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O’Shea CJ, Thomas G, Middeldorp ME, Harper C, Elliott AD, Ray N, Lau DH, Campbell K, Sanders P. Ventricular arrhythmia burden during the coronavirus disease 2019 (COVID-19) pandemic. Eur Heart J 2021; 42:520-528. [PMID: 33321517 PMCID: PMC7953962 DOI: 10.1093/eurheartj/ehaa893] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/18/2020] [Accepted: 10/13/2020] [Indexed: 12/17/2022] Open
Abstract
AIMS Our objective was to determine the ventricular arrhythmia burden in implantable cardioverter-defibrillator (ICD) patients during COVID-19. METHODS AND RESULTS In this multicentre, observational, cohort study over a 100-day period during the COVID-19 pandemic in the USA, we assessed ventricular arrhythmias in ICD patients from 20 centres in 13 states, via remote monitoring. Comparison was via a 100-day control period (late 2019) and seasonal control period (early 2019). The primary outcome was the impact of COVID-19 on ventricular arrhythmia burden. The secondary outcome was correlation with COVID-19 incidence. During the COVID-19 period, 5963 ICD patients underwent remote monitoring, with 16 942 episodes of treated ventricular arrhythmias (2.8 events per 100 patient-days). Ventricular arrhythmia burden progressively declined during COVID-19 (P < 0.001). The proportion of patients with ventricular arrhythmias amongst the high COVID-19 incidence states was significantly reduced compared with those in low incidence states [odds ratio 0.61, 95% confidence interval (CI) 0.54-0.69, P < 0.001]. Comparing patients remotely monitored during both COVID-19 and control periods (n = 2458), significantly fewer ventricular arrhythmias occurred during COVID-19 [incident rate ratio (IRR) 0.68, 95% CI 0.58-0.79, P < 0.001]. This difference persisted when comparing the 1719 patients monitored during both the COVID-19 and seasonal control periods (IRR 0.69, 95% CI 0.56-0.85, P < 0.001). CONCLUSIONS During COVID-19, there was a 32% reduction in ventricular arrhythmias needing device therapies, coinciding with measures of social isolation. There was a 39% reduction in the proportion of patients with ventricular arrhythmias in states with higher COVID-19 incidence. These findings highlight the potential role of real-life stressors in ventricular arrhythmia burden in individuals with ICDs. TRIAL REGISTRATION Australian New Zealand Clinical Trial Registry; URL: https://www.anzctr.org.au/; Unique Identifier: ACTRN12620000641998.
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Affiliation(s)
- Catherine J O’Shea
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
| | - Gijo Thomas
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
| | - Melissa E Middeldorp
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
| | | | - Adrian D Elliott
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
| | | | - Dennis H Lau
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
| | - Kevin Campbell
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
- PaceMate, USA
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
- Corresponding author. Centre for Heart Rhythm Disorders, Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA 5000, Australia. Tel: +61 883139000, Fax: +61 883622273,
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Wang H, Liang L, Cai P, Zhao J, Guo L, Ma H. Associations of cardiovascular disease morbidity and mortality in the populations watching major football tournaments: A systematic review and meta-analysis of observational studies. Medicine (Baltimore) 2020; 99:e19534. [PMID: 32195956 PMCID: PMC7220255 DOI: 10.1097/md.0000000000019534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 02/03/2020] [Accepted: 02/08/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Whether or not increased hospitalizations and/or deaths due to cardiovascular disease during major football tournaments (MFTs) remains controversial. We undertook a systematic review and meta-analysis of published studies to assess the relationships of cardiovascular events and MFTs. METHODS Observational studies reporting relationship of cardiovascular disease morbidity and mortality with MFTs during the days of games or within 2 weeks after game season were included. Relative risk ratios (RR) with 95% confidence interval (CI) were pooled and analyzed using a random/fixed-effects model. RESULTS Nineteen cross-sectional observational studies that examined the association between MFTs and non-fetal cardiovascular events and mortality were found to be eligible from 3419 references, for inclusion in the systematic review and meta-analysis. Of the 10 studies reported hospitalizations due to non-fetal acute cardiovascular events, the pooled RR was 1.17 (95% CI 1.01-1.36). Of the 10 studies reported cardiovascular mortality the pooled RR was 1.03 (95% CI 1.00-1.05). Of the studies examining the mortality, 6 studies reported the lost or win of the national team. Pooling of four studies where their national teams lost the MFTs produced a RR for the mortality of 1.19 (95% CI: 1.09-1.30), and 4 studies of the 6 whose national teams won produced a pooled RR for cardiovascular mortality of 0.88 (0.79-0.98). CONCLUSION This systematic review and meta-analysis showed an increased risk of hospitalization due to non-fetal acute cardiovascular events and cardiovascular mortality with watching MFTs.
