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Screening for Sports Participation

by Paul L. Liebert, MD

Cardiovascular screening

Screening for all children and adults should include a thorough cardiovascular history, with questions about

  • Known hypertension or heart murmur

  • Chest pain

  • Exercise-induced or unexplained syncope (including convulsive syncope), near-syncope, chest pain, or palpitations

  • Family history of sudden cardiac death at age < 50 yr, arrhythmias, dilated or hypertrophic cardiomyopathy, long QT syndrome, or Marfan syndrome

  • Risk factors for coronary artery disease in adults (see Overview of Coronary Artery Disease : Risk Factors)

Physical examination should routinely include BP in both arms, supine and standing cardiac auscultation, and inspection for features of Marfan syndrome. These measures aim to identify adults as well as rare, apparently healthy young people at high risk of life-threatening cardiac events (eg, people with arrhythmias, hypertrophic cardiomyopathy, or other structural heart disorders).

Testing is directed at clinically suspected disorders (eg, exercise stress testing for coronary artery disease, echocardiography for structural heart disease, ECG for arrhythmia or long QT syndrome). Routine stress testing in the absence of symptoms, signs, or risk factors is not recommended.

Other screening measures

Noncardiovascular risk factors are more common than cardiovascular 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 (eg, hips, knees, ankles)

  • Concussions

  • Asthma

  • Symptoms suggesting systemic infection

  • Heat-related illness

  • Seizure

Two populations at risk for injuries are commonly overlooked:

  • Boys who physically mature late are assumed to be at greater risk of injury in contact sports if competing against larger and stronger children.

  • Overweight or obese people 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.

Adolescents and young adults should be asked about use of illicit and performance-enhancing drugs. (See also the . www.usantidoping.org .)

In girls and young women, screening should detect delayed onset of menarche. Girls and young women should be screened for the presence of the female athlete triad (eating disorders, amenorrhea or other menstrual dysfunction, and diminished bone mineral density). Two questions are validated screening measures for eating disorders:

  • Have you ever had an eating disorder?

  • Are you happy with your weight?

Contraindications

There are almost no absolute contraindications to sports participation.

Exceptions in children include

  • Myocarditis, which increases the risk of sudden cardiac death

  • Hypertrophic cardiomyopathy, in which increases in heart rate can increase risk of sudden cardiac death

  • Acute splenic enlargement or recent infectious mononucleosis (Epstein-Barr virus infection) because splenic rupture is a risk

  • Fever, which decreases exercise tolerance, increases risk of heat-related disorders, and may be a sign of serious illness

  • Possibly significant diarrhea and/or recent significant vomiting because dehydration is a risk

Exceptions in adults include

  • Angina pectoris

  • Recent MI (within 6 wk)

  • Known aneurysms in the brain or large vessels

Relative contraindications are more common and lead to recommendations for precautions or for participation in some sports rather than others, for example:

  • People with a history of frequent and easily triggered dislocations or multiple concussions (see Sports-Related Concussion) should participate in noncollision sports.

  • Males with a single testis should wear a protective cup for most contact sports.

  • People at risk of heat intolerance and dehydration (eg, those with diabetes, cystic fibrosis, or previous heat-related illness) should hydrate frequently during activity.

  • People with suboptimal seizure control should avoid swimming, weight lifting, and, to prevent injury to others, sports such as archery and riflery.

  • People who have asthma need to monitor their symptoms closely.

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