To the Editor:
Research suggests a link between spectator sports and an increased risk of cardiovascular events. 1 , 2 Most of the literature involves European soccer, with some but not all studies reporting that cardiovascular mortality rises during a closely contested match. 3 , 4 , 5 An increase in total and cardiovascular death was also reported in Los Angeles County associated with a local team’s Super Bowl loss. 6 A contributing factor responsible for the increased cardiovascular risk of spectator sports may be a catecholamine‐induced rise in blood pressure (BP) and heart rate resulting from psychological stress while watching the game. Herein, we report our investigation of the hemodynamic responses of a group of New York sports fans during the 2009 baseball World Series and National Football League playoffs.
Methods
Participants were recruited to wear an ambulatory BP monitor (Oscar 2; SunTech Medical, Morrisville, NC) on the day of the sporting event and throughout the game. Forty‐two persons agreed to participate in this institutional review board–approved study. Participants completed a questionnaire regarding their age, sex, diagnoses, medications, type of fan (casual vs “diehard”), and whether they wagered on the game. Thirty‐one New York Yankees fans participated in the baseball portion of the study, and a total of 11 New York Giants and New York Jets fans participated in the football portion. One participant wore a monitor for both sports. For baseball, the games studied included the American League Championship and World Series. For football, the games studied included weeks 16 and 17 of the regular season (games with playoff implications) and the American Conference Championship game.
Participants were instructed to begin monitoring the day of the sporting event and continue until completion of the game. Heart rate and BP were recorded every 30 minutes prior to the event and every 20 minutes during game time. Participants recorded a minimum of 3 hours worth of readings prior to game time to serve as a baseline and then watched the game on television. Comparisons were made between average pregame and game time values for heart rate (HR), mean arterial BP (MAP), and the “double” product (DP) of the two parameters.
Paired sample t tests were used to assess differences in the 3 outcome measures comparing baseline with game values. Independent sample t tests were used to test for sports group differences. Independent sample t tests were used to test for possible baseline group differences for the outcome measures and for continuous level demographic measures. Chi‐square and Fisher’s exact tests were used to test for possible baseline group differences for categoric demographic measures. Statistical analyses were conducted with IBM SPSS statistical software, version 17.0 (SPSS Inc, Chicago, IL).
Results
Baseline characteristics were not significantly different for baseball and football fans, which included analyses for age, sex, history of hypertension, coronary disease, hyperlipidemia, diabetes, use of β‐blockers, fan type, and wagering. Baseball fans demonstrated a highly significant drop in MAP and DP during game time compared with baseline, whereas heart rate did not vary significantly (Table). Football fans showed a rise in MAP and DP during the game that trended toward, but did not reach statistical significance, whereas heart rate did not differ. When comparing the two sports, the fall in MAP and DP in baseball fans was significant compared with the rise seen in football fans.
Table.
Heart Rate and Blood Pressure Responses in Baseball and Football Fans
| Parameter | Day, Mean (SD) | Game, Mean (SD) | % Change | P Value |
|---|---|---|---|---|
| Baseball (n=31) | ||||
| HR | 70.3 (8.4) | 68.5 (8.6) | −2.6 | .16 |
| MAP | 103.2 (9.7) | 96.9 (12.4) | −6.1 | .001 |
| DP | 7087.3 (1219.9) | 6654.7 (1297.3) | −6.1 | .001 |
| Football (n=11) | ||||
| HR | 71.7 (11.6) | 71.8 (16.0) | 0.1 | .97 |
| MAP | 102.0 (13.0) | 105.0 (15.9) | 2.9 | .10 |
| DP | 7434.2 (2350.0) | 7691.8 (2635.3) | 3.5 | .06 |
| Parameter | Baseball Day to Game, Mean Difference (SD) | Football Day to Game, Mean Difference (SD) | P Value |
|---|---|---|---|
| Comparative | |||
| HR | −1.7 (6.6) | 0.1 (7.3) | .45 |
| MAP | −6.3 (9.4) | 3.0 (5.4) | .004 |
| DP | −432.6 (636.1) | 257.6 (395.4) | .002 |
Abbreviations: HR, heart rate; MAP, mean arterial pressure, SD, standard deviation. Double product (DP)=HR × MAP.
Comment
Sports fans typically have a profound emotional attachment to their favorite teams. Accordingly, potentially adverse physiologic alterations may occur in spectators. This has been a hypothesis to explain the observed rise in cardiovascular emergencies during sporting events. 1 , 2 The relative intensity of different sports may produce variable responses. Our results suggest that watching football is associated with a rise in BP and DP during the game, in contrast to baseball, which shows a comparative fall. Of note is that fans of the eventual champion Yankees were more often able to celebrate victories, whereas Jets and Giants fans ultimately experienced more defeats. Further study is required to determine whether observing a victory or defeat in either sport is salutary or detrimental.
Author contributions:
All the authors contributed to the final version of the manuscript. Dr Zimmerman had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Zimmerman. Acquisition of data: Deborah Okoniewski, FNP, and Holly McNamara, ANP. Analysis and interpretation of the data: Zimmerman, Fass, and Katz. Drafting of the manuscript: Zimmerman. Critical revision of the manuscript for important intellectual content: Fass, Katz, and Cole. Statistical analysis: Cole. Obtained funding: Zimmerman. Administrative, technical, and material support: Zimmerman, Fass, and Katz. Study supervision: Zimmerman. Financial disclosure: None. Funding/Support: SunTech Medical, Morrisville, NC, provided ambulatory monitors.
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