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Affiliation(s)
- Huajun Wang
- The People's Hospital of Luoding, Affiliated Luoding Hospital of Guangdong Medical University, Luoding
| | - Lunchang Liang
- The People's Hospital of Luoding, Affiliated Luoding Hospital of Guangdong Medical University, Luoding
| | - Ping Cai
- The People's Hospital of Luoding, Affiliated Luoding Hospital of Guangdong Medical University, Luoding
| | - Jianli Zhao
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou
| | - Lan Guo
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Huan Ma
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
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Lin LL, Gu HY, Yao YY, Zhu J, Niu YM, Luo J, Zhang C. The association between watching football matches and the risk of cardiovascular events: A meta-analysis. J Sports Sci 2019; 37:2826-2834. [PMID: 31500501 DOI: 10.1080/02640414.2019.1665246] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Lu-Lu Lin
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China
- Department of pathology and pathophysiology, School of basic medicine, Wuhan University, Wuhan, China
| | - Hui-Yu Gu
- Department of Orthopedic, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Yang-Yang Yao
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Jie Zhu
- Trade Union, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Yu-Ming Niu
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Jie Luo
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Chao Zhang
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China
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Gebhard CE, Gebhard C, Maafi F, Bertrand MJ, Stähli BE, Wildi K, Galvan Z, Toma A, Zhang ZW, Smith D, Ly HQ. Hockey Games and the Incidence of ST-Elevation Myocardial Infarction. Can J Cardiol 2018; 34:744-751. [DOI: 10.1016/j.cjca.2017.12.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 12/24/2017] [Accepted: 12/26/2017] [Indexed: 10/17/2022] Open
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Olsen P, Elliott JM, Frampton C, Bradley PS. Winning or losing does matter: Acute cardiac admissions in New Zealand during Rugby World Cup tournaments. Eur J Prev Cardiol 2014; 22:1254-60. [DOI: 10.1177/2047487314539433] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 05/22/2014] [Indexed: 11/16/2022]
Affiliation(s)
- P Olsen
- Department of Applied Sciences and Allied Health, Christchurch Polytechnic Institute of Technology, New Zealand
| | - JM Elliott
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - C Frampton
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - PS Bradley
- Department of Sport and Exercise Sciences, University of Sunderland, UK
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The Impact of World and European Football Cups on Stroke in the Population of Dijon, France: A Longitudinal Study from 1986 to 2006. J Stroke Cerebrovasc Dis 2014; 23:e229-35. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 10/12/2013] [Indexed: 11/20/2022] Open
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Niederseer D, Thaler CW, Egger A, Niederseer MC, Plöderl M, Niebauer J. Watching soccer is not associated with an increase in cardiac events. Int J Cardiol 2013; 170:189-94. [DOI: 10.1016/j.ijcard.2013.10.066] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 09/10/2013] [Accepted: 10/19/2013] [Indexed: 11/25/2022]
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Schwartz BG, French WJ, Mayeda GS, Burstein S, Economides C, Bhandari AK, Cannom DS, Kloner RA. Emotional stressors trigger cardiovascular events. Int J Clin Pract 2012; 66:631-9. [PMID: 22698415 DOI: 10.1111/j.1742-1241.2012.02920.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
AIMS To describe the relation between emotional stress and cardiovascular events, and review the literature on the cardiovascular effects of emotional stress, in order to describe the relation, the underlying pathophysiology, and potential therapeutic implications. MATERIALS AND METHODS Targeted PUBMED searches were conducted to supplement the authors' existing database on this topic. RESULTS Cardiovascular events are a major cause of morbidity and mortality in the developed world. Cardiovascular events can be triggered by acute mental stress caused by events such as an earthquake, a televised high-drama soccer game, job strain or the death of a loved one. Acute mental stress increases sympathetic output, impairs endothelial function and creates a hypercoagulable state. These changes have the potential to rupture vulnerable plaque and precipitate intraluminal thrombosis, resulting in myocardial infarction or sudden death. CONCLUSION Therapies targeting this pathway can potentially prevent acute mental stressors from initiating plaque rupture. Limited evidence suggests that appropriately timed administration of beta-blockers, statins and aspirin might reduce the incidence of triggered myocardial infarctions. Stress management and transcendental meditation warrant further study.
