dorian Dugmore, the heart specialist who has run the Fit to Manage programme since it was launched a year ago, believes football managers suffer stress levels higher than their counterparts in industry because they are constantly in the public eye and in even more danger of the sack. When Dr Dugmore arranged for the Bolton Wanderers manager Sam Allardyce to have his heart rate monitored during a match, it was found to be between two and three times the norm.

Mr Barnwell said: "It is the intensity of the job which makes management so difficult. Almost all managers are former players who have led a very fit life. But when they become managers all of a sudden they are concerned about looking after everybody else except themselves.

"It is a year-long programme and expensive to run, but it helps them to understand how to adjust their lifestyles. This is the only job where your performance can be analysed every single day."

Cary Cooper, a professor of occupational psychology at the University of Manchester Institute of Science and Technology, said he was surprised only a third of managers had heart problems. "In effect, they are chief executives. They have to build a team and are dealing with all sorts of stakeholders - the media, the board, the fans," he said. "But chief executives have two or three years to prove themselves; football managers have months."

* The opening match of the season for First Division clubs Watford and Coventry was called off yesterday after a player was killed en route. Jimmy Davis, 21, on loan to Watford from Manchester United, died yesterday morning following an accident on the M40 in Oxfordshire