The Sports Medical Health Assessment I — History, Examination, Resting ECG

Table of Contents

  1. What the Examination Is Asking
  2. History
  3. Physical Examination
  4. Blood Pressure
  5. Resting ECG
  6. Laboratory and Echocardiography in Context

Learning objectives:

  • Structure a sports medical history including family, personal, medication and sport history
  • Carry out and document the general internal and the orthopaedic parts of the physical examination
  • Read a resting ECG for the purpose of sports clearance and recognise training-related adaptations
  • Justify which further investigations a given finding does and does not warrant

1 What the Examination Is Asking

The scanned chapter Sportmedizinische Untersuchung (Gabriel & Puta) accompanies this lecture as the local protocol; the Scharhag handbook chapter supplies the general frame.

In the sports medical examination, prevention is in the foreground. In apparently healthy (competitive) athletes the questions are the exclusion of disease and the assessment of fitness to participate; in patients the question shifts to which sport, at which intensity, is safe and useful. Two different populations, two different prior probabilities, one procedure (Scharhag 2021). Making that difference explicit before the first question is asked is the methodological core of the examination.

2 History

The history is the highest-yield step of the whole ladder and the cheapest. It covers family history (sudden cardiac death, cardiomyopathy, early myocardial infarction), personal medical history, current complaints, medication and supplements, vaccination and infection history, and a dedicated sport history: disciplines, training volume and intensity, competition calendar, performance development, and any exertion-related symptoms. Constitutional symptoms deserve particular attention in an exercise immunology context — recurrent infections, prolonged recovery from minor illness, unexplained performance decline. In women, the menstrual cycle and, where relevant, contraception and cycle disturbances are recorded.

The single most informative question class is exertion-related: chest tightness, disproportionate breathlessness, palpitations, dizziness or syncope during or immediately after load. A positive answer changes the diagnostic pathway more than any single instrument finding.

3 Physical Examination

The examination has a general internal and an orthopaedic component. The internal part includes inspection, palpation, percussion and auscultation of heart and lungs, pulse status, and an assessment of the abdomen and lymph nodes; auscultation serves the detection of murmurs and pathological breath sounds. The orthopaedic part covers posture and spinal configuration, joint mobility and stability, muscular imbalances, and general functional tests. The written documentation must allow a second examiner to reconstruct the finding.

4 Blood Pressure

Blood pressure is measured after 3–5 minutes of seated rest, twice at 1–2 minute intervals, at the upper arm at heart level — at the first examination on both arms. The standard cuff is 12–13 cm wide and 35 cm long; arm circumferences above about 32 cm and markedly thinner arms require larger or smaller cuffs respectively, otherwise mismeasurement results. The cuff-size rule is a small point with an outsized effect on error rate in muscular athletes — a systematic measurement error, not a piece of trivia.

5 Resting ECG

The resting 12-lead ECG serves the detection of rhythm and conduction abnormalities, signs of hypertrophy, and repolarisation abnormalities. Its interpretation in athletes requires a separate norm: bradycardia, first-degree AV block, incomplete right bundle branch block and early repolarisation are common training-associated findings, whereas pathological T-wave inversion, deep Q waves, ventricular arrhythmia and marked conduction disease require clarification. The distinction has to be worked through on concrete traces, and the limits of ECG-based screening named explicitly — its sensitivity, its false-positive rate, and the cost of both to the individual athlete.

6 Laboratory and Echocardiography in Context

Laboratory diagnostics is used in a targeted way, driven by history and findings rather than as a panel. Echocardiography is used in healthy athletes within fitness examinations to exclude cardiac disease and to assess sport-related cardiac adaptation; besides standard parameters of function, chamber size and wall thickness, sports medicine additionally determines total heart volume. Related to body mass, athlete’s heart hypertrophy is defined from 13 ml·kg⁻¹ in men and 12 ml·kg⁻¹ in women; healthy untrained people typically lie between 10 and 12 ml·kg⁻¹, while highly endurance-trained athletes average 15–16 ml·kg⁻¹, with upper limits around 20 ml·kg⁻¹ in men and 19 ml·kg⁻¹ in women (Scharhag et al., cited in Scharhag 2021).

One-Minute-Paper Topics

A One-Minute-Paper (OMP) is a short, focused prompt that students answer in ~60 seconds at the end of a session to consolidate learning, surface misconceptions, and provide formative feedback. When answering, be concise, specific, and use terminology from today’s session.

  • Name three history items that, if positive, change the diagnostic pathway before any device is used.
  • Why does the same ECG finding carry different weight in a 19-year-old rower and a 58-year-old recreational runner?
  • An athlete has an arm circumference of 38 cm. What happens if the standard cuff is used, and in which direction?
  • Give one argument for and one against routine ECG screening in asymptomatic young athletes.

References

  • Gabriel HHW, Puta C. Sportmedizinische Untersuchung. Course chapter. Jena: Friedrich-Schiller-Universität Jena.
  • Scharhag J. Sportmedizinische Grundlagen: Sportmedizinische Gesundheitsbeurteilung und Beratung. In: Güllich A, Krüger M (eds), Handbuch Sport und Sportwissenschaft. Berlin, Heidelberg: Springer, 2021. doi:10.1007/978-3-662-53386-4_22-1.