Nearly half of football managers suffer serious heart problems

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Almost half of England's football managers have "significant" heart problems and their life-consuming, high-pressure jobs are a "recipe for potential disaster" according to one of the world's leading cardiovascular experts.

Almost half of England's football managers have "significant" heart problems and their life-consuming, high-pressure jobs are a "recipe for potential disaster" according to one of the world's leading cardiovascular experts.

Dr Dorian Dugmore, the secretary general of the World Council for Cardiopulmonary Rehabilitation, has spent two years monitoring managers' health - and advising on ways to improve it - and will present his findings at a series of major international conferences in Europe and America from next month. The most alarming statistic is that 44 per cent have "significant cardiovascular risk factors, some needing immediate attention."

Dugmore has identified conditions in managers including atrial fibrillation (a chaotic, irregular heartbeat arising from the top chambers), aortic stenosis (the narrowing and hardening of the heart's main outflow valve), ventricular ectopy (an irregular heartbeat arising from the main chambers), high blood pressure and dangerous levels of cholesterol.

There is a growing consensus that football managers are especially susceptible to heart disease. Jock Stein's death from a heart attack at a Wales-Scotland game in 1985 prompted Dugmore to begin detailed research. Numerous incidents since have highlighted managers' health concerns.

Graeme Souness and Gérard Houllier are among those to have major heart surgery. In 2003 Dario Gradi had a heart valve replaced and a pacemaker was fitted to Sir Alex Ferguson. Joe Kinnear and Barry Fry (twice) have suffered heart attacks.

"For every case that reaches the public domain, there's one that doesn't," Dugmore said.

It is believed that more than one manager has resigned or been forced to step down in recent years after a diagnosis of a serious heart problem that has never been made public.

Other managers with recent serious health problems include Glenn Roeder, who collapsed in 2003 and was diagnosed with a brain tumour requiring surgery, and Keith Alexander, who in the same year suffered a ruptured cerebral aneurysm, which led to a brain haemorrhage.

Dugmore, the director of Wellness International, based in Manchester, is also concerned about the potential in managers for atherosclerosis, a furring up of arteries, especially coronary arteries. "It's the commonest cause of sudden death in older athletes," he said. "Of course, as most managers are former players, they fall into this category.

"They are particularly susceptible because when their playing days stop, they stop training but eat the same or more. They put on weight, especially around the waist, accelerating the problem. And they work long hours and are subject to a lot of stress."

As The Independent's survey of managers exclusively revealed yesterday, they work an average of 80 hours per week, rising to 87.5 hours in the Premiership.

"There's added stress in being a manager because of constant job insecurity," said Dugmore, whose work at Wellness aims to reduce illness, largely heart-related, in the corporate world.

"The health problems they exhibit are similar to chief executives of major companies, but exacerbated by having their every move examined under the spotlight. They are under constant pressure.

"Some drink too much, which adds to the problem. They travel a lot, which means their diet isn't always the best. Their blood fats, blood sugars and blood pressures rise. Add all that together and it's a recipe for potential disaster."

Dugmore's first high-profile study of managers' health was in 2001, when Sam Allardyce and Dave Bassett were subjected to stress testing.

Allardyce's resting heart rate was 46bpm and Bassett's 55bpm, both rated "very good". Under maximum stress on a treadmill, Allardyce's rate reached 146bpm, but during a match, on the sidelines, it soared to 162bpm. Bassett's blood pressure during a match also rose above the level recorded at maximum exertion on the treadmill. Both men's cholesterol levels rose during matches.

A longer-term pilot study of 12 managers, including Kevin Keegan and Mick McCarthy, preceded this case study, and led to a much larger two-year study involving more than half the League's managers. The results from the latter study will be presented internationally and the revealing findings have led to a four-year research extension.

Dugmore's work with managers has been undertaken with the full support of the League Managers' Association, the chief executive of which, John Barnwell, sees the health of his members as a pressing issue.

The Professional Footballers' Association has paid for much of Dugmore's work with managers for the past two years and the Premier League recently agreed to pick up the funding for the next four.

The most positive aspect of Dugmore's work is that 75 League managers are now enrolled in the Wellness "Fit To Manage" programme, where they are regularly monitored and advised on nutrition, exercise, and lifestyle change programmes which include smoking cessation and alcohol reduction.

"We're starting to see some positive changes," Dugmore said. These include improvements in blood pressure and cholesterol levels. The key is that managers stay on the programme long-term. The danger is that the modern game is so demanding.

"I'm sure that managers back in the Sixties or Seventies were presenting symptoms of work-related health problems, but not to any such extent as now," Dugmore said. "The expectations, pressure and financial imperatives of the game mean the stakes have never been higher."