Sports Preparticipation Evaluation for Healthy Adults: A Consensus-Based German Guideline
DGSP et al. · 2025 · Germany
Source and licence
- Authors
- Christine Joisten, Anja Hirschmüller, Pascal Bauer et al.
- Title
- Sports Preparticipation Evaluation for Healthy Adults: A Consensus-Based German Guideline
- Journal
- Sports Medicine (Auckland, N.z.), 2025
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC12460515
Licence statement of the original publication
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Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
Population and General Advice
- Recommendation 1A PPE should be offered to adults practicing or intending to start sports Recommendation grade: moderate ⇑ Strength of consensus: 85%* (moderate) Justification: The available outcome data are insufficient to offer every adult an appropriate examination, especially for light- to moderate-intensity sporting activities. The idea that every sporting activity entails increased risks should be avoided. However, the Guideline Development Group assumes that the benefits of an examination outweigh the risks because it can prevent exercise-related adverse events. In addition, the examination results can be used to motivate individuals to adopt active lifestyles * DEGAM diverging view: A PPE can be offered to adults practicing or intending to start sports There is insufficient evidence about this recommendation’s benefits and harms. While the Guideline Development Group assumed a main benefit, in the opinion of the DEGAM, the potential harm and the impact on care were insufficiently recognized. First, such an offer would entail a considerable commitment of human resources, which are currently—and will increasingly be—lacking, worsening care for the rest of the population, or overburdening existing healthcare staff. Second, a “should” (moderate) recommendation means considerable uncertainty for those involved: Should sports be started and continued only after a comprehensive preventive medical check-up? Such a recommendation could discourage individuals from starting or maintaining physical activity. After all, a repeat examination is recommended every 1–5 years. In addition, whether a specific fitness level for sports can be certified on the sole basis of such an examination, given insufficient evidence, remains in question, which the DEGAM clearly rejects
- Recommendation 2A PPE should be conducted when starting an intense sport or exercise program Recommendation grade: moderate ⇑ Strength of consensus: 100% (strong) Justification: The available data are insufficient to link sports medicine screening to a specific degree of intensity or volume because subjective assessment findings can vary between individuals. In principle, however, physical activity at higher intensities defined by metabolic equivalents (METs) is assumed to be associated with greater risk, particularly for sedentary individuals and/or those with preexisting conditions
- Recommendation 3A PPE should be offered at 1–5-year intervals, depending on the individual’s risk profile, performance level, sport type, and intensity Recommendation grade: moderate ⇑ Strength of consensus: 100% (strong) Justification: The available data are insufficient to determine specific time intervals between examinations. The consensus group assumes that such a recommendation depends on individual risk factors, such as age and fitness level (especially cardiorespiratory fitness level). Furthermore, it concluded that annual screening is not sensible, feasible, or deserving of prioritization
- Recommendation 4Use the PPE results to derive individualized exercise and training recommendations Recommendation grade: strong ⇑⇑ Strength of consensus: 100% (strong) Justification: The Guideline Development Group agrees that a strong recommendation is appropriate here, especially as PPE results can be used for individual counseling
- Recommendation 5Techniques to support behavioral change should be used when communicating exercise recommendations Recommendation grade: moderate ⇑ Strength of consensus: 100% (strong) Justification: Increasing evidence shows that communication techniques to support behavioral change are important in the medical field. However, no gold standards are currently available as the techniques and applications examined in literature are heterogeneous. Therefore, medical practitioners could use PPEs to motivate individuals to adopt active lifestyles by adopting behavioral change techniques. Although this may appear to contradict the primary focus of this guideline, the Guideline Development Group decided to include this recommendation
- Recommendation 6A PPE should be conducted by a specialized physician with an additional qualification in sports medicine Recommendation grade: moderate ⇑ Strength of consensus: 80% (moderate) Justification: The available data are insufficient to specify a specific qualification as a prerequisite for conducting a PPE. However, owing to the interdisciplinary nature of the corresponding examination, the Guideline Development Group assumes that in addition to the specialist knowledge associated with a “sports medicine” qualification, it guarantees a higher level of quality and expertise in conducting such screenings. This notion applies especially to cases where individuals plan to increase their physical activity levels, as knowledge of sports medicine appears necessary to properly assess individuals’ levels of physical exertion and resilience
