Preparticipation Health Screening Research Articles

Prevalence of Iron Deficiency in Female Collegiate Athletes at a Division I Institution

BACKGROUND: Iron deficiency is widely underdiagnosed in female college athletes and may limit their athletic performance. Routine screening is necessary to identify potential female athletes who might benefit from iron supplementation. A retrospective study on the prevalence of iron deficiency in female collegiate division I athletes is imperative to bring awareness to the prevailing problem. The objective of this study is to determine the prevalence of iron deficiency in female athletes presenting to a Division 1 Athletic Training Room for initial health screening evaluation from January 2017 to July 2022. METHODS: A retrospective chart review was performed for female athletes who presented for initial pre-participation examination health screening to a Division 1 Athletic Training Room The data collected included the patients’ age, BMI, menstrual history, ferritin, and hemoglobin lab values. The primary sports analyzed was swim and dive, soccer, basketball, track and field/cross country, softball, lacrosse, volleyball, high tech, tennis, golf, and cheerleading. Descriptive statistics were used to describe the prevalence of iron deficiency among female athletes and the Student’s t-test and Pearson correlation analysis are used to identify any potential risk factors for iron deficiency. RESULTS: There was a total of 336 participants. The prevalence of athletes with low initial ferritin values under 40 ng/mL at pre-participation examination was 194 (57.74%, n=336). The mean ferritin value at pre-participation examination was 43.18 ng/mL (n=336). Statistical analysis of the other variables collected in this study including body mass index, menstrual history and primary sport showed no significant differences in relationship to initial ferritin levels. Female athletes with low ferritin levels were more likely to receive iron supplementation (p=8.089e-18, 95% CI= -31.33142, -20.19980). An increase in ferritin levels was correlated with iron supplementation (p=0.0217, 95% CI= 1.45825, 18.34014) and hemoglobin levels were higher in female athletes with higher ferritin levels (p-value=0.04971, 95% CI=0.00546, 0.14506). Initial ferritin levels were positively correlated with hemoglobin levels (p=2.402e-11, 95% CI=0.26962, 0.46399). Statistical analysis showed an increase in ferritin levels with usage of contraception (p=0.0073, 95% CI= 3.15448, 20.05362). CONCLUSION: This study’s findings represent the importance of screening ferritin levels in all female collegiate athletes regardless of sport, BMI, or menstrual history due to the high prevalence of low ferritin values. There was an increase in ferritin levels with usage of birth control suggesting the need to further evaluate the impact of menstrual history and contraception usage on ferritin and hemoglobin levels. In these authors experience, it is uncommon for institutions to incorporate routine screening measures in place for screening all female athletes with a ferritin value and complete blood count at initial pre-participation examination.

Self-reported exertional heat illness and risk factors among collegiate marching band artists

Marching band (MB) artists are often part of the general student population and not required to complete a pre-participation health screening to identify predisposing medical conditions or risks for injury/illness. Anecdotally, exertional heat illnesses (EHI) are a concern for MB artists. As more athletic trainers provide MB healthcare, research is needed on EHI occurrence and MB associated EHI risk factors. We utilized an exploratory cross-sectional study design to determine EHI risk factors, including previous EHI occurrence, among collegiate MB artists. MB artists (n ​= ​1 207; age ​= ​[19.6 ​± ​1.3] years) actively participating in their college/university's MB during the 2019 football season completed an online survey to characterize demographics, medical history, medication and supplement use, and nutrition behaviors. Chi-square and binomial logistical regressions assessed associations between categorical variables. Previous EHI was reported by 50.6% of MB artists, with 466 (76.3%) experiencing exertional heat exhaustion and 31 (5.1%) exertional heat stroke. More females reported exertional heat exhaustion overall (68.2%, p ​< ​0.001) and in the previous year (73.3%, p ​< ​0.001). Experiencing a previous EHI was significantly associated with having a mood/neurological condition (63.5%, p ​< ​0.001), diagnosed (74.3%, p ​= ​0.004) or perceived eating disorder (66.7%, p ​< ​0.001), and taking prescription medications (59.4%, p ​< ​0.001), over-the-counter medications (58.9%, p ​= ​0.002), and supplements (55.4%, p ​= ​0.037). Half of collegiate MB artists reported experiencing previous EHIs and engaged in behaviors known to increase EHI risk. MB artists should complete pre-participation examinations to identify pre-existing medical conditions and risks for adverse medical events. Healthcare providers working with MB artists should develop policies and procedures to mitigate EHI risks and occurrence.

