Pre-participation assessment in young athletes: a state affair

Abstract

One of the main goals for maintaining ‘‘wellness’’ is to promote and sustain physical activity as an ‘‘habitual practice’’. In both moderate and more vigorous forms, it normally generates numerous and well-known benefits in both young and not-so-young subjects [2]. More recently, sports activity, either in a competitive or non-competitive form, has started to involve a larger group of subjects from different age groups. Therefore, an accurate clinical evaluation in athletes is necessary. All the benefits obtained from sport activity are inevitably associated with several risks that can potentially induce various diseases, ranging from acute musculoskeletal injuries to sudden death [2, 3]. In this context, the Italian National Health Service has to deal with the protection of people who are going to start a competitive-elite sport activity. In fact, the National Health Service provides a medical check-up in order to allow all athletes to practice the type of physical activity best suited to maintain their well-being, to prevent avoidable diseases, and to maintain the highest level of safety during sport activity. In this context, the pre-participation evaluation (PPE) represents the first step in the commencement of sport activity. This plan has also been adopted by European and American associations even if regular use and schemes have not yet been completely utilized. According to ACSM, which is the main organization in US [4], athletes should undergo a complete examination before starting a seasonal competitive sport activity. In most states, this assessment is composed of a simple questionnaire, while only recently the electrocardiogram (ECG) has been introduced [5]. At present, the European PPE context is very dissimilar among countries and lacks a group of homogenous and standardized rules all leading to the same final objective. For example, in Austria, pre-participation screening (PPS) may be performed from the age of 6 years under the guidance of dedicated-trained professionals; in Finland, where the risk of sudden death is estimated to be higher than elsewhere, PPS is required at least 6–8 weeks before starting sporting activities; in France, a general medical clearance to carry out physical activity is sufficient for ‘‘amateur sports’’, while in the case of ‘‘competitive sports’’, certification of the absence of physical contraindications is necessary; in The Netherlands, all citizens are currently submitted to a regular screening, and therefore a special program does not exist for all sports, as is the case of many other countries in Europe. In the UK, in order to better monitor the impact of high level sport activity, this type of assessment is requested exclusively for elite athletes [6, 7]. Since 1982, in Italy, PPE, mandatory for competitive athletes, is officially under the supervision of the state. When an athlete is aged under 18 years, the National Health Service guarantees all the support required, and no additional financial contribution to obtain the eligibility is necessary. The Italian PPE is composed of several recommended exams, in addition to clinical history and physical This text has been the object of an Invited Lecture given at the Royal College of Sports Medicine London by Professor Giorgio Galanti on 19 March 2010.