Abstract
Background
Several pre-participation screening algorithms (PPSAs) have been proposed to assess sports eligibility in different populations. They are usually based on self-administered questionnaires, without further medical assessment if no risk factors are documented. The Med-Ex “Formula Benessere” worksite program includes a complete cardiovascular (CV) screening for all participants. The purpose of this study was to assess PPSAs accuracy in detecting medical and/or CV abnormalities in the general population, comparing the results with the date derived from Med-Ex program.
Methods
The Med-Ex medical evaluation, consisting of medical history, physical examination (including body composition), resting electrocardiogram (ECG) and exercise stress test in 464 male subjects (38.4 aged) was analyzed and matched to several PPSAs – Physical Activity Readiness Questionnaire (PAR-Q) (2002–2020), American Heart Association (AHA)/American College of Sport Medicine (ACSM) (1998–2009–2014–2015), European Association of Cardiovascular Prevention and Rehabilitation (EACPR) (2011) – retrospectively simulated.
Results
Five-hundred and 67 abnormalities were detected though Med-Ex medical evaluation, and one-fourth (24%) would have been undetected applying PPSA alone. In particular 28% of high blood pressure, 21% of impaired fasting glycaemia, 21% of high Body Mass Index (BMI) values and 19% of ECG abnormalities would have been missed, on average, by all PPSAs.
Conclusions
The simulation analysis model performed in this study allowed to highlight the limits of PPSAs in granting sport eligibility, compared to a medical-guided CV screening. These findings emphasize the importance of a more balanced approach to pre-participation screening that includes a thorough evaluation of the cost/benefit ratio.
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Research funding: Not applicable.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: Authors state no conflict of interest.
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Informed consent: Informed consent was obtained from all individuals included in this study.
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Ethical approval: The local Institutional Review Board deemed the study exempt from review.
References
1. Schmied, C, Borjesson, M. Sudden cardiac death in athletes. J Intern Med 2014;275:93–103. https://doi.org/10.1111/joim.12184.Search in Google Scholar
2. Palermi, S, Serio, A, Vecchiato, M, Sirico, F, Gambardella, F, Ricci, F, et al.. Potential role of an athlete-focused echocardiogram in sports eligibility. World J Cardiol 2021;13:271–97. Available from: http://www.ncbi.nlm.nih.gov/pubmed/34589165. [Accessed 6 Jan 2022].10.4330/wjc.v13.i8.271Search in Google Scholar
3. Lear, SA, Hu, W, Rangarajan, S, Gasevic, D, Leong, D, Iqbal, R, et al.. The effect of physical activity on mortality and cardiovascular disease in 130,000 people from 17 high-income, middle-income, and low-income countries: the PURE study. Lancet 2017;390:2643–54. https://doi.org/10.1016/s0140-6736(17)31634-3.Search in Google Scholar
4. Palermi, S, Sacco, AM, Belviso, I, Romano, V, Montesano, P, Corrado, B, et al.. Guidelines for physical activity—a cross-sectional study to assess their application in the general population. Have we achieved our goal? Int J Environ Res Publ Health 2020;17:3980. https://doi.org/10.3390/ijerph17113980.Search in Google Scholar PubMed PubMed Central
5. Sattelmair, J, Pertman, J, Ding, EL, Kohl, HW3rd, Haskell, W, Lee, I-M. Dose response between physical activity and risk of coronary heart disease: a meta-analysis. Circulation 2011;124:789–95. https://doi.org/10.1161/circulationaha.110.010710.Search in Google Scholar
6. Corrado, D, Schmied, C, Basso, C, Borjesson, M, Schiavon, M, Pelliccia, A, et al.. Risk of sports: do we need a pre-participation screening for competitive and leisure athletes? Eur Heart J 2011;32:934–44. https://doi.org/10.1093/eurheartj/ehq482.Search in Google Scholar PubMed
7. Van Brabandt, H, Desomer, A, Gerkens, S, Neyt, M. Harms and benefits of screening young people to prevent sudden cardiac death. BMJ 2016;353:i1156. https://doi.org/10.1136/bmj.i1156.Search in Google Scholar PubMed
