From the Guidelines
Sports medicine clearance for individuals with pre-existing medical conditions requires a comprehensive medical evaluation tailored to the specific condition, including a detailed medical history review, physical examination, and often specialized testing relevant to the condition, as recommended by the American Heart Association and American College of Cardiology 1. The evaluation should be conducted by a physician knowledgeable about both the medical condition and the physical demands of the intended sport.
- For cardiac conditions, an electrocardiogram (ECG), echocardiogram, or stress test may be necessary, as outlined in the guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death 1.
- Individuals with asthma might need pulmonary function tests, while those with diabetes require documentation of blood glucose control.
- Documentation of stable disease management is essential, including medication adherence and symptom control, such as proper use of maintenance inhalers like fluticasone/salmeterol (Advair) and rescue medications such as albuterol for asthmatic athletes. The clearance process aims to ensure safe participation while minimizing risk of medical emergencies during activity, and some conditions may require specific precautions or modifications, such as availability of emergency medications or activity restrictions based on environmental conditions, as noted in the eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities 1. Regular follow-up evaluations are often necessary to monitor the condition's stability with ongoing athletic participation. In specific cases, it may be consistent with accepted, customary, or reasonable medical practice for a physician to deviate from the American Heart Association/American College recommendations by providing medical clearance based on individualized factors evidencing that participation by an athlete with a cardiovascular abnormality in a particular sport would not create a significant risk of sudden cardiac death or other serious injury to the athlete or others 1.
From the Research
Requirements for Sports Medicine Clearance
For individuals with pre-existing medical conditions, sports medicine clearance is crucial to ensure safe participation in sports. The following are the key requirements:
- A preparticipation evaluation (PPE) is necessary to detect conditions that predispose the athlete to injury or limit full participation in certain activities 2.
- The PPE should focus on the cardiovascular and musculoskeletal systems, as these are frequently associated with mortality and morbidity in athletes 2, 3.
- The evaluation should include a thorough medical history, questioning about exertional symptoms, presence of a heart murmur, symptoms of Marfan syndrome, and family history of premature serious cardiac conditions or sudden death 3.
- A physical examination should be performed to focus on the cardiovascular and musculoskeletal systems 3, 4.
- Laboratory tests, such as screening electrocardiography and blood and urine testing, are not usually necessary for asymptomatic patients 3, 5.
- Further evaluation should be considered for persons with heart or lung disease, bleeding disorders, musculoskeletal problems, history of concussion, or other neurologic disorders 3.
Clearance Decision
The decision for sports medicine clearance depends on the outcome of the evaluation and the type of sport (and sometimes position or event) in which the athlete participates 3. The physician's clinical judgement should be used in interpreting guidelines and recommendations for each individual athlete 5. The PPE is an excellent opportunity for the physician to positively influence the health care and safety of a local sports program 5.
Timing and Frequency of Evaluation
The ideal timing for the PPE is 6 weeks prior to the competitive season to allow adequate time for treatment and rehabilitation of problems 5. The PPE should be repeated every 1 to 3 years, or as needed 4, 5. Annual limited reevaluations should focus on the medical history with the physical examination emphasizing the cardiovascular system and interim injuries and medical problems 5.