Football Refereeing and Cardiovascular Health: A Scoping Review

The study followed PRISMA guidelines for data extraction and thematic analysis.

• This scoping review examines what is known about cardiovascular health and acute cardiac event risk for football referees during matches.
• A librarian-assisted search across six databases was conducted, including English-language publications or those with English translations.

• Publications were analyzed to produce descriptive summaries and thematic syntheses of the literature related to referees’ cardiovascular risk, stress, physical demands, physiological aspects of refereeing, and cardiac events on the field.
• The review aggregates evidence across studies rather than reporting primary trial outcomes or a meta-analysis.

• The literature documents prevalence of hypertension, dyslipidaemia, and diabetes among football referees.

• Referees experience verbal and physical abuse at all competition levels.
• Such experiences are associated with elevated psychological stress, anxiety, and anger.

• Referees cover substantial distances and engage in high-intensity activity during matches, illustrating notable physical demands.

• The review notes various physiological considerations related to officiating, though specific mechanistic details are not individualized in the summary.

• Instances of cardiac events among referees are reported; however, referees infrequently participate in cardiopulmonary resuscitation (CPR) or on-field life-saving interventions.

• The synthesis indicates meaningful cardiovascular and psychological demands placed on referees, coupled with exposure to abuse.
• There is a noted paucity of research evaluating educational or preventive interventions targeting referees’ cardiovascular health.
• Referees may function as first responders during ACS events, underscoring a potential need for symptom awareness and first-aid preparedness among officials.
• The review explicitly notes limitations in the available literature and calls for more targeted research on interventions and practical training.