Under pressure: life in a relegation dogfight

As Wolves face a six-pointer against Burnley, Glenn Moore joins Mick McCarthy for a medical to find out how much stress a manager feels in a bottom-of-the-table scrap – and to ask who will escape the drop

Mick McCarthy is beginning to sweat, his breath is coming in short bursts as he gulps for air, his face is etched with strain. He is not having a nightmare at the prospect of Wolves' match at Turf Moor this afternoon; he is making sure his heart is as prepared for the battle against relegation as he hopes his team is.

The Wolverhampton Wanderers manager is enduring a stress test, a measure of his heart's ability to recover from being placed under the sort of strain imposed by Premier League management. Last weekend, for example, McCarthy watched powerlessly as Sam Vokes missed an open goal in injury-time which would have snatched Wolves an equaliser against Manchester United. McCarthy's anguish was writ large and his heart-rate, already raised for the previous 90 minutes' action, will have rocketed.

The result left Wolves out of the relegation zone but above today's opponents only on goal difference. McCarthy said, "If someone had given me where we are now, and the games we have got I'd have taken it. It's two [with Portsmouth] from seven but I'm not bothered who goes down as long as we finish above them."

At Turf Moor today and at the Reebok where Bolton meet Wigan in another relegation battle there will be more "heart-stopping" moments like Vokes's miss for the managers to deal with. It is impossible to replicate that experience, but it is possible to put the human heart under similar strain with physical activity, and measure the speed with which it returns to normal. And that is the measure of whether a manager's heart can cope with his job.

Ideally this is done on a treadmill, as I will find out, but McCarthy's ankles are shot, the legacy of 562 senior games as a centre-half, and running is out. Instead he climbs on to the exercise bike, and starts pedalling. The pace is gentle at first, then the resistance is increased until the Wolves manager has a sweat on. Soon he is straining for air, a task made more difficult by the fact he has to breathe through a tube so his aerobic capacity can be measured. He is also wired up with 10 electrodes attached to his chest to monitor his heart rate and rhythm. Finally McCarthy signals enough and the bike is switched to warm-down mode.

This cardiovascular test is the key element of the six-monthly check-up McCarthy has under the "Fit to Manage" programme offered by the League Managers' Association, with funding from the Premier League. Although no British football manager has died from a touchline heart attack since Jock Stein collapsed during Scotland's World Cup qualifying play-off at Cardiff's Ninian Park in 1985 there have been enough scares to underscore the value of McCarthy's test. Gérard Houllier and Joe Kinnear have suffered cardiac arrest during Premier League matches while Sam Allardyce is only the latest of many managers to have required medical intervention after experiencing heart problems.

"It is not an exaggeration to say the health check has probably saved lives," said Tricia Kalloo, the chief executive officer of Wellness International, the Stockport-based health assessment centre which conducts the tests for the LMA. A frighteningly high 25 per cent of managers are referred for further tests. All are given advice on lifestyle, especially diet, and are monitored on a regular basis.

The programme was set up after Allardyce and Dave Bassett were wired up to heart monitors during a Premier League match. Allardyce's readings, in particulars, alarmed doctors. His heartbeat rose to a worrying degree for a man doing nothing more strenuous than standing in a technical area, shouting. After that the LMA collaborated with Wellness International to create an assessment programme for managers, modelled on one devised for CEOs.

"Fit to Manage" was launched in 2001 and McCarthy, then managing the Republic of Ireland, was one of the first to take part. He became an immediate convert. "I know I am in good shape on the outside," he said. "I try and keep myself in good shape, I always have done. But that's on the outside. You don't know what is going on inside. So I come here and get my ticker checked out."

Wellness International do around 80 managerial assessments a year under the LMA programme. That sounds like a high proportion of the 92 coaches are participating, until you discover it includes those who are currently between jobs, like Roy McFarland who comes in later the same day, and former managers now working as assistants. In fact more than two-thirds of the eligible managers do not bother. That includes all the foreign managers except Roberto Martinez who has attended in the past.

McCarthy cannot understand why so many of his peers do not take the test. Wellness is soon to open a London centre which should increase take-up although McCarthy does not think the location is a valid excuse as most clubs play in the North-west several times a season. He does have an intriguing theory. "I think some people are scared of what they might find out. Some say they don't have time. I'm not having that. You can always make time. We should all do it and we don't.

