A sports medical check-up is a test that goes a little further than a stress test. It is a very complete review that includes the typical questions of family history, personal history, operations, allergies, possible anemia, etc.. The patient is also asked about the type of training or sport he/she does (when, how, for what duration and at what intensity) and what diet he/she usually follows. All this would be the first step.
Once all this information is known, the next step is the data review. Weight and height are analyzed and anthropometry is performed, which consists of analyzing the weight, height and measuring the body folds and diameters to know the person’s fat, bone and muscle percentage, and to know how he/she is (if he/she has excess fat, little muscle, bone weight, etc.). Next, the morphology of the person is analyzed, always focusing on the sport. It is at this point where we study the possibility of having flat feet or valgus, very curved knees, if they have scoliosis, how flexible they are, sometimes we also explore any joint (knee, feet or back if the patient has any discomfort).
Once these morphological differences have been established, we move on to the cardiovascular examination. An electrocardiogram is performed, blood pressure is analyzed, auscultation of the heart is performed, sometimes an ultrasound of the heart is also performed (recommended in patients who do a lot of sport, or high intensity). When these data are available, a spirometry or pulmonary capacity evaluation is performed to see if it is good or not. It consists of blowing through a tube to analyze the capacity of the person’s lungs.
When it is verified that all of the above “works” and the patient is a good candidate, the stress test is performed. This part of the examination consists of subjecting the person to a specific effort, which may be on a bicycle or treadmill, depending on the sport the person is doing. The difference between the sports stress test and the cardiological test is that in Sports Medicine the person is subjected to a very high intensity, while the cardiologist does it at a very low intensity, for a longer time. Thus, if the stress test is done on a treadmill, the sports physician puts the person to run, and he or she gets tired running. On the other hand, the cardiologist (who is normally treating people with pathologies), puts the patient on a treadmill and tires him out by walking. The sports doctor puts him to run faster and faster, with the same slope; that is, at 0 slope and faster and faster and, in the end, he is running at 14km/h or even 16km/h. On the other hand, the cardiologist goes up the slope while the patient is walking and the patient gets tired because he goes up the slope. Although both give cardiological information, the stress test in Sports Medicine tries to put the heart in the sports situation, imitating what the patient feels when exercising.
If the stress test is performed on a bicycle it works in the same way: the cardiologist uses very slow rhythms while in Sports Medicine the bicycle protocol is based more on power, going to the extreme. The aim is to see the heart’s response to a programmed effort.
Why is a sports medicine check-up carried out?
There are two clear reasons for undergoing a sports medical check-up. The most important and the clearest is the fact that it is an important check-up. A person who does sport regularly, either twice a week or every day (this can range from a marathon runner who trains 70km a week to a person who plays tennis twice a week), should have a sports check-up every so often. Within all this, perhaps the most important part is the stress test, by putting the heart in a situation of sports overload, imitating the patient’s usual load, to see that the heart responds normally. This is the most important thing: to see that the heart works and responds well.
Another reason to perform it is to assess the training. Once we know that the person is healthy, after performing the stress test and seeing that the heart responds well, the training can be assessed afterwards.
Adapting the stress test
The stress test is usually adapted according to the type of sport and intensity that the person performs. If the person plays tennis about twice a week a protocol will be applied and if it is a person who normally runs marathons a tougher protocol will be applied.
What information will the sports medical examination yield and what will be recommended?
The sports-medical checkup gives a sports aptitude. Sometimes, in fact, sports doctors are asked to sign a fitness certificate. For example, in Spain not yet, but in France or Italy, when signing up for a marathon, or for important events such as the Titan Desert, they ask for a signature from a doctor confirming that the person is suitable for competitions of maximum “sporting stress”.
Another usefulness of the sports examination is for athletes who exercise regularly, but not at a professional level, and they are interested in knowing if they are well. In other words, the sports medical examination and sports fitness can be useful either because you are asked for it or to find out for yourself.
In addition, the medical-sports examination can be used, as it is a sports test, to determine the other parameters: whether the spirometry is correct, the percentage of fat, how are the feet, the knees, etc., as well as to determine one’s fitness for sport and whether or not I am well trained. Once it is known that a person is fit to do sport and is cardiologically well, the patient can be told if the heart, for example, is beating too fast because it is poorly trained, or if there is little strength in the legs when cycling… And this would already be part of the training assessment.
Based on the results of the sports medical check-up, the training sessions can be adapted.
Once the person is fit, he/she is looked at in a different way and will be advised on how to do sport and train better. It may be recommended to train differently, lower the loads, train less days or other days with less force ….
If a person’s heart rate is always high and it shoots up when exercising, for example, he may have a bad adaptation to the effort, and his heart rate goes up very fast. What you are advised to do is to train with less load, less power or less speed, until your heart gets used to these loads progressively.
Stress tests to assess training are all of the above or, sometimes, a mask is also placed on the patient to analyze oxygen consumption or ventilatory consumption, in addition to analyzing the heart. This is simply because, sometimes, people who are training are interested in knowing breathing and ventilation parameters in order to, with the heart rate monitor, know how to train. This would be the gas stress test, observing and analyzing what is breathed and, therefore, what is consumed, how it is consumed and thus be able to establish training guidelines. This is for people who train with a heart rate monitor and who are analyzing breathing, which, at a certain point in training, changes from aerobic to anaerobic, but this is an aspect that can only be known by performing the stress test with ventilatory parameters. These values will allow to improve the training.