Comparing cardiorespiratory fitness and physical activity levels between third- and fifth-year medical students in a South African university.

Cardiovascular disease (CVD) risk factors such as sedentary behaviour, decreased physical activity (PA), and low cardiorespiratory fitness lead to an increased and accelerated risk of cardiovascular disease and mortality. Medical students tend to adopt sedentary lifestyles due to a demanding curriculum. This may have a negative effect on CVD risk factors and cardiorespiratory fitness levels of medical students. To compare physical activity and cardiorespiratory fitness levels in a cohort of third- and fifth-year undergraduate medical students in a South African university. Data from 123 third-year and 139 fifth-year medical students in the Graduate Entry Medical Programme (GEMP) at the Faculty of Health Sciences, University of the Witwatersrand, were collected. Measurements included CVD risk factors, height, weight, blood pressure, waist circumference, cardiorespiratory fitness, physical activity vital signs and pre-participation health screening questionnaires. Descriptive statistics were presented as mean ± standard deviation or median [interquartile range] depending whether the data were normally distributed or not. Both groups had low cardiorespiratory fitness when compared to norm values (GEMPI VO2 peak was 29.1 ± 5.9 ml.kg-1.min-1 and GEMPIII VO2 peak was 30.0[11.0] ml.kg-1.min-1). Most participants did not meet WHO physical activity requirements (GEMP I: 72%; GEMP III: 78%). There were significant differences in BMI (p=0.046), diastolic blood pressure (p=0.034) and VO2 peak (p=0.00001) between students meeting and not meeting WHO physical activity requirements (p<0.05). Third- and fifth-year medical students at a South African university fail to meet recommended WHO physical activity levels and are below cardiorespiratory fitness norms. Therefore, medical institutions should promote and implement targeted physical activity interventions to reduce the prevalence of low fitness levels and the associated health hazards among their students.

Comprehensiveness, Accuracy, and Readability of Exercise Recommendations Provided by an AI-Based Chatbot: Mixed Methods Study.

Regular physical activity is critical for health and disease prevention. Yet, health care providers and patients face barriers to implement evidence-based lifestyle recommendations. The potential to augment care with the increased availability of artificial intelligence (AI) technologies is limitless; however, the suitability of AI-generated exercise recommendations has yet to be explored. The purpose of this study was to assess the comprehensiveness, accuracy, and readability of individualized exercise recommendations generated by a novel AI chatbot. A coding scheme was developed to score AI-generated exercise recommendations across ten categories informed by gold-standard exercise recommendations, including (1) health condition-specific benefits of exercise, (2) exercise preparticipation health screening, (3) frequency, (4) intensity, (5) time, (6) type, (7) volume, (8) progression, (9) special considerations, and (10) references to the primary literature. The AI chatbot was prompted to provide individualized exercise recommendations for 26 clinical populations using an open-source application programming interface. Two independent reviewers coded AI-generated content for each category and calculated comprehensiveness (%) and factual accuracy (%) on a scale of 0%-100%. Readability was assessed using the Flesch-Kincaid formula. Qualitative analysis identified and categorized themes from AI-generated output. AI-generated exercise recommendations were 41.2% (107/260) comprehensive and 90.7% (146/161) accurate, with the majority (8/15, 53%) of inaccuracy related to the need for exercise preparticipation medical clearance. Average readability level of AI-generated exercise recommendations was at the college level (mean 13.7, SD 1.7), with an average Flesch reading ease score of 31.1 (SD 7.7). Several recurring themes and observations of AI-generated output included concern for liability and safety, preference for aerobic exercise, and potential bias and direct discrimination against certain age-based populations and individuals with disabilities. There were notable gaps in the comprehensiveness, accuracy, and readability of AI-generated exercise recommendations. Exercise and health care professionals should be aware of these limitations when using and endorsing AI-based technologies as a tool to support lifestyle change involving exercise.

