Characteristics of Second-Line Investigations of Middle-Aged Athletes Who Failed Preparticipation Examinations

Objective:The role of exercise testing during preparticipation examinations (PPEs) of middle-aged athletes is uncertain. This study examined the characteristics of disqualifications after an initial PPE that includes an exercise test in competitive athletes older than 30 years. We investigated disqualification rates and reasons, second-line investigations performed, and final decisions regarding competitive sports participation.Design:Chart review.Setting:Sports medicine clinic.Participants:Athletes aged >30 years that performed an exercise test as part of their annual PPE at our sports medicine clinic (n = 866).Independent Variables:Age, sex, height, weight, sport type, cardiovascular risk factors, and abnormal PPE findings.Main Outcome Measures:Additional investigations performed, approval/disqualification regarding competitive sports participation.Results:The initial disqualification rate of athletes was 9.8%. Three (3.6%) athletes were disqualified following questionnaire and physical examination, 19 (22.4%) because of resting electrocardiogram findings, and 65 (76.5%) following the exercise test. After additional work-up, only 5 athletes (0.4%) were ultimately found ineligible for competitive sports. From those, only 2 athletes (0.2%) were disqualified because of exercise test findings, which were episodes of supraventricular tachycardia and not ischemia-related.Conclusions:The addition of an exercise test to the PPE of middle-aged athletes is of limited value. If exercise testing of older athletes is performed, arrhythmias are probably of higher significance than ST-T changes.