The sports preparticipation physical (or preparticipation physical examination [PPE]) is a clinical examination used to evaluate athletes for injuries, illnesses, or other conditions that might increase the risk of harm to themselves or others when participating in sports.     Although the PPE is often considered a screening tool, it can also be used to evaluate the suitability of athletes with known conditions in order for them to participate in a particular athletic endeavor.
A PPE is a legal or administrative requirement for many competitive athletes in the US. It can be an excellent vehicle for discussing health promotion and maintenance issues with young athletes. However, there is great variability in the way PPEs are performed and little objective data demonstrating that it leads to improved health outcomes. Adding a screening ECG to a history and physical increases the likelihood of detecting potentially life-threatening cardiovascular conditions, and has been associated with a decrease in the rate of sudden cardiac death in athletes in Italy.     However, it is debatable whether implementing standard ECG screening in PPEs across the US would show similar benefit and the debate on augmented cardiac screening continues.       There is a growing body of evidence suggesting possible benefit from augmented screening,   with a study demonstrating higher rates of ECG abnormalities in young males of black African descent.  Possibly legal and social pressures may result in a change of attitude in the US regarding this issue. However, the costs, ramifications of false positives, and lack of appropriate health system infrastructure to manage the athletes involved make it difficult to apply in the US, and these issues are likely to prevent widespread adoption of an Italian-style program in the near future.  The American Heart Association recommendations remain unchanged on this issue. While recognizing the limitations of the standard history and physical PPE, the AHA does not recommend routine augmented screening with ECG or other cardiovascular testing as part of the PPE at present. 
Despite lack of objective data, the PPE may be an excellent vehicle for screening athletes for high-risk behaviors and medical conditions that would otherwise have a profound effect on their lifelong health, if not directly on their short-term athletic performance.
The American College of Cardiology has produced a list of key points concerning cardiovascular care of college athletes.
Clinical Assistant Professor of Medicine
Robert Wood Johnson Medical School
University of Medicine and Dentistry
PHC declares that he has no competing interests.
University of Kentucky School of Medicine
President and Chief Executive Officer
American Board of Family Medicine
JCP declares that he has no competing interests.
Director of Athletic Medicine
MP is an author of a reference cited in this monograph.
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