• To identify conditions that may interfere with a person’s ability to participate in a sport • To identify health problems that increase the risk for injury or death during sports participation • To help select an appropriate sport for a person’s particular abilities and physical status Recommended Components of the PPE • Illnesses or injuries since the last health visit or PPE • History of having been denied or restricted from participation in sporting activities and reason for restriction • History of heat illness or muscle cramps • Current viral illness (patients with mononucleosis may return to play after 3 weeks if no longer symptomatic and no splenomegaly; fever at the time of the examination is an absolute contraindication because of the association with viral myocarditis) • Sickle cell trait or disease (adequate hydration is necessary, and caution should be taken to avoid extreme conditions because of the risk for rhabdomyolysis) • Hospitalizations or surgeries • All medications used by the athlete (including steroids and nutritional supplements or medications taken to enhance performance) • Use of any special equipment or protective devices during sports participation • Allergies (including food-, insect bite–, and exercise-provoked allergies), particularly those associated with anaphylaxis or respiratory compromise • Absence of paired organs (single-organ athletes may participate if the single organ can be protected and the patient/caregivers understand the risks involved) • Immunization status including hepatitis B, varicella, meningococcal, human papillomavirus, and pertussis • Height, weight, and body mass index • Symptoms of exertional chest pain/discomfort • Unexplained syncope/near-syncope • Excessive exertional and unexplained dyspnea/fatigue, associated with exercise • Prior recognition of a heart murmur • Elevated systemic blood pressure • Family history of premature death (sudden and unexpected, or otherwise) before age 50 years because of heart disease in one or more relatives • Family history of disability from heart disease in a close relative younger than 50 years • Specific knowledge of certain cardiac conditions in family members: hypertrophic or dilated cardiomyopathy, long QT syndrome or other ion channelopathies, Marfan syndrome, or clinically important arrhythmias • Heart murmur (auscultation should be performed in both supine and standing positions, or with Valsalva maneuver, to identify murmurs of dynamic left ventricular outflow obstruction); heart rate and rhythm to assess for arrhythmias • Femoral pulses to exclude coarctation of the aorta • Physical stigmata of Marfan syndrome (e.g., arm span greater than height and hyperextensible joints) • Brachial artery blood pressure (sitting position with appropriate size cuff, preferably taken in both arms)
Sports Participation Evaluation
Examination Guidelines
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