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 ( 6 september 2018