8. Mosterd, A. Pre-participation screening of asymptomatic athletes: “Don’t do stupid stuff”. Neth Heart J 2018;26:123–6. https://doi.org/10.1007/s12471-018-1075-7.Search in Google Scholar PubMed PubMed Central
9. Mont, L, Pelliccia, A, Sharma, S, Biffi, A, Borjesson, M, Brugada Terradellas, J, et al.. Pre-participation cardiovascular evaluation for athletic participants to prevent sudden death: position paper from the EHRA and the EACPR, branches of the ESC. Endorsed by APHRS, HRS, and SOLAECE. Eur J Prev Cardiol 2017;24:41–69. https://doi.org/10.1177/2047487316676042.Search in Google Scholar PubMed
10. Borjesson, M, Dellborg, M, Niebauer, J, LaGerche, A, Schmied, C, Solberg, EE, et al.. Recommendations for participation in leisure time or competitive sports in athletes-patients with coronary artery disease: a position statement from the sports cardiology section of the European Association of Preventive Cardiology (EAPC). Eur Heart J 2019;40:13–8. https://doi.org/10.1093/eurheartj/ehy408.Search in Google Scholar PubMed
11. Nocon, M, Hiemann, T, Müller-Riemenschneider, F, Thalau, F, Roll, S, Willich, SN. Association of physical activity with all-cause and cardiovascular mortality: a systematic review and meta-analysis. Eur J Cardiovasc Prev Rehabil 2008;15:239–46. https://doi.org/10.1097/hjr.0b013e3282f55e09.Search in Google Scholar PubMed
12. Corrado, D, Pelliccia, A, Bjørnstad, HH, Vanhees, L, Biffi, A, Borjesson, M, et al.. Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol: consensus statement of the study group of sport cardiology of the working group of cardiac rehabilitation and. Eur Heart J 2005;26:516–24. https://doi.org/10.1093/eurheartj/ehi108.Search in Google Scholar PubMed
13. Morrison, BN, McKinney, J, Isserow, S, Lithwick, D, Taunton, J, Nazzari, H, et al.. Assessment of cardiovascular risk and preparticipation screening protocols in masters athletes: the Masters Athlete Screening Study (MASS): a cross-sectional study. BMJ Open Sport Exerc Med 2018;4: e000370. https://doi.org/10.1136/bmjsem-2018-000370.Search in Google Scholar PubMed PubMed Central
14. Thompson, PD, Franklin, BA, Balady, GJ, Blair, SN, Corrado, D, Estes, NAM3rd, et al.. Exercise and acute cardiovascular events placing the risks into perspective: a scientific statement from the American heart association council on nutrition, physical activity, and metabolism and the council on clinical cardiology. Circulation 2007;115:2358–68. https://doi.org/10.1161/CIRCULATIONAHA.107.181485.Search in Google Scholar PubMed
15. Ermolao, A, Gasperetti, A, Rigon, A, Patti, A, Battista, F, Frigo, AC, et al.. Comparison of cardiovascular screening guidelines for middle-aged/older adults. Scand J Med Sci Sports 2019;29:1375–82. https://doi.org/10.1111/sms.13457.Search in Google Scholar PubMed
16. Biffi, A, Fernando, F, Adami, PE, Messina, M, Sirico, F, Di Paolo, F, et al.. Ferrari corporate wellness program: results of a pilot analysis and the “drag” impact in the workplace. High Blood Pres Cardiovasc Prev 2018;25:261–6. https://doi.org/10.1007/s40292-018-0266-z.Search in Google Scholar PubMed
17. Biffi, A, Gallo, G, Fernando, F, Sirico, F, Signorello, MG, De Martino, L, et al.. Relationship between cardiorespiratory fitness, baseline blood pressure and hypertensive response to exercise in the Ferrari corporate population. High Blood Pres Cardiovasc Prev 2021;29:81–8. https://doi.org/10.1007/s40292-021-00491-5.10.1007/s40292-021-00491-5Search in Google Scholar PubMed
18. Sirico, F, Fernando, F, Bianco, A, Loiacono, C, Nuccio, F, Gambardella, F, et al.. Parental perception of children’s weight status: love overpasses scientific evidence! A cross-sectional observational study. High Blood Pres Cardiovasc Prev 2020;27:29–34. https://doi.org/10.1007/s40292-019-00352-2.Search in Google Scholar PubMed
19. Biffi, A, Gallo, G, Fernando, F, Sirico, F, Signorello, MG, Messina, M, et al.. Usefulness of the corporate wellness projects in primary prevention at the population level: a study on the prevalence, awareness, and control of hypertension in the Ferrari company. J Hum Hypertens 2022;36:308–14. https://dx.doi.org/10.1038/s41371-021-00528-1.10.1038/s41371-021-00528-1Search in Google Scholar PubMed
