Written by Dimitrios Vrachatis, Specialist Cardiologist, PhD, National and Kapodistrian University of Athens.
What is pre-participation screening?
“Pre-participation screening”, “sports clearance”, “exercise clearance”, “health certificate for sport” and “athlete health-card assessment” are terms used interchangeably to describe the clinical examinations and diagnostic tests performed periodically to gather the information needed to determine whether a person can participate in sporting activities.
Why is pre-participation screening necessary?
Physical exercise is generally beneficial. However, intense exercise can also act as a stressor that triggers an undiagnosed condition and leads to very serious clinical events, including sudden death.
For example, among people under 35, a common cause of sudden death is hypertrophic cardiomyopathy, which can be diagnosed using an electrocardiogram and an echocardiogram. In older people, coronary artery disease is an important cause, for which modern cardiology has a structured diagnostic approach.
The need to diagnose conditions early and prevent adverse events makes pre-participation screening essential.
What are the aims of pre-participation screening?
Pre-participation screening aims to diagnose cardiovascular abnormalities early, while they are still asymptomatic, and thereby prevent an adverse outcome in the future.
Unfortunately, however thorough the assessment is, it cannot guarantee that every person with an underlying condition will be identified. Each diagnostic method has specific strengths and limitations; so-called “false-negative” results are an inherent feature of every medical test. No preventive assessment can therefore prevent 100% of sudden deaths.
Nevertheless, a significant number of conditions can be diagnosed in time, allowing the necessary interventions or appropriate precautions.
Who is advised to undergo pre-participation screening?
People of any age — children, teenagers, adults and older people — who want to participate in sport at either an amateur or professional level are advised to undergo pre-participation screening.
The value and usefulness of this process lie in the examination itself, rather than in the certificate issued for participation in sports clubs or other organised settings. It is not simply a routine procedure or a signature, but a meaningful medical examination.
Who performs pre-participation screening?
The assessment is performed by a cardiologist, who evaluates the person’s history and current condition and carries out any tests considered necessary to assess cardiovascular function. If there are non-cardiac conditions, such as respiratory disease, other medical specialists may also need to contribute.
What does the examination for a sports certificate include?
Pre-participation screening includes:
- A detailed family history, focusing on heart failure, cardiomyopathies — such as dilated or hypertrophic cardiomyopathy — and sudden, unexplained deaths in relatives, particularly at a young age.
- A detailed personal history, focusing on loss of consciousness, fainting or syncope, previous myocarditis, or symptoms such as chest pain, shortness of breath, sweating, dizziness or palpitations during exercise or at rest.
- A physical examination, including listening to the lungs and heart and measuring blood pressure and blood oxygen saturation.
- An electrocardiogram.
- An echocardiogram, if considered necessary.
- Further non-invasive tests, such as cardiac MRI, Holter ECG or an exercise stress test, or invasive investigations, such as coronary angiography or an electrophysiological study, in specific cases.
What should I expect during the examination for sports clearance?
The process includes taking a medical history, so it is helpful to be prepared to provide the cardiologist with the relevant information. It also includes a physical examination, during which you will need to uncover your upper chest (remove your top).
Are there risks or pain during pre-participation screening?
In the vast majority of cases, pre-participation screening consists of non-invasive, painless tests. As a rule, the assessment therefore carries no risk.
How often should I obtain a sports health certificate?
The assessment is usually annual. It should be repeated after symptoms develop or after a COVID-19 infection.