Athletes are commonly screened to identify risk before participation in sports. Screening should look for risks related to heart disease and other risks (for example, musculoskeletal injuries).
Screening for Risk of Sudden Cardiac Death in Athletes
People are commonly screened by their doctor before starting an exercise program. Doctors screen people who have medical disorders and also those who do not think they have any medical disorders. People without known medical disorders should typically be checked because some serious disorders do not cause problems until people exercise. People in the United States are reevaluated every 2 years (if high school age) or every 4 years (if college age or older). In Europe, screening is repeated every 2 years no matter what the athlete's age.
Doctors always ask people questions and do a physical examination, but they do testing only when the person's age and reported symptoms are cause for concern. Questions focus on 3 areas:
Symptoms such as chest pain or discomfort, fainting or near-fainting, fatigue, and difficulty breathing, particularly when these symptoms occur during vigorous exercise
Family history, particularly any history of family members who fainted or died during exercise, or who died suddenly before about age 50
Use of certain prescription medications or performance-enhancing or illegal drugs
The physical examination focuses on listening to the heart with a stethoscope for heart murmurs that indicate a possible heart disorder with the person lying down and again while the person is standing and measuring blood pressure.
For younger people, doctors typically do not do any tests unless something abnormal is identified in the person's history or is found during the physical examination. Routine use of electrocardiography (ECG) screening of young athletes is not considered practical in the United States. However, if findings suggest a heart problem, doctors typically do ECG, echocardiography, or both.
For people over age 35 years, doctors may also do ECG and exercise stress testing before approving vigorous exercise.
If a heart disorder is found, the person may need to stop participating in competitive sports and undergo further testing.
Some people with severe heart disease, such as hypertrophic cardiomyopathy, should not participate in competitive sports. However, most people with heart disease may participate in noncompetitive sports. Increased activity is directly related to better health outcomes such as a decrease in "bad" cholesterol levels (low-density lipoproteins), prevention of high blood pressure, and reduction of body fat. Regular exercise is routinely included in care plans for people with most forms of heart disease (cardiac rehabilitation).
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Screening for Other Risks of Sports Participation
People should consult their doctor before beginning competitive sports or an exercise program. Most schools and organized sports associations require that people have a doctor evaluate whether they can safely participate before they join the program. Doctors ask questions about general health and do an examination. Occasionally, additional testing may be needed after this evaluation.
Risk factors that are related to the heart are less common than other risk factors. Adults are asked about the following:
Previous or current musculoskeletal injuries (including easily triggered dislocations)
Arthritic disorders, particularly those involving major weight-bearing joints (for example, hips, knees, or ankles)
Symptoms suggesting an infection
Two groups of people may be at particular risk of injury:
Boys who physically mature late may be at greater risk of injury in contact sports if competing against larger and stronger children.
People with overweight or obesity are at increased risk of musculoskeletal problems because of excess body weight and associated forces on the joints and tissues. One risk is overuse injury and soft-tissue inflammation, particularly if people increase intensity and duration of exercise too rapidly. A long-term risk is osteoarthritis affecting weight-bearing joints. Another risk may be injury due to sudden stops and starts if they participate in activities that require jumping or high levels of agility.
Athletes, particularly adolescents and young adults, are asked about use of illicit and performance-enhancing drugs. (See also the US Anti-Doping Agency)
In girls and women, doctors look for delays in the onset of menstruation and presence of the female athlete triad (eating disorders, amenorrhea or other menstrual dysfunction, and diminished bone mineral density), which is common among adolescent and young women who engage in overly intensive physical activity and overly zealous loss of body fat.
Limitations on Activity
Most people can safely exercise even if problems are identified during the screening. However, certain people should not participate in competitive sports or high-intensity recreational sports. These are people who have
Severe heart valve disorders
Most other heart disorders that are severe or increase risk of cardiac arrest (for example, certain cardiomyopathies, coronary artery abnormalities, and certain disorders present at birth)
A recent heart attack
An aneurysm in the brain or large blood vessels
Inflammation of the heart muscle (myocarditis)
People who are recovering from a heart attack should work with their doctor to safely resume athletic activity and may participate in a cardiac rehabilitation program.
People may have to start more slowly or increase exercise more gradually. Some people may benefit from starting an exercise program under the supervision of a trainer who can help them develop proper techniques and monitor them for safety.
Other people may need to select a different activity.
