Merck Manual

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Screening for Sports Participation


Jack T. Andrish

, MD, Cleveland Clinic

Reviewed/Revised Oct 2021 | Modified Sep 2022
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Athletes are commonly screened to identify risk before participation in sports, In the US, they 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 regardless of age.

Cardiovascular screening

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

Physical examination should routinely include blood pressure in both arms, supine and standing cardiac auscultation, and inspection for features of Marfan syndrome Symptoms and Signs Marfan syndrome consists of connective tissue anomalies resulting in ocular, skeletal, and cardiovascular abnormalities (eg, dilation of ascending aorta, which can lead to aortic dissection)... read more Symptoms and Signs . These measures aim to identify adults as well as 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 Overview of Coronary Artery Disease Coronary artery disease (CAD) involves impairment of blood flow through the coronary arteries, most commonly by atheromas. Clinical presentations include silent ischemia, angina pectoris, acute... read more Overview of Coronary Artery Disease , echocardiography for structural heart disease, electrocardiogram [ECG] for arrhythmia or long QT syndrome). Routine stress testing in the absence of symptoms, signs, or risk factors is not recommended. European guidelines differ from American guidelines in that a screening ECG is recommended for all children, adolescents, and college-age athletes.

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

  • Easy bruising or bleeding

  • Seizure

Two populations at risk for injuries are commonly overlooked:

  • Have you ever had an eating disorder?

  • Are you happy with your weight?


There are almost no absolute contraindications to sports participation.

Exceptions in children include

Exceptions in adults include

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

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NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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