Human Limits

Exploring performance and health with Michael J. Joyner, M.D.

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Is The Super Bowl Dangerous?

Super Bowl Sunday is about to land on us again.  I will leave to others to analyze the football, advertising, TV viewership and economic impact statistics associated with the game.  I want to cover the potential health related effects of the big game – on fans – not the players.  So here is a list of some of the main risk of mass spectator sporting events.


1.     Heart Attacks

The risk of heart attack during and after the game goes up especially in people (middle aged and older men) who have multiple risk factors and are passionate fans of team that loses.  There is also some interesting data from Germany showing a 2-3 fold increase in emergency room admissions for cardiovascular events when Germany was playing.  This study concluded that:


“Viewing a stressful soccer match more than doubles the risk of an acute cardiovascular event. In view of this excess risk, particularly in men with known coronary heart disease, preventive measures are urgently needed.”


Here is a chart from that study, the 2006 data is from the World Cup year, the 2003 and 2005 is data from years with no World Cup:




My advice for passionate fans who know they have heart issues to make sure they take their medicine the day of the game.  These folks also need to remember that no matter who wins or loses, the sun will come up in the morning and the key is to make sure they do too.


2.     Terrorism & Stampedes

The idea that the Super Bowl or some other major sporting event might be the target for a terrorist attack is nothing new.  However, as I searched for information on this topic the issues of fan stampedes at major public events popped up.  This is a particular problem in the developing world but events have occurred all over and one of the most notorious is the Hillsborough disaster in the UK.  It appears that the risk of stampedes can be reduced considerably via a combination of effective crowd control and better stadium design.  The authorities responsible for Super Bowl XLVIII should be able to prepare for either of these possibilities and hopefully they will have a bit of luck too.


3.     Riots & Hormones?

Riots in one of the participating cities (Seattle or Denver) are a possibility.  What is interesting is that rioting in the city of the winning team is not unusual.  There are all sorts of theories about what triggers these riots, but one idea is that there is a hormonal surge especially in the young men who are passionate fans via the sociology of “basking in reflected glory”.


“Basking in reflected glory, in which individuals increase their self-esteem by identifying with successful others, is usually regarded as a cognitive process that can affect behavior. It may also involve physiological processes, including changes in the production of endocrine hormones. The present research involved two studies of changes in testosterone levels among fans watching their favorite sports teams win or lose. In the first study, participants were eight male fans attending a basketball game between traditional college rivals. In the second study, participants were 21 male fans watching a televised World Cup soccer match between traditional international rivals. Participants provided saliva samples for testosterone assay before and after the contest. In both studies, mean testosterone level increased in the fans of winning teams and decreased in the fans of losing teams. These findings suggest that watching one’s heroes win or lose has physiological consequences that extend beyond changes in mood and self-esteem.”


These surges might then drive violent or territorial behavior after the game and some people think that the mere presence of the police trying to keep a victory celebration in line might actually contribute to the problem.  These sorts of data drive all sorts of speculation about the evolutionary biology of behavior for other hormones like cortisol which can also rise in fans:


The cortisol data from this study are in line with social self-preservation theory, as higher cortisol secretion among young and greater soccer fans suggests that especially they perceived that a negative outcome of the match would threaten their own social esteem.”


Win Drink & Be Violent?

There is also all sorts of evidence that excessive fan drinking can contribute to most of the problems outlined above and winning may amplify the urge to drink and perhaps feed into some of the effects of hormones on “bad” postgame behavior here is the summary from a study on Rugby fans:


“… success but not failure may increase aggression among supporters, and…..aggression, not celebration, drives post-match alcohol consumption. Losing and drawing decreased happiness but winning did not increase it. Better understanding of pathways to violence in these circumstances will pave the way for more effective prevention and management strategies.”


Beyond drinking there is also some evidence that illicit drug use in the host cities goes up as well.


What to Do?

The take home messages from the data above are pretty clear cut.   If you have known cardiac issues make sure you take you meds and be aware that simply watching the game on TV is not risk free.  If you are watching the game with folks who might have health issues and they develop chest pain, shortness of breath or an irregular heartbeat, call 911.   If you are out in a crowd of revelers, pay attention to your surroundings and avoid situations where you could be trapped with no escape route.  Finally, how much do you really need to drink?   Have a few but not a few too many.


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