It's the time of year when school sports start gearing up for fall with two-a-day football practices, afternoon soccer scrimmages and long cross-country runs. Unfortunately, it's also the time of year when we start hearing about young athletes—seemingly healthy, robust kids—who die suddenly on the field.
According to the Centers for Disease Control, every year between one and three out of every 100,000 young athletes suffer sudden death due to cardiac problems that had never been diagnosed. Adult athletes are also susceptible. The numbers are definitely small, but they are significant, especially if they involve someone close to you. Also significant is that over 50 percent of these tragic deaths are preventable through screening.
In many parts of the world, the testing of every child with an interest in sports is the law. In some areas of Europe, screening for heart disease, using an ECG, begins at age 12. There is no such law in the United States, since the cost-benefit ratio of the screening is still open for discussion. Some children's sports programs require that athletes get a doctor's pre-participation evaluation note, but doctors are often asked to sign the form without even seeing the patient for the purpose of assessing them for strenuous exercise. Thus, many Americans reach adulthood having never been screened via a supervised exercise stress test.
Before you allow your children to participate in any strenuous physical activity this fall, and before you begin an exercise program—even if you have been fit in the past—discuss the following topics relevant to athletic screening with your doctor:
1. Your past medical history (or your child's), with a focus on cardiovascular disease, high blood pressure, elevated cholesterol, diabetes, asthma or allergies, and musculoskeletal conditions.
2. Your family history for sudden death, coronary heart disease (especially in first-degree relatives under age 50), stroke, hypertension and diabetes.
3. Your social history for cigarette smoking, drug use and exercise habits.
4. A review of your systems, paying particular attention to exercise-related symptoms such as fainting, light-headedness, shortness of breath, wheezing, chest pain or tightness, palpitations, headache and so on.
We also recommend a general physical exam, starting with your height and weight in order to assess your BMI (the ratio between your weight and the square of your height; we offer instructions for doing this on our Web site, and including an accurate measurement of your blood pressure, ideally in resting condition and again after a short effort, like a step test, a handgrip test or going up stairs. Based on the findings, your doctor will determine if you need further tests, such as blood work, a pulmonary function test (PFT), a stress test or more.
Knowing your risk factors or that of your child can be very motivating, because proper exercise will help lower that risk significantly. If you belong to a high-risk category (for example, you are an overweight, sedentary male smoker, over 45, with high blood pressure and a family history of heart attacks), you are the perfect candidate for exercise—you can get better, but you will need to see your doctor before you begin.
Exercise could become a significant component of your life or your child's life, but you will want to tailor any exercise to take risk factors into account. And even if—worst-case scenario—a risk for sudden death is uncovered during testing, that does not rule out exercise. It simply means that exercise will need to be approached more slowly and with medical guidance.
( Eric Heiden, M.D., a five-time Olympic gold medalist speed skater, is now an orthopedic surgeon in Utah. He co-authored "Faster, Better, Stronger: Your Fitness Bible" (HarperCollins) with exercise performance physician Max Testa, M.D., and DeAnne Musolf. Visit www.fasterbetterstronger.com.)