20. Sirico, F, Fernando, F, Di Paolo, F, Adami, PE, Signorello, MG, Sannino, G, et al.. Exercise stress test in apparently healthy individuals − where to place the finish line? The Ferrari corporate wellness programme experience. Eur J Prev Cardiol 2019;26:731–8.10.1177/2047487318825174Search in Google Scholar PubMed
21. Balady, GJ, Chaitman, B, Driscoll, D, Foster, C, Froelicher, E, Gordon, N, et al.. Recommendations for cardiovascular screening, staffing, and emergency policies at health/fitness facilities. Circulation 1998;97:2283–93. https://doi.org/10.1161/01.cir.97.22.2283.Search in Google Scholar PubMed
22. American College of Sports Medicine, Riebe, D, Ehrman, JK, Liguori, G, Magal, M. ACSM’s guidelines for exercise testing and prescription, 10th ed. Philadelphia: Wolters Kluwer; 2018.Search in Google Scholar
23. Riebe, D, Franklin, BA, Thompson, PD, Garber, CE, Whitfield, GP, Magal, M, et al.. Updating ACSM’s recommendations for exercise preparticipation health screening. Med Sci Sports Exerc 2015;47:2473–9. https://doi.org/10.1249/mss.0000000000000664.Search in Google Scholar PubMed
24. Borjesson, M, Urhausen, A, Kouidi, E, Dugmore, D, Sharma, S, Halle, M, et al.. Cardiovascular evaluation of middle-aged/senior individuals engaged in leisure-time sport activities: position stand from the sections of exercise physiology and sports cardiology of the European Association of Cardiovascular Prevention and Rehabilitation [Internet]. Eur J Cardiovasc Prev Rehabil 2011;18:446–58. Available from: http://cpr.sagepub.com/content/18/3/446.abstract. [Accessed 8 May 2020]. https://doi.org/10.1097/hjr.0b013e32833bo969.Search in Google Scholar
25. Modified from American College of Sports Medicine and American Heart Association. ACSM/AHA Joint Position Statement: recommendations for cardiovascular screening, staffing, and emergency policies at health/fitness facilities. Med Sci Sports Exerc 1998;30:1009–18.10.1249/00005768-199806000-00034Search in Google Scholar
26. Thomas, S, Reading, J, Shephard, RJ. Revision of the physical activity readiness questionnaire (PAR-Q). Can J Sport Sci 1992;17:338–45.Search in Google Scholar
27. Warburton, D, Jamnik, V, Bredin, S, Gledhill, N. The physical activity readiness questionnaire for everyone (PAR-Q+) and electronic physical activity readiness medical examination (ePARmed-X+). Health Fit J Canada 2011;4:3–23.Search in Google Scholar
28. Warburton, DER, Gledhill, N, Jamnik, VK, Bredin, SSD, McKenzie, DC, Stone, J, et al.. Evidence-based risk assessment and recommendations for physical activity clearance: consensus Document 2011. Appl Physiol Nutr Metabol 2011;36:S266–98. https://doi.org/10.1139/h11-062.Search in Google Scholar PubMed
29. Shapero, K, Deluca, J, Contursi, M, Wasfy, M, Weiner, RB, Lewis, GD, et al.. Cardiovascular risk and disease among masters endurance athletes: insights from the boston MASTER (masters athletes survey to evaluate risk) initiative. Sport Med Open 2016;2:29. https://doi.org/10.1186/s40798-016-0053-0.Search in Google Scholar PubMed PubMed Central
30. Williams, B, Mancia, G, Spiering, W, Agabiti Rosei, E, Azizi, M, Burnier, M, et al.. ESC/ESH guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European society of cardiology (ESC) and the European society of hypertension (ESH). Eur Heart J 2018;39:3021–104. https://doi.org/10.1714/3026.30245.Search in Google Scholar PubMed
31. Jae, SY, Franklin, BA, Choo, J, Choi, Y-H, Fernhall, B. Exaggerated exercise blood pressure response during treadmill testing as a predictor of future hypertension in men: a longitudinal study. Am J Hypertens 2015;28:1362–7. https://doi.org/10.1093/ajh/hpv036.Search in Google Scholar PubMed
32. Kurl, S, Laukkanen, JA, Rauramaa, R, Lakka, TA, Sivenius, J, Salonen, JT. Systolic blood pressure response to exercise stress test and risk of stroke. Stroke 2001;32:2036–41. https://doi.org/10.1161/hs0901.095395.Search in Google Scholar PubMed
