Give your sports physicals a performance boost

With preparticipation physical evaluations (PPEs) required for competitive athletic activities at colleges nationwide¹ and at high schools and middle schools in the vast majority of states,² the start of a new school year often brings a barrage of student visits. Yet despite this almost universal requirement, there is no universal standard for the PPE.

There is, however, a new evidence-based guideline. Preparticipation Physical Evaluation, 4th edition,³ released earlier this year, was created by the American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine.

This guideline describes how to conduct a thorough medical history and a targeted physical exam, with a focus on activity-related risks to various organ systems. Regardless of the specific activity the student is interested in pursuing, however, emphasis on cardiac, neurological, and musculoskeletal systems is crucial because of the frequency and gravity of complications.

Help with the medical history: A downloadable form

The history is the most important part of the PPE, which should be scheduled at least 6 weeks before the sports season starts to allow time for follow-up testing or consultation. A form (which can be downloaded along with a physical exam form from the American College of Sports Medicine’s [ACSM] Web site at http://www.ppesportsevaluation.org/body.html) features 54 questions, which cover a range of organ systems and highlight areas of common sports injury and disability. The answers to these questions alone can identify 75% of problems affecting athletes,³ including chronic conditions and medications that may require adjustment or closer monitoring.

Start with the cardiovascular system
As many as 85% of sudden deaths in young athletes are related to underlying cardiac abnormalities, according to a 10-year study of 150 such cases.⁴ Indeed, sudden cardiac death occurs in approximately 1 in 200,000 high school athletes.^5,6 Not surprisingly, those engaged in high-intensity activity are at highest risk.⁷

Thus, screening school-aged athletes for potential causes of sudden cardiac death is a primary objective of the PPE.³ The American Heart Association (AHA) recommends a 12-part evaluation (TABLE 1) of the heart, with 8 history questions and 4 physical exam components, to properly screen for cardiac disease in the young athlete.⁸ Syncope, chest pain, and dyspnea, particularly if associated with exertion, may be signs of underlying cardiac disorders that warrant confirmatory testing;⁵ a family history of premature death or disability from cardiac disease indicate a need for additional testing, as well. Further evaluation normally entails a combination of cardiac testing and consultation with a cardiologist.

Ask about asthma, including exercise-induced asthma (EIA). Identifying any respiratory conditions is vital to ensure adequate treatment and optimal performance. Patients with EIA are normally asymptomatic at rest, with no disturbance of peak expiratory flow. The presence of cough, chest tightness, wheezing, dyspnea, or loss of endurance during exercise suggests an EIA diagnosis.⁹ If a patient reports any such symptoms, order pulmonary function tests for confirmation.

EIA affects between 10% and 50% of athletes, depending on the sport.¹⁰ In up to 80% of athletes with EIA, use of inhaled short-acting beta-agonists prior to participation can help to prevent symptoms.⁹ Any athlete who reports symptoms of asthma, whether or not it is exercise-induced, requires treatment to prevent serious respiratory sequelae.

TABLE 1
Ask these 12 questions during cardiovascular screening⁵