Evaluation of Exercise Mobile Applications for Adults with Cardiovascular Disease Risk Factors.

To conduct a systematic review to determine if there are exercise mobile applications (apps) that can produce evidence-based, individualized exercise plans. We searched the Apple Store and Google Play for exercise apps with terms related to exercise and health. Exercise apps were eligible if they: (1) had a ≥4 out of 5 overall rating with ≥1000 reviews; (2) were free to download; and (3) were not gender specific. Exercise apps were evaluated via the evidence-based exercise prescription (ExRx) standards of the American College of Sports Medicine (ACSM) and American Heart Association. For the exercise app evaluation criteria, an app was included if it (1) was evidence-based; (2) contained a preparticipation health screening protocol; (3) built a cardiovascular disease (CVD) risk factor profile; (4) prioritized one chronic disease or health condition to focus on; (5) framed the exercise plan by the frequency, intensity, time, and type principle (FITT) of ExRx; and (6) specified special considerations. Of the 531 potentially qualifying apps, 219 qualified. The qualifying apps were rarely evidenced-based (0.5%) or had a preparticipation screening protocol (3.7%). Only 27.7% built CVD risk factor profiles. Most apps (64.8%) focused on body image and/or athletic performance. Only 4.3% focused on chronic diseases or health conditions, while the remainder (34.5%) did not disclose a focus. No app framed the exercise plans by the FITT of ExRx. Only 1.4% of the apps specified special considerations. There are no commercially available exercise apps that generate an evidence-based, individualized exercise plan for adults with CVD risk factors.

Medical Clearance of Older Adults Participating in Preventative Direct Access Physical Therapy.

Background The purpose of this study was to determine if the use of evidence-based cognitive and cardiovascular screening prior to initiating a prevention-focused exercise program that utilizes a physical therapist (PT) direct consumer access referral model is safe. Methods A retrospective descriptive analysis of data from a prior randomized controlled trial (RCT) was performed. Two data sets emerged: Group S was screened for study inclusion but not enrolled, and Group E was enrolled and participated in preventative exercise. Participant outcomes of cognitive screenings (Mini-Cog, Trail Making Test-Part B) and cardiovascular screening (American College of Sports Medicine Exercise Pre-participation Health Screening) were extracted. Descriptive statistics were generated for demographic and outcome variables and inferential statistics were analyzed (p < 0.05). Results Records from 70 individuals (Group S) and 144 individuals (Group E) were available for analysis. Overall, 18.6% (n = 13) in Group S were not enrolled due to medical instability or potential safety considerations. The need for medical clearance prior to initiating an exercise program was identified and then clearance was obtained for 40% (n = 58) of the participants in Group E. No adverse events related to program participation were reported. Conclusions A PT-led program utilizing direct access referrals from senior centers offers a safe option for older adults to participate in individualized preventative exercise programming.

The Effects of High Intensity Exercise to Exhaustion on the Concentrations of Endostatin and VEGF in Plasma

Endostatin and Vascular Endothelial Growth Factor (VEGF) are important markers driving the angiogenic switch. It is clear that short periods of moderate to high intensity exercise significantly increase the concentration of endostatin and VEGF in plasma. Objective: To investigate concentration of circulatory endostatin in plasma and impact of different intensities of exercise encompassing from low to maximum on distribution of endostatin and VEGF concentrations in plasma. Methods: Eight healthy male volunteers were recruited through advertisements and personal contacts, after assessing their fitness through two pre-participation health screening questionnaires, PAR-Q and ACSM Health Fitness Facility pre-participation health screening questionnaire for performing maximal exercise to volitional exhaustion. All the volunteers attend the lab on 2 consecutive days. The blood was centrifuged at 1000 RPM for 15 minutes for endostatin and VEGF and at 3000 RPM for 15 minutes for lipid profiles and insulin. Samples were analysed for endostatin and VEGF concentrations using QuantikinR ELISA kit of the R&amp;D systems, while Insulin was measured using ELISA kit (Mercodia, Uppsala Sweden). Results: The basal endostatin concentration remained consistent and higher intensity of exercise significantly increased the endostatin concentration for up to 2 hours. Exercise also influenced VEGF concentration transiently and only at 30 minutes’ interval increase in VEGF was statistically significant. Conclusion: It is worth noting that those participants who showed an immediate decrease in VEGF after exercise, later on exhibited a concentration higher than basal

