Twenty Years of FIFA Medical Assessment and Research Centre
The 2014 FIFA World Cup Brazil was played in five different regions where the environmental conditions ranged from temperate to tropical. This provided an ideal setting to analyse the association of environmental heat stress with performance during the 64 matches. The web-bulb globe temperature (WBGT) were obtained prior to, during and after matches while various physical and technical performance parameters were recorded. Nassis et al reported that top level players adapted their activity in hot and humid environments by trading off high-intensity activity with a larger volume of low-intensity activity. Thus, they still covered the same total running distance and maintained playing time in the more challenging conditions.
It is notable that the WBGT reached the critical level of 32° for just one match and therefore the FIFA Medical Officer ordered a cooling break. During the entire 2014 FIFA World Cup Brazil no player or official reported a heat-related adverse medical condition.
FIFA pioneered a new antidoping programme and biological monitoring before the 2014 FIFA World Cup Brazil. All players who were registered to compete were tested unannounced prior to the competition; testing included blood parameters as well steroid profiles in urine. Players' results were then compared with the samples they provided after each match during the World Cup competition. Over 1000 samples were collected and analysed at the WADA accredited laboratory of Lausanne. The steroid profile of the urine of the players was stable and consistent with literature in this field. In this large population of players, we found no significant differences in haemoglobin value between precompetition and postmatch samples. The experience from Brazil documented the feasibility of implementing biological monitoring during a footballer's career. This important advance, the biological passport, provides an important additional avenue to detect doping.
The use of medication has been analysed since the 2002 FIFA World Cup. More than two-thirds of adult male players used medication(s) during the tournament, and more than half were using non-steroidal anti-inflammatory drugs (NSAIDs). Up to one-third of the players were using NSAIDs prior to every match. During the FIFA Women's World Cup, the prevalence of total medication use was 12% higher than in the men's event; NSAID use was similar to that of men. Prevalence of medication use was lower in Under-20 and Under-17 male competitions (60% of the players using some kind of medication and 43% of the players using NSAIDs during the tournaments). No decrease in the use of medication was observed despite of potential side effects especially of NSAIDs.
Following the tragic death of Marc-Vivien Foé during the FIFA Confederations Cup 2003 in France, FIFA has been fully committed to a programme of standard research education and practical implementation to prevent and manage emergency cardiac arrest on the football field. In the meantime, this strategy has been routinely implemented with the aim of detecting football players with a medical risk during mandatory precompetition medical assessment and by implementing the international accepted guidelines for the interpretation of an athlete's ECG based on the Seattle criteria. A clear protocol has been developed and applied for field of play for the recognition response, resuscitation and the removal of a player under sudden cardiac arrest. FIFA have introduced and distributed the FIFA Medical Emergency bag including an automated electric defibrillator to all 209 FIFA Mas.
The FIFA Sudden Death Registry has been established at the FIFA Medical Centre of Excellence of the University of Saarland to document and examine fatal events in football worldwide. Thus, anyone in the world can confidentially report cases of sudden death as well as successfully resuscitated sudden cardiac arrest of football players. The article by Scharhag et al should encourage the medical community to use this platform to better understand the causes of sudden death in football, and thus, mitigate risk and apply appropriate management when sudden cardiac arrest occurs.
Answers and Questions From the 2014 FIFA World Cup Brazil
The 2014 FIFA World Cup Brazil was played in five different regions where the environmental conditions ranged from temperate to tropical. This provided an ideal setting to analyse the association of environmental heat stress with performance during the 64 matches. The web-bulb globe temperature (WBGT) were obtained prior to, during and after matches while various physical and technical performance parameters were recorded. Nassis et al reported that top level players adapted their activity in hot and humid environments by trading off high-intensity activity with a larger volume of low-intensity activity. Thus, they still covered the same total running distance and maintained playing time in the more challenging conditions.
It is notable that the WBGT reached the critical level of 32° for just one match and therefore the FIFA Medical Officer ordered a cooling break. During the entire 2014 FIFA World Cup Brazil no player or official reported a heat-related adverse medical condition.
FIFA pioneered a new antidoping programme and biological monitoring before the 2014 FIFA World Cup Brazil. All players who were registered to compete were tested unannounced prior to the competition; testing included blood parameters as well steroid profiles in urine. Players' results were then compared with the samples they provided after each match during the World Cup competition. Over 1000 samples were collected and analysed at the WADA accredited laboratory of Lausanne. The steroid profile of the urine of the players was stable and consistent with literature in this field. In this large population of players, we found no significant differences in haemoglobin value between precompetition and postmatch samples. The experience from Brazil documented the feasibility of implementing biological monitoring during a footballer's career. This important advance, the biological passport, provides an important additional avenue to detect doping.
The use of medication has been analysed since the 2002 FIFA World Cup. More than two-thirds of adult male players used medication(s) during the tournament, and more than half were using non-steroidal anti-inflammatory drugs (NSAIDs). Up to one-third of the players were using NSAIDs prior to every match. During the FIFA Women's World Cup, the prevalence of total medication use was 12% higher than in the men's event; NSAID use was similar to that of men. Prevalence of medication use was lower in Under-20 and Under-17 male competitions (60% of the players using some kind of medication and 43% of the players using NSAIDs during the tournaments). No decrease in the use of medication was observed despite of potential side effects especially of NSAIDs.
Following the tragic death of Marc-Vivien Foé during the FIFA Confederations Cup 2003 in France, FIFA has been fully committed to a programme of standard research education and practical implementation to prevent and manage emergency cardiac arrest on the football field. In the meantime, this strategy has been routinely implemented with the aim of detecting football players with a medical risk during mandatory precompetition medical assessment and by implementing the international accepted guidelines for the interpretation of an athlete's ECG based on the Seattle criteria. A clear protocol has been developed and applied for field of play for the recognition response, resuscitation and the removal of a player under sudden cardiac arrest. FIFA have introduced and distributed the FIFA Medical Emergency bag including an automated electric defibrillator to all 209 FIFA Mas.
The FIFA Sudden Death Registry has been established at the FIFA Medical Centre of Excellence of the University of Saarland to document and examine fatal events in football worldwide. Thus, anyone in the world can confidentially report cases of sudden death as well as successfully resuscitated sudden cardiac arrest of football players. The article by Scharhag et al should encourage the medical community to use this platform to better understand the causes of sudden death in football, and thus, mitigate risk and apply appropriate management when sudden cardiac arrest occurs.
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