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Affiliation(s)
- B G Schwartz
- Heart Institute, Good Samaritan Hospital, Los Angeles, CA, USA
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Culic V. Football matches and acute cardiac events: potential effects of a complex psychosocial phenomenon on cardiovascular health. Int J Epidemiol 2011; 40:1422-5; author reply 1425-6. [PMID: 21459806 DOI: 10.1093/ije/dyr060] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Diener E, Chan MY. Happy People Live Longer: Subjective Well-Being Contributes to Health and Longevity. Appl Psychol Health Well Being 2011. [DOI: 10.1111/j.1758-0854.2010.01045.x] [Citation(s) in RCA: 835] [Impact Index Per Article: 64.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Leeka J, Schwartz BG, Kloner RA. Sporting events affect spectators' cardiovascular mortality: it is not just a game. Am J Med 2010; 123:972-7. [PMID: 21035586 DOI: 10.1016/j.amjmed.2010.03.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 02/10/2010] [Accepted: 03/15/2010] [Indexed: 10/18/2022]
Abstract
Physiologic and clinical triggers, including mental stress, anxiety, and anger, often precipitate acute myocardial infarction and cardiovascular death. Sporting events can acutely increase cardiovascular event and death rates. A greater impact is observed in patients with known coronary artery disease and when stressful features are present, including a passionate fan, a high-stakes game, a high-intensity game, a loss, and a loss played at home. Sporting events affect cardiovascular health through neuroendocrine responses and possibly an increase in high-risk behaviors. Acute mental stress increases the activity of the hypothalamic-pituitary-adrenocortical axis and the sympathetic-adrenal-medullary system while impairing vagal tone and endothelial function. Collectively, these mechanisms increase myocardial oxygen demand and decrease myocardial oxygen supply while also increasing the risk of arrhythmias and thrombosis. Measures can be taken to reduce cardiovascular risk, including the use of beta-blockers and aspirin, stress management, transcendental meditation, and avoidance of high-risk activities, such as smoking, eating fatty foods, overeating, and abusing alcohol and illicit drugs. Sporting events have the potential to adversely affect spectators' cardiovascular health, and protective measures should be considered.
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Affiliation(s)
- Justin Leeka
- Heart Institute, Good Samaritan Hospital, Los Angeles, CA, USA
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Barone-Adesi F, Vizzini L, Merletti F, Richiardi L. It is just a game: lack of association between watching football matches and the risk of acute cardiovascular events. Int J Epidemiol 2010; 39:1006-13. [DOI: 10.1093/ije/dyq007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Schwartz BG, Mayeda GS, Burstein S, Economides C, Kloner RA. When and why do heart attacks occur? Cardiovascular triggers and their potential role. Hosp Pract (1995) 2010; 38:144-152. [PMID: 20890064 DOI: 10.3810/hp.2010.06.308] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Coronary heart disease affects 7.6% of the population in the United States, where > 900,000 myocardial infarctions (MIs) occur annually. Approximately half of all MIs have an identifiable clinical trigger. Myocardial ischemia, MI, sudden cardiac death, and thrombotic stroke each occur with circadian variation and peak after waking in the morning. In addition, physical exertion and mental stress are common precipitants of MI. Waking in the morning, physical exertion, and mental stress influence a number of physiologic parameters, including blood pressure, heart rate, plasma epinephrine levels, coronary blood flow, platelet aggregability, and endothelial function. Upregulation of sympathetic output and catecholamines increase myocardial oxygen demand and can decrease myocardial oxygen supply and promote thrombosis. Ischemia ensues when myocardial oxygen demand exceeds supply. Increases in blood pressure and ventricular contractility increase intravascular shear stress and may cause vulnerable atherosclerotic plaques to rupture, forming a nidus for thrombosis that can precipitate MI. Numerous clinical triggers of MI have been identified, including blizzards, the Christmas and New Year's holidays, experiencing an earthquake, the threat of violence, job strain, Mondays for the working population, sexual activity, overeating, smoking cigarettes, smoking marijuana, using cocaine, and particulate air pollution. Avoiding clinical triggers or participating in therapies that prevent clinical triggers from precipitating cardiac events could potentially postpone clinical events by several years and improve cardiovascular morbidity and mortality. Direct or indirect evidence suggests that the risk of triggered MIs is reduced with β-blockers, aspirin, statins, stress management, and transcendental meditation.