CHARACTERISTICS OF RESTING ECG AMONG SABAH PROFESSIONAL MALE FOOTBALLERS

The purpose of this study is to describe the resting electrocardiogram (ECG) seen among 176 professional male footballers from Sabah Football Association Club during preparticipation evaluation. Data were analysed retrospectively from 2017 to 2019. Majority of the players were Sabah natives (n=153, 87%) while the remaining were Malay footballers (n=23, 13%). Mean age of the players was 19.9 ± 3.1, mean body mass index was 22.6 kg/m2 ± 7, mean resting heart rate was 53.6 beats per minute ± 9.4, mean systolic blood pressure was 122.3 mmHg ± 12, and mean diastolic blood pressure was 65.1 mmHg ± 8.8. Using the International Criteria for ECG Interpretation in Athletes 2017 consensus guidelines, 8.5% (n=15) had abnormal ECG while 2.8% (n=5) had borderline ECG. The most common ECG changes seen in the normal findings were sinus bradycardia (n=123, 69.9%), early repolarization (n=115, 65.3%) and left ventricular hypertrophy (n=83,47.2%). Abnormal ECGs were abnormal t wave inversion (n=7,4.0%) and pre-excitation syndrome (n=5,2.9%). All footballers with abnormal ECG findings were subjected to further evaluation by a cardiologist using echocardiography assessment and exercise stress test. They passed the cardiology assessment; thus, they were deemed fit to play. ECG is a valuable tool for pre-participation health screening prior to exercise or sports participation, as it is vital for a physician to identify any abnormal ECG to minimise the risk of sudden cardiac death during exercise due to cardiac pathology.

Characteristics of resting ECG among sabah professional male footballers

The purpose of this study is to describe the resting electrocardiogram (ECG) seen among 176 professional male footballers from Sabah Football Association Club during preparticipation evaluation. Data were analysed retrospectively from 2017 to 2019. Majority of the players were Sabah natives (n = 153, 87%) while the remaining were Malay footballers (n = 23, 13%). Mean age of the players was 19.9 ± 3.1, mean body mass index was 22.6 kg/m2 ± 7, mean resting heart rate was 53.6 beats per minute ± 9.4, mean systolic blood pressure was 122.3 mmHg ± 12, and mean diastolic blood pressure was 65.1 mmHg ± 8.8. Using the International Criteria for ECG Interpretation in Athletes 2017 consensus guidelines, 8.5% (n = 15) had abnormal ECG while 2.8% (n = 5) had borderline ECG. The most common ECG changes seen in the normal findings were sinus bradycardia (n = 123, 69.9%), early repolarization (n = 115, 65.3%) and left ventricular hypertrophy (n = 83,47.2%). Abnormal ECGs were abnormal t wave inversion (n = 7,4.0%) and pre-excitation syndrome (n = 5,2.9%). All footballers with abnormal ECG findings were subjected to further evaluation by a cardiologist using echocardiography assessment and exercise stress test. They passed the cardiology assessment; thus, they were deemed fit to play. ECG is a valuable tool for pre-participation health screening prior to exercise or sports participation, as it is vital for a physician to identify any abnormal ECG to minimise the risk of sudden cardiac death during exercise due to cardiac pathology.

