II. Epidemiology: Clearance

  1. Denied participation: 0.3 to 1.3%
  2. Require further evaluation: 3.2 to 13.5%
  3. Eventually qualified for some activity: 99%

III. Causes: Items that predict disqualification

  1. Dizziness with Exercise
  2. History of Asthma
  3. High Body Mass Index
  4. Elevated Systolic Blood Pressure
  5. Impaired Vision
  6. Heart Murmur
  7. Musculoskeletal Findings
  8. Reference
    1. Rifat (1995) J Fam Pract 41:42-50 [PubMed]

IV. Approach: General Participation Recommendations

  1. No contact OR strenuous sports
    1. Acute Myocarditis or Pericarditis
    2. Enlarged Spleen
      1. Fragile during infection (e.g. Mononucleosis)
      2. May be stable if due to hereditary spherocytosis
    3. Sickle Cell Disease
      1. Sickle Cell Trait does not contraindicate participation but positive status should be documented
      2. Sickle Cell Trait exertional sickling may occur with dehydration, heat with increased sudden death risk
        1. Harmon (2012) Br J Sports Med 46(5): 325-30 [PubMed]
    4. Risk of Sudden Cardiac Death
      1. Hypertrophic Cardiomyopathy
      2. Long QT Syndrome
      3. Suspected or confirmed Coronary Artery Disease (until cleared)
      4. Exercise-induced ventricular dysrhythmia
      5. Left ventricular systolic ejection fraction <50%
  2. No contact or Collision Sports
    1. Liver Enlargement (below level of ribs)
    2. Spleen Enlargement (Acute OR Chronic stable)
    3. Cervical or Atlantoaxial Instability (e.g. Down Syndrome, transient upper extremity weakness or quadriplegia)
      1. In addition, in swimming, no diving starts, Breaststroke or butterfly
    4. Bleeding Disorders (e.g. Hemophilia, some forms of von willebrand's syndrome)
    5. Recent Concussion or post-Concussion findings
    6. Single Kidney (Consider Flack Jacket)

V. Approach: Special Situations

  1. Congenital Heart Disease
    1. See Bethesda guidelines
  2. Single Eye or Best corrected vision worse than 50/20
    1. No wrestling
    2. Eye Protection
      1. Football
      2. Hockey
      3. Basketball
      4. Soccer
  3. Poorly controlled Seizure disorder
    1. No archery, riflery, swimming, weight lifting or sports involving heights (e.g. rock climbing)
  4. Poorly controlled Insulin Dependent Diabetes Mellitus
  5. Severe Uncontrolled Hypertension
    1. No participation (esp. high Static Sports such as weight lifting) until controlled
  6. Eating Disorder
    1. Non-compliant with therapy and follow-up OR
    2. Diminished performance or potential injury due to uncontrolled Eating Disorder
  7. Retinal Detachment

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