Medical History and Physical Examination
- Recommendation 7A standardized medical history form should be used in the PPE. It should include: • Personal and family medical history • Sports history • Individual risk-factor profile • Medication history • Nutritional history • Gynecological history • Vaccination status • Participation and results of previous check-ups • Previous injuries and/or surgeries Recommendation grade: moderate ⇑ Strength of consensus: 100% Justification: The (predominantly indirect) evidence and the benefit–harm–cost balance supports a moderate recommendation for a standardized medical history form
- Recommendation 8Use a validated score (e.g., Arriba and SCORE2) to assess cardiovascular risk from the age of 35 years Recommendation grade: strong ⇑⇑ Strength of consensus: 100% (strong) Justification: The evidence and benefit–harm balance support a strong recommendation. The use of a validated instrument also objectifies the risk assessment; however, the available data are insufficient to recommend one gold standard among the validated scores
- Recommendation 9A sports history should include questions about the following factors: • Frequency, intensity, time, and type (FITT) • Previous sporting experience • Goals of the physical activity • Environmental conditions during the sport (e.g., heat, cold, or altitude) • Complaints at rest and during exercise • Individual sport-related risk profile • Aids (e.g., visual aids) or mobility restrictions Recommendation grade: moderate ⇑ Strength of consensus: 100% (strong) Justification: There is no robust evidence in literature on the specific structure of a patient’s “sports history”. However, the Guideline Development Group assumes these aspects are relevant in the context of risk assessment and counseling
- Recommendation 10Determine whole-body status as part of the PPE, which should be based on the recommendations in Table 2 Recommendation grade: strong ⇑⇑ Strength of consensus: 100% (strong) Justification: The evidence and benefit–harm balance support a strong recommendation, although the individual examination components are supported to varying degrees
- Recommendation 11Patients with joint swelling, joint pain, relevant range-of-motion restrictions or large joint instability, as well as movement or knocking pain in the spine (with or without neurological deficits), should be referred to a specialist for further evaluation (preferably a specialist in orthopedics/trauma surgery or physical and rehabilitative medicine) Recommendation grade: moderate ⇑ Strength of consensus: 100% (strong) Justification: There is insufficient evidence for a strong recommendation. However, the benefits appear to outweigh the risks and effort involved. Furthermore, an orthopedically experienced sports physician who feels confident in performing an orthopedic examination and clarification should not be denied this opportunity
- Recommendation 12Individuals with arthroplasties or serious injuries in their medical history (e.g., vertebral fractures or severe/recurrent joint injuries) should be regularly monitored by a specialist, preferably in orthopedics/trauma surgery or physical and rehabilitative medicine Recommendation grade: moderate ⇑ Strength of consensus: 91% (moderate) Justification: There is insufficient evidence for a strong recommendation. Presumably, most individuals benefit from this recommendation because the advice regarding their physical activity will be based on a thorough examination and important information from their medical history
Laboratory Tests
- Recommendation 13If necessary, a blood count, plasma glucose, HbA1c and lipid status, liver/kidney values, electrolyte concentration, and urine status can be determined as part of a PPE Recommendation grade: weak ⇔ Strength of consensus: 100% (strong) Justification: The available data are insufficient to recommend specific laboratory tests. In principle, however, the Guideline Development Group assumes that the mentioned parameters are helpful if there are corresponding indications or risk constellations. In addition, lipid status is required to determine some scores. However, this is often available from other examinations, particularly the general health examination
Cardiovascular Examinations
- Recommendation 14A 12-lead resting ECG should be performed as part of each PPE Recommendation grade: moderate ⇑ Strength of consensus: 100% (strong) Justification: The limited evidence, cost–benefit analysis, and considerations of likely consequences (e.g., follow-up examinations after false-positive findings) support a moderate recommendation. Therefore, a resting ECG should be performed if no recent resting ECG is available or the medical history and/or physical examination indicate one
