A sports fitness examination should be performed by anyone who wants to start active sports. In addition, active athletes should also have regular examinations. The German Society for Sports Medicine and Prevention e. V. (DGSP) recommends in its S1 guideline a one-time sports medical examination for all persons under the age of 35 who participate in sports. From the age of 35, all sportspeople should have sports medicine check-ups every two years, and competitive athletes as well as performance-oriented amateur athletes should have sports medicine check-ups every year. The examination should be performed by an experienced physician (sports physician, pediatrician, cardiologist) before the start of competitive club training or participation in competitive sports.
The procedure
In the sports fitness examination, the following measures are part of the basic examination:
- Detailed medical history
- Family history (FA): this is considered incriminated if a relative has suffered a myocardial infarction (heart attack) or sudden cardiac death (PHT; Sudden Cardiac death, SCD) before the age of 50; other risks include congenital heart disease such as Marfan syndrome; ion channel defects, cardiomyopathies, etc.
- Long-term history (LA): exercise and nutritional history; symptoms such as decline in performance, dyspnea (shortness of breath), chest pain (chest pain), or syncope (momentary loss of consciousness) during physical exertion
- Pre-existing conditions including surgery (allergies, bronchial asthma, etc.).
- Review of current findings
- Collection of anthropometric data (body weight, length, body mass index (BMI), blood pressure value/blood pressure should be measured in a sitting position after 5-min rest on the right upper arm).
- Physical examination (internal and orthopedic examination) including assessment of general and nutritional status.
- Inspection of the skin and mucous membranes
- Examination of the eyes
- Auscultation (listening) of heart and lungs [pathologic heart and/or lung sounds?]
- Palpation (palpation) of the abdomen
- Orienting examination of the musculoskeletal system including muscle function examinations [scoliosis?, kyphosis?, axis malposition?, asymmetry?, instabilities?].
- Orienting neurological examination
- Urine examination by strip test (urine pH, proteins, glucose, nitrite content, bilirubin, ketones).
- Sports medicine consultation
Square brackets [ ] indicate possible pathological (pathological) physical findings. The following examinations are performed during the major sports physical examination:
- Detailed medical history (see above).
- Physical examination (see above)
- Collection of anthropometric data (see above).
- 12-lead electrocardiogram (12-lead ECG) – examination of the electrical activity of the heart.
- Resting ECG (ECG at rest).
- Exercise ECG by bicycle ergometry (from the age of 40, in the case of a conspicuous history also in those under 40 years): e.g. in the case of suspicion of:
- Hypertrophic cardiomyopathy (HCMP; deep Q jags and negative T wave left precordial; 1-2 cases of juvenile cardiac death per 100,000 adolescents).
- Brugada syndrome – included in the “primary congenital cardiomyopathies” and there in the so-called ion channel diseases; an autosomal dominant point mutation of the SCN5 gene underlies 20% of the cases of the disease; Characteristic are the occurrence of syncope (brief loss of consciousness) and cardiac arrest, which first occurs due to cardiac arrhythmias such as polymorphic ventricular tachycardia or ventricular fibrillation; patients with this disease are apparently completely heart healthy, but can already suffer sudden cardiac death (PHT) in adolescence and early adulthood.
- Juvenile coronary artery disease (CAD).
- Echocardiography (echo; cardiac ultrasound).
- In families with cardiomyopathies (annually).
- In cases of suspected valve disease
- Structural heart disease
- Spirometry (pulmonary function test: vital capacity (VC), one-second capacity (FEV1), forced vital capacity (FVC); FEV1/FVC)).
- Urine examination by strip test (see above).
- Blood tests (optional)
- Total cholesterol, LDL cholesterol, HDL cholesterol.
- Fasting glucose (fasting blood glucose)
- Sports medicine advice incl. preventive education of athletes about nutrition (prevention of anorexia/anorexia) and doping; advice on what to do in case of infections (myocarditis/heart muscle inflammation) or load-dependent complaints (chest pain/chest pain or syncope/short-term unconsciousness).
Sports fitness testing should be repeated every 2 years.