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Affiliation(s)
- Bryan G Schwartz
- Heart Institute, Good Samaritan Hospital, Los Angeles, CA 90017-2395, USA
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Steptoe A, Brydon L. Emotional triggering of cardiac events. Neurosci Biobehav Rev 2008; 33:63-70. [PMID: 18534677 DOI: 10.1016/j.neubiorev.2008.04.010] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Revised: 04/25/2008] [Accepted: 04/28/2008] [Indexed: 12/19/2022]
Abstract
Psychological factors may contribute not only to the evolution of coronary atherosclerosis and long-term risk of coronary heart disease, but also to the triggering of acute cardiac events in patients with advanced atherosclerosis. Evidence for emotional triggering of cardiac events derives both from population-based studies of hospital admissions and sudden deaths following major traumas such as earthquakes and terrorist incidents, and from individually based interview studies with survivors of acute coronary syndromes (ACS). The latter indicate that acute anger, stress and depression or sadness may trigger ACS within a few hours in vulnerable individuals. The psychobiological processes underlying emotional triggering may include stress-induced haemodynamic responses, autonomic dysfunction and parasympathetic withdrawal, neuroendocrine activation, inflammatory responses involving cytokines and chemokines, and prothrombotic responses, notably platelet activation. These factors in turn promote coronary plaque disruption, myocardial ischaemia, cardiac dysrhythmia and thrombus formation. The implications of these findings for patient care and ACS prevention are outlined.
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Affiliation(s)
- Andrew Steptoe
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK.
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Bhattacharyya MR, Steptoe A. Emotional triggers of acute coronary syndromes: strength of evidence, biological processes, and clinical implications. Prog Cardiovasc Dis 2007; 49:353-65. [PMID: 17329181 DOI: 10.1016/j.pcad.2006.11.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Emotional triggers of acute coronary syndromes include population-level events such as earthquakes and terrorist attacks, and individual experiences of acute anger, stress and depression. The methodology of studying emotional triggers has developed markedly over recent years, though limitations remain. The biological processes underlying triggering include acute autonomic dysregulation, neuroendocrine activation, hemostatic and inflammatory responses which, when associated with plaque disruption, promote myocardial ischemia, cardiac dysrhythmia and thrombosis formation. Prevention and management strategies for ameliorating emotional triggering remain to be effectively developed.
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Affiliation(s)
- Mimi R Bhattacharyya
- Department of Epidemiology and Public Health, University College London, London, UK
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McCrory P. Always look on the bright side.... Br J Sports Med 2007; 41:63. [PMID: 17287535 PMCID: PMC2658937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
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Abstract
OBJECTIVE To review whether watching football increases the population cardiac event risk in New South Wales. DESIGN Analysis of hospital admissions for acute myocardial infarction, other cardiovascular disease, and other acute injuries at the time of two stressful sporting events in NSW in 2005: the Sydney Swans playing in the Australian Football League (AFL) Grand Final, and the Socceroos' penalty shoot-out in their World Cup qualifying match against Uruguay. RESULTS There were no increases in any of the studied admission events at the time of, or in the days immediately following, these football matches. CONCLUSIONS Australians appear to be resistant to acute stressors associated with watching sporting events, possibly due to higher rates of motivational deficiency disorder (MoDeD) than in European populations.
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Affiliation(s)
- Adrian E Bauman
- Centre for Physical Activity and Health, School of Public Health, University of Sydney, Sydney, NSW
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