• AAFP, Other Medical Groups Update Sports Physical Guidance

    June 11, 2019 12:41 pm News Staff – The AAFP has joined with five other medical organizations to update the Preparticipation Physical Evaluation Monograph, a key resource that provides guidance on the proper timing, setting and structure of the evaluation.

    Also known as the sports physical, the PPE is used to determine the medical eligibility of students to participate in organized team or individual sports or to attend sports camps from middle school through college.

    The organizations joining the AAFP in this effort were the American Academy of Pediatrics, the American College of Sports Medicine, American Medical Society for Sports Medicine, the American Orthopaedic Society for Sports Medicine and the American Osteopathic Academy of Sports Medicine.

    Among other updates, this fifth edition of the PPE offers new direction for evaluating students' mental health, as well as additional information on and recommendations specific to female and transgender athletes.

    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 professional, before the child may participate in the activity. The PPE monograph includes this form, along with medical history forms in both English and Spanish and a medical eligibility form.

    Medical experts from the six groups recommended incorporating the sports physical into a student's routine health screening visit for reasons that include ensuring privacy, having access to comprehensive medical records, reserving adequate 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 the AAP's David Bernhardt, M.D., co-editor of the edition, in a news release. "These are the doctors who know your son or daughter best, so we can start conversations about health, diet and physical activity."

    Also, these experts noted, performing the exam in the student's medical home ensures that the physician has access to the patient's and family's health history. This information can then be entered into the patient's EHR, which helps the physician manage ongoing or chronic medical needs, according to the release.

    "The sports physical can alert us to any red flags if a family is predisposed to a condition or illness," said William Roberts, M.D., M.S., co-editor of the publication and ACSM representative to the joint group, in the release. "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."

    Sports physicals are typically required every one to three years, but the timing varies by state, the release noted. Other physical exam requirements may differ, too, and can be dictated by different athletic organizations, high school state athletic/activity associations or state law.

    This updated guidance also acknowledges that, increasingly, teens and young adults are struggling with mental health issues such as anxiety or depression. During the sports physical, physicians can cover topics such as bullying, drug and alcohol use, and birth control within a safe, confidential space.

    Additionally, the evaluation now asks for sexual identity at birth and identifying gender. And a new chapter in the PPE addresses resources that transgender athletes need.

    "Every patient coming into your clinic should be considered an athlete, as we are in the business of promoting wellness and physical activity," said Bernhardt, who recommended that 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 National Athletic Trainers' Association and the National Federation of State High School Associations have also endorsed the monograph.

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