Development of a Novel Clinical Decision Support System for Exercise Prescription Among Patients With Multiple Cardiovascular Disease Risk Factors

Cardiovascular disease (CVD) risk factors cluster in an individual. Exercise is universally recommended to prevent and treat CVD. Yet, clinicians lack guidance on how to design an exercise prescription (ExRx) for patients with multiple CVD risk factors. To address this unmet need, we developed a novel clinical decision support system to prescribe exercise (prioritize personalize prescribe exercise [P3-EX]) for patients with multiple CVD risk factors founded upon the evidenced-based recommendations of the American College of Sports Medicine (ACSM) and American Heart Association. To develop P3-EX, we integrated (1) the ACSM exercise preparticipation health screening recommendations; (2) an adapted American Heart Association Life’s Simple 7 cardiovascular health scoring system; (3) adapted ACSM strategies for designing an ExRx for people with multiple CVD risk factors; and (4) the ACSM frequency, intensity, time, and time principle of ExRx. We have tested the clinical utility of P3-EX within a university-based online graduate program in ExRx among students that includes physicians, physical therapists, registered dietitians, exercise physiologists, kinesiologists, fitness industry professionals, and kinesiology educators in higher education. The support system P3-EX has proven to be an easy-to-use, guided, and time-efficient evidence-based approach to ExRx for patients with multiple CVD risk factors that has applicability to other chronic diseases and health conditions. Further evaluation is needed to better establish its feasibility, acceptability, and clinical utility as an ExRx tool.

Avaliação em saúde antes da prática de exercícios físicos

Introdução: A prática regular de exercício físico (EF) é compreendida como principal meio não medicamentoso de prevenir doenças e melhorar a qualidade de vida. A avaliação antes do início da prática de exercícios (pré-participação) é fundamental para a prática segura e eficiente. Objetivos: Este estudo tem como objetivo abordar a relevância da avaliação em saúde, seus principais protocolos e as atualizações do American College of Sports Medicine (ACSM). Metodologia: O termo “preparticipation health screening” foi utilizado na base de dados PubMed e Google Scholar. Resultados e Discussão: De acordo com a literatura, informações obtidas por meio da avaliação pré-participação facilitam a escolha do exercício mais adequado e seguro. Os principais protocolos de avaliação pré-participação em saúde se baseiam, em geral, na presença de sintomas de doenças cardiovasculares, metabólicas e renais. As novas orientações do ACSM indicam que na avaliação pré-participação é mais adequado considerar a presença de sinais ou sintomas de doenças cardiovasculares (DCV), metabólicas ou renais, o condicionamento físico atual do indivíduo e a intensidade do exercício desejada. Conclusão: Considerando as novas orientações do ACSM, é possível diminuir as barreiras para o início de um programa de EF e ainda assim garantir a segurança de seus praticantes.

ACSM Preparticipation Health Screening Guidelines: A UK University Cohort Perspective.

Preparticipation health screening is recommended to detect individuals susceptible to serious adverse cardiovascular complications during exercise. Although expert opinion and best available scientific evidence have informed recent modifications, there remain limited experimental data to support or refute current practice. We therefore aimed to quantify the impact of change to the preparticipation health screening guidelines of the American College of Sports Medicine (ACSM) on risk classification and referral for medical clearance in a large cohort of undergraduate university students. Participants attended the laboratory on a single occasion to undergo preparticipation health screening. Information concerning health status was obtained via self-report questionnaire and objective physiological assessment with all data recorded electronically and evaluated against the ACSM screening guidelines (9th and 10th editions). Five hundred and fifty-three students completed the study. The 9th edition screening guidance resulted in 82 subjects (15%) classified as high risk, almost one-quarter (24%) classified as moderate risk, and almost two-thirds (61%) classified as low risk. In comparison, the updated 10th edition screening guidance resulted in a significant reduction in those previously classified as either high risk (5%) or moderate risk (2%), respectively. The majority of subjects (93%) were therefore cleared to begin a structured exercise program. Taken together, approximately one-third (32%) fewer medical referrals were required when applying the updated 10th edition guidance (χ4 = 247.7, P < 0.001). The updated ACSM 10th edition preparticipation screening guidance reduces medical referrals by approximately one-third. These findings are in keeping with previous reports and thus serve to consolidate and justify recent modification-particularly when applied to young adult or adolescent populations. The findings and arguments presented should be used to refine and inform future guidance.