33. Mundal, R, Kjeldsen, SE, Sandvik, L, Erikssen, G, Thaulow, E, Erikssen, J. Exercise blood pressure predicts cardiovascular mortality in middle-aged men. Hypertension 1994;24:56–62. https://doi.org/10.1161/01.hyp.24.1.56.Search in Google Scholar PubMed
34. Niebauer, J, Börjesson, M, Carre, F, Caselli, S, Palatini, P, Quattrini, F, et al.. Recommendations for participation in competitive sports of athletes with arterial hypertension: a position statement from the sports cardiology section of the European Association of Preventive Cardiology (EAPC). Eur Heart J 2018;39:3664–71. https://doi.org/10.1093/eurheartj/ehy511.Search in Google Scholar
35. Calzolari, A, Turchetta, A, Biondi, G, Drago, F, De Ranieri, C, Gagliardi, G, et al.. Rehabilitation of children after total correction of tetralogy of Fallot. Int J Cardiol 1990;28:151–8. https://doi.org/10.1016/0167-5273(90)90055-a.Search in Google Scholar
36. Budts, W, Pieles, GE, Roos-Hesselink, JW, Sanz de la Garza, M, D’Ascenzi, F, Giannakoulas, G, et al.. Recommendations for participation in competitive sport in adolescent and adult athletes with congenital heart disease (CHD): position statement of the sports cardiology & exercise section of the European association of preventive cardiology (EAPC). Eur Heart J 2020;41:4191–9.10.1093/eurheartj/ehaa501Search in Google Scholar PubMed
37. Drezner, JA, Sharma, S, Baggish, A, Papadakis, M, Wilson, MG, Prutkin, JM, et al.. International criteria for electrocardiographic interpretation in athletes: consensus statement. Br J Sports Med 2017;51:704–31. https://doi.org/10.1136/bjsports-2016-097331.Search in Google Scholar PubMed
38. American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes—2020. Diabetes Care 2020;43(1 Suppl):S14–31.10.2337/dc20-S002Search in Google Scholar PubMed
39. Huang, Y, Cai, X, Mai, W, Li, M, Hu, Y. Association between prediabetes and risk of cardiovascular disease and all cause mortality: systematic review and meta-analysis. BMJ 2016;355:i5953. https://doi.org/10.1136/bmj.i5953.Search in Google Scholar PubMed PubMed Central
40. Huang, Y, Cai, X, Chen, P, Mai, W, Tang, H, Huang, Y, et al.. Associations of prediabetes with all-cause and cardiovascular mortality: a meta-analysis. Ann Med 2014;46:684–92. https://doi.org/10.3109/07853890.2014.955051.Search in Google Scholar PubMed
41. Palermi, S, Iacono, O, Sirico, F, Modestino, M, Ruosi, C, Spera, R, et al.. The complex relationship between physical activity and diabetes: an overview. J Basic Clin Physiol Pharmacol 2021. https://doi.org/10.1515/jbcpp-2021-0279 [Epub ahead of print].10.1515/jbcpp-2021-0279Search in Google Scholar PubMed
42. Laukkanen, JA, Mäkikallio, TH, Rauramaa, R, Kurl, S. Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men: a population-based follow-up study. Eur Heart J 2009;30:558–65. https://doi.org/10.1093/eurheartj/ehn584.Search in Google Scholar PubMed PubMed Central
43. Mach, F, Baigent, C, Catapano, AL, Koskinas, KC, Casula, M, Badimon, L, et al.. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk: the task force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). Eur Heart J 2020;41:111–88. https://doi.org/10.1093/eurheartj/ehz455.Search in Google Scholar PubMed
44. European guidelines on CVD prevention in clinical practice 2016. Eur J Prev Cardiol 2016;23:NP1–96.Search in Google Scholar
45. Brunström, M, Carlberg, B. Association of blood pressure lowering with mortality and cardiovascular disease across blood pressure levels a systematic review and meta-analysis. JAMA Intern Med 2018;178:28–36. American Medical Association. https://doi.org/10.1001/jamainternmed.2017.6015.Search in Google Scholar PubMed PubMed Central
46. Maron, BJ, Friedman, RA, Kligfield, P, Levine, BD, Viskin, S, Chaitman, BR, et al.. Assessment of the 12-lead electrocardiogram as a screening test for detection of cardiovascular disease in healthy general populations of young people (12-25 years of age): a scientific statement from the American Heart Association and the American Colle. J Am Coll Cardiol 2014;64:1479–514. https://doi.org/10.1016/j.jacc.2014.05.006.Search in Google Scholar PubMed
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