Should wilderness athletes have pre-participation exams?

Getting a sports pre-participation exam (PPE) is a familiar preseason ritual for student athletes. But what about the growing number of people, of all ages, interested in participating in wilderness athletic and adventure events? Issues and advice on the PPE for wilderness athletes are featured in a special September issue of the Clinical Journal of Sport Medicine.

The special issue provides health care providers, event organizers, and participants with an update on the PPE for wilderness athletes and adventurers. "By matching the patient's fitness and skill level to the environment, the physician can help reduce the risk of serious injury," according to a Guest Editorial by Dr. Chad A. Asplund of Georgia Regents University, Augusta, and colleagues.

Pre-Participation Exams for Wilderness Athletes—Expert Updates

Recent years have seen a surge in popularity of wilderness, adventure, and extreme endurance events. "Wilderness sports and adventures combine the traditional risks of physical activity and exertion with the remoteness and exposure associated with backcountry environments," Dr. Asplund and coauthors write. In contrast to the standard "sports physical," there's little information to guide the PPE for those interested in wilderness adventures—including growing numbers of middle-aged and older adults.

A collaboration between the Wilderness Medical Society and the American Medical Society for Sports Medicine, the special issue seeks to outline an "an appropriate process for evaluation of wilderness athletes and adventurers." Twelve invited contributions by noted experts provide updates on screening and medical evaluation for patients planning to participate in wilderness events and activities. The special issue is now available as a free download on the journal website: http://www.cjsportsmed.com/.

A contribution by Dr. Gary Green of the UCLA Division of Sports Medicine provides insights into what should be included in the wilderness adventure PPE, which patients should receive one, and when. The main goal is not to "disqualify" patients with health risks—but rather to identify and address risk factors for injuries and illnesses during strenuous activities in remote settings or under extreme conditions. This reduces the likelihood of wilderness rescues and enhances the outdoor experience.

The wilderness adventure PPE addresses "extrinsic" risk factors related to the activity and environment, as well as "intrinsic" health issues and other characteristics that may affect the person's ability to participate. "The combination of underestimating risk and overestimating skills is a common denominator in many wilderness rescues," writes Dr. Green.

With sufficient lead time, a training program may enable participants to be better prepared for their outdoor experience. Dr. Green adds, "With a minimal amount of additional education, physicians can adequately assess both the intrinsic and extrinsic risk factors, address them and create a positive environment for their patients."

In addition to ethical/legal and general medical issues related to the PPE for wilderness athletes, the expert contributions address unique issues related to activities at high altitudes, mountaineering and climbing events, desert and land sports, water sports, extremes of cold and hot, and special populations. Dr. Asplund and colleagues conclude, "Proper screening and evaluation for participation should mitigate some of the risk of injuries, illnesses and deaths in wilderness and adventure athletes, and should allow for safer participation for recreational wilderness adventurers."