New Preparticipation Health Screening Recommendations

New Preparticipation Health Screening Recommendations

Updating ACSM’s Recommendations for Exercise Preparticipation Health Screening

Updating ACSM’s Recommendations for Exercise Preparticipation Health Screening

Exercise Testing and Training Strategies for Healthy and Frail Elderly

Exercise Testing and Training Strategies for Healthy and Frail Elderly

Pre-exercise participation cardiovascular screening in a heterogeneous cohort of adult cancer patients.

The purpose of this study was to investigate the extent of pre-exercise participation ("preparticipation") health screening in a heterogeneous cohort of adult cancer patients. Patients (n = 413) with histologically confirmed solid or hematologic malignancy were categorized into preparticipation health screening risk stratification based on American College Sports Medicine (ACSM) recommendations. Risk of an exercise-related event was evaluated during a symptom-limited cardiopulmonary exercise test (CPET) with 12-lead electrocardiography (ECG). Participant risk was categorized as low risk (n = 59, 14%), moderate risk (n = 217, 53%), and high risk (n = 137, 33%). Mean peak oxygen consumption was 21.7 ± 6.7 mL/kg(-1) per minute(-1) or 19.5 ± 21.7% below age- and sex-predicted sedentary values. No major serious adverse events or fatal events were observed during CPET procedures. A total of 31 positive ECG tests were observed, for an event rate of 8%. ACSM risk stratification did not predict the risk of a positive test. Age, statin use, antiplatelet therapy use, cardiovascular disease, prior treatment with anthracycline or radiation therapy, and being sedentary were predictors of a positive test (all p < .10). The patient risk-stratification profile strongly suggests that the use of formalized preparticipation health screening is required in all oncology scenarios; however, risk of an exercise-induced event is low, suggesting that the use of exercise testing is not required for pre-exercise clearance in the majority of patients.

ACSM’s New Preparticipation Health Screening Recommendations from ACSM’s Guidelines for Exercise Testing and Prescription, Ninth Edition

ACSM’s New Preparticipation Health Screening Recommendations from ACSM’s Guidelines for Exercise Testing and Prescription, Ninth Edition

A Study of the Effect of Structured Exercise Programme on the Resting Heart Rate of Female Workers at the University of Lagos, Nigeria

The present study is aimed at assessing the various cardiovascular changes in the female staff of University of Lagos as a result of structured exercise programme. The study examines whether pre-exercise resting heart rate of these workers is more than the post exercise resting heart rate. Using experimental research method, a treatment variation was administered on the experimental and control groups and the effect of the treatment was determined. Questionnaire which identified the age, sex, family health history and pre-participation health screening test was administered. Descriptive statistics which include measures of central tendency, measures of deviation and percentages were used in presenting the data collected. One-way Analysis of Variance (ANOVA) and t—test were used to test the hypotheses. All hypotheses were tested at 0.05 level of significance. Furthermore, two regression models were fitted to confirm the significance of the difference of the pre-test and post-test exercise resting heart rate of the participants The finding revealed that structured exercise programme has a significant effect on the resting systolic and diastolic blood pressures and the resting heart rate of the participants. There is evidence that structured exercise programme had effect on the blood sugar level of the participants and also aids the management of the older adults by keeping them fit, thereby prolonging the effects of aging in the development of cardiovascular disease.

Preparticipation health screening of young athletes. Results of 1268 examinations.

The major purpose of the preparticipation physical examination of athletes is to screen for conditions that could predispose the athlete to injury or death. However, this examinations offered to many of the athletes in this country fail to adequately accomplish this. This study analyzed the preparticipation health exams of prospective sports participants from all public schools in Richmond County, Georgia for two consecutive years. We sought to identify the components of a preparticipation exam which most accurately identified athletes who were at risk of sustaining injury. The most frequently reported problems on the health history were previous injuries, previous hospitalizations, and joint problems. These were consistent over the two years. The problems recorded most frequently on the physical exam involved the lower extremities, mouth, teeth, heart, eyes, and genitalia. However the prevalence of abnormalities found during the first year of the study was significantly lower than that identified in the second study. Analysis of the findings resulted in a more standardized approach to the examination and in an improved examination form.