The relevance of pre-participation screening

First published on The Sunday Times on 10 June 2018

Dr Yeo Tee Joo – Last year, I explained the importance of pre-participation screening (PPS), where a combination of blood tests, physical examination, electrocardiogram (ECG) and questions on medical history can help active individuals calculate their cardiovascular risk as well as identify potentially life-threatening heart conditions.

For the masses

While PPS can be performed for anyone, it is particularly beneficial for sedentary individuals who wish to start training, as well as those with pre-existing heart disease or cardiovascular risk factors. Based on results of the PPS, a healthcare provider (ideally a sports medicine physician or cardiologist) can then advise on the suitability of the race event you have in mind, and the appropriate duration and intensity of training.

For athletic individuals

Puzzling as it may sound, fitter active individuals, Asians in particular, also face challenges, but of a different nature, with their ECGs during PPS. This is because prolonged periods of training have conditioned their body and led to changes in the electrical system and structure of their heart. As a result, their ECG may look very different from the general population and others who are generally more sedentary.

To identify normal or training-related ECG features, healthcare providers refer to international recommendations, which have taken more than a decade of research to establish and refine. Unfortunately, these recommendations are currently based on predominantly Caucasian and African-Caribbean athletes, with minimal representation from Asia.

Recent local developments

The National University Hospital and Singapore Sports Institute are working together to bridge this knowledge gap by creating a Sports Cardiology Registry of national athletes’ ECGs in Singapore. This collection of localized data will be helpful in determining  “normal” baseline indicators for our local population and improve the robustness of PPS. In the long run, these findings can potentially be applied to, and benefit a wider population of recreational athletes.

In spite of the above challenges, PPS remains an important tool for anyone participating in sports. With a greater nationwide emphasis on, and enthusiasm in, fitness and active lifestyle, as well as increased participation in endurance events, there is no better time to get yourself screened.

Dr Yeo Tee Joo

Dr Yeo Tee Joo is a consultant with the National University Heart Centre, Singapore and part of the multidisciplinary team at the NUH Sports Centre. He is also the lead investigator for the Sports Cardiology Registry project.

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