Revista de Medicina Desportiva (English) September 2018 | Page 8

Dr. José Ramos
Sports medicine
specialist
Faculty of Medicine
of Porto
Medical
knowledge for
Fitness Sports
Consensus document of the
Spanish Society of Medicine of
Sport (SEMED-FEMEDE)
The Spanish Society of Sports Medi-
cine produced a consensus on the
pre-participation medical exam as
a consequence of the law of protec-
tion of the sportsman and the fight
against doping in the sports activity,
modified by the Royal Decree-law,
published on 17 February 2017.
We recommend the reading, we
applause the initiative and we share
the reflections and the concerns.
We would appreciate that in Portu-
gal there were similar initiatives by
organisms that have the capacity
and are suitable to do so.
We emphasize this consensus:
The recommendation that pre-
participation exam should be carried
out by specialists in sports medicine,
because they are well trained (bet-
ter than some cardiologists) for the
evaluation of the sportsman and
especially of the ECG, avoiding then
false-positives cases with the conse-
quent unnecessary complementary
exams that succeed them. In Spain,
like here in Portugal, they doubt
about the responsiveness of the
trained specialists and of their geo-
graphic distribution, but they foresee
that in the deprived areas official
training actions will be carried out,
especially orientated to the “inter-
pretation of the sportsman’s ECG,
determination of the indications and
of the contraindications and advice
for sport”. In Portugal, we have the
post-graduation on sports medicine,
also with the distant learning, as
well as an online ECG course, that
would allow, if needed, to gradu-
ate and to distribute the physicians
along the country to make the pre-
participation medical examination
to the sports practitioner.
The periodicity of the examina-
tion, which considers the type of
sport, the age and the competitive
level, is by defect of two years, with
the exception of the professionals
and of the high-competition athle-
tes, that that would be done yearly.
The doctor who performs the exam
can decide the periodicity that
is more suitable for that athlete,
without being limited by law.
The contraindications to practice
may be absolute and definitive,
absolute and temporary, relative
and definitive, relative and tempo-
rary. It may be contraindicated to an
athlete to perform a certain sport,
but he could be able to practice
another. It also allows the physi-
cian the possibility to temporarily
contraindicate the participation
while performing more exams to the
athlete. All decisions must be duly
justified. In Portugal, this situation
does not occur, because the medical
decision is not binding, allowing the
athlete, if he/she wish so, to look for
another decision until it is found the
most convenient. He just needs a
pre-participation exam, validated by
any doctor, of any specialty, with or
without special training, to present
at the correspondent sports federa-
tion. If there was an online certifi-
cation, like the driving licences, it
would be more difficult this situa-
tion to occur, and the contraindica-
tion to practice should be justified.
These consensus highlights the
pre-participation examination
with the aim to prescribe physical
exercise to the patients with car-
diovascular or other diseases. The
exercise as therapy is another acti-
vity of sports medicine that should
be dynamized and implemented
mainly by public health services, as
it would allow to save a lot of money
on medications.
The definition of the type of exa-
minations that the sportsman must
perform values the clinical history,
the physical examination and the
EKG. The internationally criteria are
considered to have a positive EKG
and the sports-related physiological
adaptations. It is shown pictures to
summarize these changes, making
it easier to the physician to analyze
the electrocardiograms with changes
that justify a visit to the cardiologist,
especially with interest in sports.
The document states the low sen-
sitivity (68%) of the stress test, which
means that one third of patients
with ischemic heart disease have a
normal stress test, although it has a
specificity of 80%. It is recommen-
ded that the stress test be perfor-
med by athletes with a high risk of
coronary incidents. It is valued the
stress test for other purposes, such
as an assessment of blood pressure
behavior, the study of arrhythmias
and the evaluation of the physical
performance and its progression
related to the training. It is said that
it could be useful as a diagnostic aid
in patients with long QT syndrome,
polymorphic ventricular tachycardia
catecholaminergic, congenital coro-
nary anomalies, hypertrophic myo-
cardiopathy, Wolf-Parkinson-White
syndrome, bradiaarrhytmias and
other tachycardias. The recommen-
dation is to perform in men over 35
years or women over 45 years of age,
asymptomatic and with one or more
risk factors, as well as in postmeno-
pausal women of any age, in sports
practitioners with high cardiovas-
cular risk, in symptomatic subjects
with possible ischemic cardiopathy
of any age and sex.
It is not recommended to perform
echocardiography as a screening
tool, because it does not improve
the sensitivity of the sport medical
examinations. The echocardiogram,
as well as other complementary exa-
minations, should be performed by
the specialized doctor to clarify any
doubt about a particular pathology.
Finally, the document refers that
the sports medical examination
should have other objectives beyond
the prevention of sudden death,
such as preventing other health
risks related to sports practice,
through the diagnosis of any disease
or injury.
Full text on the magazine website
(www.revdesportiva.pt)
6 september 2018 www.revdesportiva.pt