"Look at Gérard Houllier. He had this test booked, but didn't come, and ends up in hospital. The job is stressful, it's high-pressure, high-maintenance, very public. The games are stressful. Sam's heart-rate was higher at that game when he was wired up than when he fell off the running machine. We're in the middle of playing Bolton away, Man U at home, Burnley away and Villa at home. That's stressful. You don't really switch off, you'll be watching TV and thinking, 'should I play him, or him?' Results affect you and the disparity between the feelings is wrong. You are not high as a kite when you win, but when you lose you are very low.

"But the real pressure, the guys who really should come here, is down below in the second division, doing your first job. It's less magnified but they have all the same problems Alex [Ferguson] and I have but with less back-up. They'll be doing warm-ups, strength and conditioning, scouting, everything.

"And when you are new into the job, you know if you lose your job you might not get another one. That adds huge pressure. You are not thinking about it on a daily basis, but does it help you think clearly on the touchline? If you have lost a couple, the crowd's on your back, the chairman's on your back, that pressure does not help you think clearly. Experience helps, and a bit of job security does, knowing you have a bit of a CV, that people recognise you can do the job. It means it is not the job you are concerned about, you are concerned about results, about the team, not about your livelihood. That first job I had at Millwall, when a bit of pressure came in you think, 'what am I going to do next? No one else is going to give me a job'. A lot of managers do not get second jobs."

The test is available to anyone, not just football managers. The standard test, without the bespoke aftercare monitoring that managers receive, is £465. McCarthy said: "People won't spend that on looking after themselves, but are happy to pay it when they take the car in for the annual service and MOT. You can always get another car, but you've only got one body."

How effective is the test? There is only one way to find out. After completing a lengthy and all-too-revealing lifestyle and diet questionnaire, along with a medical history form, I am asked to provide urine and blood samples to assess cholesterol and glucose levels. Measurements are taken of height, weight, fat percentage and waist circumference. My lung capacity is measured via a device akin to a snorkel. Then comes the nasty bit. Several parts of my chest are shaved, swabbed, and covered with sticky pads to which electrodes are attached. Then I am directed to the treadmill.

The initial pace is walking, though one manager gave up after two minutes of this. Steadily the pace and incline are increased. The room is cold but I'm getting warm. Soon I am also gulping for air – I am still wearing the snorkel– and trying to set time and distance targets to keep going. At 17 minutes, which I am later told is about average, with visions of collapsing on the treadmill and being thrown off the back, I give the thumbs down and the machine is mercifully slowed.

The tests do not pick up everything. They would not have spotted the stroke which cost Keith Alexander his life. But they do pick up warning signs for cardiac arrest and diabetes, two dangers which football managers, due to their age and lifestyle, are at a high risk of suffering.

McCarthy, now 51 and a manager for nearly 20 years, added: "It gives you a bit of comfort and security. It pricks your conscience every six months, just gives you that little jolt if you are not doing enough. They get on your case about how much you drink, what you eat, what's your diet. When I go away I always feel better about myself. We should all do it, but we don't."

Who will stay up? Race to beat the dreaded drop

14th: Bolton

Owen Coyle's side have six of the top 10 still to play, including trips to Man United, Aston Villa and Spurs, but winnable home games with Wigan and Portsmouth may be enough to keep them up.

Odds to be relegated: 15/2

15th: Wigan

Games against those around them, beginning with today's trip to Bolton, could make it a nervy end to the season for Roberto Martinez's erratic side. Still to visit Man City and Chelsea and host Aston Villa and Arsenal.

Odds: 7/1

16th: West Ham

With just one away win all season and trips to Chelsea, Arsenal and Liverpool to come, will have to maintain their fine home form to have a chance of staying up.

Odds: 7/1

17th: Wolves

Recent upturn in performances and winnable games against teams with little to play for could be the saving grace for Mick McCarthy's team.

Odds: 11/10

18th: Burnley

With games against the Big Four out of the way, they will have to return to winning ways at Turf Moor to stand any chance of staying up, given their horrific record on their travels.

Odds: 2/5

19th: Hull

With just one win in the last 14 matches Phil Brown's side have it all to do to replicate last season's escapades. A number of winnable games in April could aid cause.

Odds: 8/11

20th: Portsmouth

Likely nine-point deduction remains hovering overhead. Avram Grant's side are running out of chances and with games against Chelsea, Tottenham, Everton, Liverpool and Aston Villa on the horizon, appear doomed.

Odds: 1/500 (Bet365)

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