The Preparticipation Physical Exam

1. Chapter 3 The Preparticipation Physical Exam

2. Overview Elements of the PPE Health status info Physical components of the PPE Fitness/performance testing PPE results Special considerations Administration of the PPE

3. Elements of the PPE NCAA and state guidelines Some sports bodies require annual (ex: NFL, many states) Others require one-time exam (ex: NCAA and some states) Importance of PPE for all participants, regardless of participation level and whether they are nondisabled or disabled

4. Health Status Information Personal information Name, date of birth, identifying number/SSN, signatures, contact information, health insurance information, health status information Medical history Cornerstone of the exam process Critical to the physician's ability to anticipate and understand the need for special examinations and laboratory tests Health Status Questionnaire and "PAR-Q & You" (See examples in textbook)

5. Physical Components of the PPE Height and weight These can signal conditions that otherwise might be overlooked Changes in stats can provide clues to understanding complaints Blood pressure and pulse rate Normal, low, and high blood pressure Reevaluate elevated blood pressure to ensure validity and reliability If still elevated, consider possible reasons: weight change, medications, anabolic steroid use Normal resting heart rates

6. Physical Components of the PPE Blood tests Not always necessary Most often done to help explain unusual symptoms or suspicious information in the medical history; also for those new to a program Complete blood count (CBC), hemoglobin/hematocrit (Hb/Hct) Sickle cell test for black athletes

7. Physical Components of the PPE Urinalysis Detecting medical conditions No legal permission needed Urinary tract infection, dehydration, diabetes, kidney pathology Random drug testing Legal consent required Typically obtained as a condition of participation

8. Physical Components of the PPE Visual acuity: Snellen Eye Chart Changes in vision can affect performance General medical examination Dental, heart and lung, abdomen and pelvis, ear/nose/throat, and musculoskeletal conditions Must be performed by trained physicians Detect pathology and establish normative data for the athlete

9. Physical Components of the PPE Specific tests for individuals with disabilities More in-depth clinical evaluation may be necessary Lab tests should be done after all other aspects of the exam have been completed so that the physician is more prepared to order the particular tests that may be needed Critical to consider activities the person will be participating in; no reason to withhold participation if the sport does not create additional risks

10. Fitness/Performance Testing Teams conduct fitness or performance testing as part of the PPE Other groups use this testing to provide a baseline for exercise prescription

11. Fitness/Performance Testing Organizer decides which tests to include; can vary by situation Graded exercise test For all men over age 40 & all women over age 50 before entering a high-intensity exercise program Also recommended for patients with high risk of heart disease Fitness evaluation when new member joins fitness facility or when a person hires a personal trainer

12. PPE Results Permission given on PPE form applies only to the sport or activities indicated on the form Three categories of clearance, according to the Preparticipation Physical Evaluation Task Force Unrestricted clearance Clearance after completion of further evaluation or rehabilitation Not cleared for certain types of sports or, in extreme cases, any sports

13. PPE Results Medical referral In all cases of restricted clearance, the person must be referred to a medical provider Activity clearance with supervision The coach or other supervisor must be present when the athlete is participating in the sport Asthma, bronchitis, diabetes, epilepsy, bleeding traits, colitis, and other treatable ailments may require this type of supervision

14. PPE Results Disqualification of an athlete Team physician responsible for this decision Efforts should be made to find some avenue for participation Only two medical conditions would prevent a person from participation in any physical activity: myocarditis (inflammation of the heart) and fever (temporary disqualification only)

15. Considerations for Athletes w/ Impairments Who is considered "impaired"? Considerations for athletes with only one of a set of paired organs

16. Administration of the PPE Individual PPEs Athlete responsible for getting his or her own PPE Common at high school and pre�high school levels Advantages of having family physician conduct tests Disadvantages of having health maintenance organization (HMO) physicians conduct tests

17. Administration of the PPE Group PPEs Health care professionals staff various stations through which the athlete must pass to complete the physical examination Because of the number of physicians involved, the physician might be able to do a more thorough exam Having same physician evaluate each team member provides great reliability and quality control AT has the advantage of knowing the physician and knowing that all athletes underwent the same thorough exam Problems of conducting a PPE with a large group?

18. Facility Setup for Group PPEs Preplanning needed to allow for appropriate space, equipment, and personnel Smooth traffic flow and transition from one test to the next Special concerns for stations Quiet area needed at blood pressure station Well-lit, long area needed for vision screening Private area for physician consultation