From the Guidelines
A preparticipation evaluation (PPE) entails a comprehensive medical screening that includes a 14-point history and physical examination, and consideration of additional screening tests, particularly a 12-lead ECG, to assess the cardiac health of competitive athletes. This evaluation is crucial in identifying conditions that may increase the risk of morbidity and mortality during physical activity, ensuring safe participation, and establishing baseline health measurements 1. The PPE typically includes a detailed medical history review covering past injuries, surgeries, chronic conditions, medication use, family history of cardiac issues, and any exercise-related symptoms. The physical examination portion assesses vital signs, cardiovascular health, pulmonary function, musculoskeletal evaluation, neurological screening, and vision testing.
Some key components of the PPE include:
- A detailed medical history review to identify potential risk factors for cardiovascular disease
- A physical examination to assess cardiovascular health and identify any abnormalities
- Additional screening tests, such as electrocardiograms, for athletes with concerning history or symptoms
- Education on self-monitoring and risk of cardiovascular events, including warning signs and symptoms of cardiovascular disease 1.
The evaluation serves multiple purposes, including identifying conditions that might increase risk during physical activity, ensuring safe participation, establishing baseline health measurements, and meeting organizational or insurance requirements. It is recommended that PPEs be conducted 6-8 weeks before the activity season begins to allow time for any necessary follow-up testing or treatment. This comprehensive approach helps protect participants by identifying potential health concerns before they engage in strenuous physical activity, as emphasized in guidelines from the American Heart Association and American College of Cardiology 1.
From the Research
Overview of Preparticipation Evaluation (PPE)
The preparticipation evaluation (PPE) is a standard of care for athletes preparing for organized athletic participation, aiming to detect conditions that predispose the athlete to injury or limit full participation in certain activities 2. The PPE seeks to identify underlying cardiovascular and musculoskeletal conditions, which are frequently associated with mortality and morbidity in athletes.
Components and Timing of PPE
The ideal timing for the PPE is 6 weeks prior to the competitive season, allowing adequate time for treatment and rehabilitation of problems 3. A complete screening evaluation is recommended prior to entrance into a new level of school, with annual limited reevaluations thereafter. The annual reevaluation should focus on the medical history, with the physical examination emphasizing the cardiovascular system and interim injuries and medical problems.
Methods and Decision-Making in PPE
Two different methods can be used to perform the PPE: station-type mass screening and office setting, each with its own advantages and disadvantages 3. The most important decision for the physician is determining clearance for activity, using guidelines based on the demands of the sport and specific medical problems, as well as clinical judgement.
Purpose and Effectiveness of PPE
The PPE is used to screen athletes prior to sports participation to prevent injury or illness, with its effectiveness, practicality, and worthiness being a matter of debate 4. The PPE is the first step in satisfying the responsibility of maintaining the health and safety of the athlete. Electronic PPE (ePPE) can be a valuable tool for collecting and analyzing aggregate injury and illness data in athletes 5.
Current Best Practice Recommendations
Current best practice recommendations for PPE include common elements such as medical history, physical examination, and cardiovascular screening 6. Additional considerations may be necessary for specific populations, such as transgender, masters athletes, and Special Olympians. The goal of the PPE is safe participation in sport for athletes, and it is a traditional and legal requirement by many governing bodies for sport.