The nation's leading medical experts have updated guidance for the Preparticipation Physical Evaluation (PPE), also known as the sports physical. The exam determines the medical eligibility of students to participate in an organized team sport or individual sport or attend sports camps from middle school through college years.
The updated publication, "Preparticipation Physical Evaluation 5th Edition" provides new guidance for the PPE that includes evaluating students' mental health, as well as additional information on female and transgender athletes.
Six national primary care and sports medicine organizations jointly produced the exam requirements that are outlined in the publication, which is intended to encourage sports participation safety and promote healthy lifestyles. The organizations that created the exam requirements are the American Academy of Pediatrics; the American Academy of Family Physicians; American College of Sports Medicine; American Medical Society for Sports Medicine; American Osteopathic Academy of Sports Medicine; and the American Orthopaedic Society for Sports Medicine. The PPE also is endorsed by the National Federation of State High School Associations and National Athletic Trainers' Association.
The experts recommend incorporating the sports physical into the student's routine health screening visit for important reasons related to privacy, access to comprehensive medical records, time for anticipatory guidance and updating immunizations.
"Whenever possible, the sports physical should be performed in the primary care physician's office, the same place where the child receives immunizations and other health care," said David T. Bernhardt, MD, FAAP, co-editor of the edition. "These are the doctors who know your son or daughter best, so we can start conversations about health, diet and physical activity."
Many sports teams, camps and other organized activity groups require parents to submit their child's physical evaluation form, signed by a physician or primary care provider, before the child may participate in the activity. As part of the PPE, forms are available that will cover the child's health history, physical examination and medical eligibility.
The physical is typically required between every one to three years, but the timing varies by state. Some other physical exam requirements may differ, too, and can be dictated by different athletic organizations, high school state athletic/activity associations, or state law. Experts recommend that the primary care provider perform the exam -- rather than a clinic outside the medical home – so that the provider has access to the patient and family's health history. This information can be entered into the patient's electronic record, which helps the physician manage ongoing or chronic medical needs.
"The sports physical can alert us to any red flags if a family is predisposed to a condition or illness," said William O. Roberts, MD, MS, FACSM, FAAFP, co-editor of the publication. "For instance, if a parent or sibling has a history of heart disease or if the child has had prior concussions, the primary care physician would want to know that for future monitoring."
The updated guidance acknowledges that, increasingly, teens and young adults struggle with mental health issues such as anxiety or depression. During the sports physical, a physician can cover topics such as bullying, drug and alcohol use, and birth control within a safe, confidential space. The evaluation now asks for sexual identity at birth and identifying gender. For the transgender athlete, resources are provided within a new chapter in the publication.
"Every patient coming into your clinic should be considered an athlete, as we are in the business of promoting wellness and physical activity," said Dr. Bernhardt, who recommends that the physicals be performed at least six weeks before the sports season. "We want every child to get exercise, whether that's on the playground, on a bike, a hike or skateboard."
The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org and follow us on Twitter @AmerAcadPeds