Pre-Participation Heart Check (PPHC)

Before signing up for a pre-participation screening program, here is some information you may need to know.  Pre-Participation Screening is aimed at reducing the risk of sudden deaths and injury during exercise.  There are 3 components (aims) to this pre-participation screening program and include:

1. Pre-participation heart check (i.e. cardiovascular screening) to reduce the risk of sudden death
2. Pre-participation muscular-skeletal screening to identify injuries that need to be managed to prevent aggravation or to identify factors that may predispose the participants to future injuries
3. Identify factors that may limit performance, e.g. anemia or existing medications etc.
   (MOH Clinical Practice Guides – Screening for Cardiovascular Disease and Risk Factors – 2011).

Why and What is Pre-participation Heart Check?

Since sudden death is often related to underlying heart conditions the concept of pre-participation heart check appears sensible. Pre-participation heart check usually requires one or more stages of screening process.  One usually begins with stage one, (i.e. PYCC-PPHC I) which consists of a personal and family history-taking, a pre-participation cardiovascular screening questionnaire (recommended by the American Heart Association) and a physical examination by a cardiologist.  Biometric analysis (BMI), resting ECG and blood biochemistry are also done.  A cardiovascular risk score is then computed based on the above and depending on the risk score, further cardiac evaluation may be needed such as chest x-ray, exercise treadmill stress test, 2D Echo/Doppler study, CAC Score, etc.

Source: MOH Clinical Practice Guides – Screening for Cardiovascular Disease and Risk Factors 1/ 2011
Figure 1.  Athletes’ competitive levels

2. The degree of risk of the particular sport or activity (see figure 2 below).

Source: Maron et al. 36th Bethesda Conference: Eligibility Recommendations for Competitive Athletes With Cardiovascular Abnormalities. 173
Figure 2.  Categorization of sports based on cardiovascular activity

3. Other factors such as age. For example, a 55-year-old novice marathon runner may be zealously undergoing high-intensity, high-mileage training without building up to it and would be considered at risk of sudden death even though he may be doing casual runs or a weekend runner.
4. Assessment of the duration and intensity of the sports participation e.g. endurance or ultra-endurance demands and environmental stress.

The recognition that pre-participation screening is only part of a strategy to decrease the chance of sudden death and adverse events occurring, education is the other crucial component of the overall strategy.  Individuals should be educated on symptoms and signs that require medical attention before embarking on sports activity or exercise and this will be given in pre-run advice.

Finally, to reiterate:- the purpose of pre-participation cardiovascular screening is to detect in the asymptomatic individual cardiovascular risks and disease with the view that early intervention will forestall the disease and complications respectively.

Also see article on Sudden Death and Sudden Cardiac Death.