- Recommendation 15Perform an echocardiogram as part of a PPE if there is reason to suspect structural heart disease Recommendation grade: strong ⇑⇑ Strength of consensus: 90% (moderate) Justification: The Guideline Development Group believes the cost–benefit analysis supports a moderate recommendation
- Recommendation 16An exercise ECG should be performed as part of a PPE if warranted by the PPE findings, the individual risk profile, possible exercise-induced symptoms, the type of sport in question, and the performance level and intensity Recommendation grade: moderate ⇑ Strength of consensus: 100% (strong) Justification: The Guideline Development Group finds that the cost–benefit analysis and the limited evidence in the area of sports medicine screening support a moderate recommendation. However, the individual performance/fitness assessment is emphasized (see also Recommendation 17)
Determination of Physical Fitness
- Recommendation 17A CPET can be used to determine cardiorespiratory fitness and provide training recommendations/guidance as part of a PPE Recommendation grade: weak ⇔ Strength of consensus: 100% (strong) Justification: The Guideline Development Group agrees that the evidence is insufficient to recommend a CPET as standard. Nonetheless, such a test can provide helpful findings, especially for tailoring and managing training recommendations. Therefore, it is regarded as an optional component of a PPE
- Recommendation 18Muscle strength can be determined to measure muscular fitness (e.g., hand grip strength) as part of a PPE Recommendation grade: weak ⇔ Strength of consensus: 100% (strong) Justification: The available data are insufficient to make a strong recommendation. In principle, however, the Guideline Development Group assumes that muscular fitness will play an increasingly important role over time as a general surrogate parameter and for specific training recommendations
Additional Aspects
- Recommendation 19Perform laboratory and instrumental examinations as part of a PPE that go beyond Recommendations 13–18 only in justified individual cases Recommendation grade: strong ⇑⇑ Strength of consensus: 100% (strong) Justification: The Guideline Development Group considers the evidence for investigative procedures other than those listed in Recommendations 13–18 insufficient to recommend them as standard for PPEs. In its opinion, besides the limited evidence, the benefit–harm–cost balance strongly supports performing them only in justified individual cases
- Recommendation 20During the PPE and counseling, assess each individual’s risk of danger to themselves and others and consider the possible worsening of previous injuries Recommendation grade: strong ⇑⇑ Strength of consensus: 100% (strong) Justification: Given its objectives, assessment and counseling about the risk of danger to oneself and others is an essential part of the PPE. Therefore, the Guideline Development Group believes that the benefit–harm–cost balance supports a strong recommendation
Abstract
The benefits of physical activity are undisputed. However, adverse events can occur in rare cases, particularly during high-intensity or prolonged exercise. During physical activity, at-risk patients can experience major cardiac events, whereas adverse events affecting the musculoskeletal system are more common but less severe. A sports preparticipation evaluation (PPE) for apparently healthy adults is designed to detect at-risk individuals and prevent potentially fatal events. This guideline for conducting PPEs was developed by consensus among 16 medical societies and sports associations and is based on previously published guidelines and consensus papers. Sports medicine physicians and potential participants were also surveyed to assess the recommendations’ content, feasibility, and implementation. On the basis of the 20 recommendations developed and agreed upon by the abovementioned entities, PPE comprises individuals’ personal, family, and sports histories, as well as a physical examination. The need for additional examinations (e.g., laboratory parameters, echocardiograms, or stress tests) is determined on the basis of the PPE findings. This approach’s feasibility in various regions, including resource-limited settings, and the extent to which it prevents adverse or potentially fatal events, should be examined in future research.
Supplementary Information: The online version contains supplementary material available at 10.1007/s40279-025-02230-5.
Contents of the original publication
The section headings of the original.
- Key Points
- Introduction
- Methods
- Guideline Classification
- Stakeholder Involvement
- Management of Competing Interests
- Systematic Review of Existing Guidelines and Recommendations
- Guideline Questions
- Evidence Base
- Development of the Recommendations
- Strength of the Recommendations
- Consensus Procedure
- Peer Review
- Overall Approval and Updating
- Editorial Independence
- Recommendations
- Population and General Advice
- Algorithm for the PPE
- Medical History and Physical Examination
- Further Examinations
- Additional Aspects
- Discussion
- Strengths and Limitations
- Recommendations for Future Research
- Conclusions
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