Doc Talk

Screen before you start on intensive sports

Pre-participation screening can help prevent tragedies such as cardiac events during a race


People take part in sports for different reasons, but it is the challenge and achieving that personal best that matters to most of us.

However, a significant injury can easily get in the way.

Worse still, some people have collapsed halfway through a race. It is a tragedy when a sudden cardiac event happens at a sports meet.

When this occurs, the immediate question sports physicians are asked is: "Could it have been prevented or could the risk have been reduced?"

The answer, in some cases, is yes. This is where pre-participation screening (PPS) can play a role.


People do health screenings for work or personal reassurance, so PPS should be no different.

It is but a more holistic, in-depth assessment of your health and it can keep you safe.


When patients see us, we will first attempt to identify symptoms or risk factors, using either a screening questionnaire or medical consultation.

Questions will include those on medical problems in the family, the person's medical history and medication usage, and if he has had any operations.

Like most health screening, PPS includes a clinical assessment of the cardiac and respiratory systems. It includes an evaluation of the patient's entire spine, shoulder, hips, and upper and lower limbs.

Patients typically undergo an electrocardiogram (ECG), an exercise treadmill test (ETT), as well as blood and urine tests.

During PPS, sports doctors will also discuss performance issues, previous injuries and the person's training goals.

Most people taking part in regular sports activities can develop a pain or problem at some point in training. Often, it is an overuse problem that can be corrected through muscle strengthening or by adjusting their running gait.

Pre-participation screening (PPS) has helped to pick up conditions like low blood iron, a high level of cholesterol, kidney impairment or an underlying infection.

These factors potentially lead to difficulty in breathing, increased fatigue during a run, cardiac chest pain and chronic infection, which can cause further injury.

If it remains ignored, it can affect the person's performance and lead to serious chronic injuries such as stress fractures or compartment syndrome, a painful exercise-induced condition where blood flow to the nerves and muscles is restricted.

Through the checks, we can tell patients what might be the underlying problem and how best to treat it.

Miss Y, a veteran runner in her mid-40s, did a PPS to get clearance for a trail run abroad.

She said that on some occasions, she could feel her heart racing when running or even at rest.

While she did not report any chest pain or other cardiac symptoms, she said there were a number of serious medical conditions among her family members.

This alerted me to the risk of potential structural cardiac conditions such as hypertrophic obstructive cardiacmyopathy or electrical anomalies such as atrial fibrillation. These are conditions that can be inherited and can cause sudden cardiac arrest during very intense physical activity.

It meant that the ensuing elements of the screening process were more important.

Fortunately, Miss Y had a completely normal ECG and performed exceptionally well on the ETT.

Her normal assessment and the investigations enabled her to continue with training and competition without fear of a significant underlying medical problem.


Another patient, Miss T, who is in her mid-20s, came to do a PPS as this was a prerequisite to take part in an overseas race.

She had taken part in a number of 10km races and half-marathons before.

Although she did not report any symptoms or significant risk factors, an electrical abnormality of the heart, known as bigeminy, was identified on her ECG and there were similar changes on her ETT.

This came as a surprise to her as she had not experienced any symptoms, nor did she have a family history of medical problems.

The significant findings from those tests meant that I had to refer her to a cardiologist for a detailed assessment.

The cardiologist found that the blood supply to her heart was abnormal. He advised her against high-intensity exercise as he was concerned that her condition might trigger a cardiac event.

After discussing with Miss T, I drew up a lower-intensity exercise programme for her. It combined resistance training and moderate-intensity cardio-respiratory exercises that included cycling and gentle swimming.

This meant that she could still take part in sports, albeit at a lower intensity so as not to put her at risk, but also in different ways so that she could benefit from the cross-training.

Often, one may not immediately feel unwell but there are already changes in the body that need to be addressed.

PPS has helped to pick up conditions like low blood iron, a high level of cholesterol, kidney impairment or an underlying infection.

These factors potentially lead to difficulty in breathing, increased fatigue during a run, cardiac chest pain and chronic infection, which can cause further injury.

Although there have been considerable improvements in our understanding of injury prevention and medical conditions that affect active people, we can only identify them when people come to see us.

I thus urge those with any symptoms of concern, a family history of medical problems or those who are planning to take up or return to sports, to consider getting screened.

If annual assessments are not possible, you should consider doing a PPS if there is any significant change in your health or sports ambitions.

To be forewarned is to be forearmed.

•Dr Dinesh Sirisena is a sports medicine consultant at Khoo Teck Puat Hospital.

A version of this article appeared in the print edition of The Straits Times on March 14, 2017, with the headline 'Screen before you start on intensive sports'. Subscribe