Sports preparticipation physical

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Last reviewed: 5 Apr 2025

Last updated: 01 Apr 2025

Sports preparticipation physical exams (or preparticipation physical exams [PPEs]) are clinical exams 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.[1][2][3][4] American Medical Society for Sports Medicine: preparticipation physical evaluation history form Opens in new window 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.[5] 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.[1]

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.[6][7][8][9] 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.[5][10][11][12][13][14][15] 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.[16][17][18] 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.[19] 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, and instead continues to recommend the 14-point cardiovascular history and physical exam.[1][20][21]

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.

Although estimates vary, studies find that only a small percentage of athletes (<1%) are denied clearance to participate.[22]

The American College of Cardiology has produced a list of key points concerning cardiovascular care of college athletes. American College of Cardiology: cardiovascular care of college student-athletes Opens in new window

Details

Objectives of examination
Timing and frequency
History
Physical examination
Clearance for sport
Medicolegal considerations
Implementation issues
Fulfilling the PPE objectives
Controversies

Full details

Contributors

Authors

Philip H. Cohen, MD

Clinical Associate Professor of Medicine

UCLA David Geffen School of Medicine

Los Angeles

Disclosures

PHC has been reimbursed for travel/lodging costs and has been given a stipend for medical education lectures for MCE Conferences.

Peer reviewers

James C. Puffer, MD

Professor

University of Kentucky School of Medicine

President and Chief Executive Officer

American Board of Family Medicine

Lexington

Disclosures

JCP declares that he has no competing interests.

Margot Putukian, MD

Director of Athletic Medicine

Princeton University

Princeton

Disclosures

MP is an author of a reference cited in this topic.

References

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Key articles

MacDonald J, Schaefer M, Stumph J. The preparticipation physical evaluation. Am Fam Physician. 2021 May 1;103(9):539-46.Full text Abstract

Maron BJ, Douglas PS, Graham TP, et al. Task Force 1: preparticipation screening and diagnosis of cardiovascular disease in athletes. J Am Coll Cardiol. 2005 Apr 19;45(8):1322-6. Abstract

Rice SG; American Academy of Pediatrics Council on Sports Medicine and Fitness. Medical conditions affecting sports participation. Pediatrics. 2008 Apr;121(4):841-8.Full text Abstract

Drezner JA, O'Connor FG, Harmon KG, et al. AMSSM position statement on cardiovascular preparticipation screening in athletes: current evidence, knowledge gaps, recommendations, and future directions. Clin J Sport Med. 2016 Sep;26(5):347-61.Full text Abstract

Harmon KG, Clugston JR, Dec K, et al. American Medical Society for Sports Medicine position statement on concussion in sport. Br J Sports Med. 2019 Feb;53(4):213-25.Full text Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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Sports preparticipation physical

Summary

Details

Contributors

Authors

Philip H. Cohen, MD

Disclosures

Peer reviewers

James C. Puffer, MD

Disclosures

Margot Putukian, MD

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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