Authors: Nima Vasigh, Queen’s University, Department of Medicine, Nicholas Grubic, University of Toronto, Dalla Lana School of Public Health
Why does this matter?
- Sudden cardiac arrest (SCA) is one of the leading causes of death among young athletes, making early detection a priority for sports medicine. Cardiovascular pre-participation screening (PPS) is widely used to identify at-risk individuals before the occurrence of life-threatening cardiac events.
- While previous research has explored the physiological implications of PPS, these studies primarily used survey-based methods.
- A comprehensive understanding of how young athletes perceive and react to PPS is needed to optimize screening protocols that prioritize a holistic approach to athlete well-being.
What did we do?
- This study used a mixed-methods design to capture quantitative and qualitative insights into athletes’ psychological reactions to PPS.
- A total of 222 young competitive athletes (mean age: 18.7 years) from a Canadian university participated in this study. All athletes completed a cardiovascular history questionnaire, while a subset (n=165) underwent additional screening via electrocardiogram (ECG) and physical examination.
- To assess psychological responses, athletes completed surveys measuring levels of anxiety, stress, and worry related to screening (mean scores reported below). Additionally, focus groups and interviews were conducted to gather in-depth perspectives on their screening experiences.
What did we find?
Minimal psychological distress: Most athletes reported minimal anxiety (-1.29), stress (-1.41), and worry (-1.12) related to PPS on a five-point scale (-2 as strongly disagree to +2 as strongly agree).
Positive perception of screening: Athletes strongly agreed that PPS was beneficial for their safety (1.25) and necessary for participation (0.84).
Higher distress in certain groups: Athletes with cardiovascular symptoms or a family history reported higher anxiety (-1.02), stress (-1.24), and worry due to PPS (-0.73) compared to those without (-1.40, -1.49, -1.25, respectively).
Comprehensive screening reduces stress: Those undergoing ECGs and physical exams reported lower stress (-1.50), anxiety (-1.45), and worry (-1.19) compared to those who only completed a history questionnaire (-1.09, -1.05, -0.89, respectively).
Qualitative insights:
- While infrequent, distress related to PPS mainly arose from the possibility of discovering an unknown cardiovascular condition, the potential for sport disqualification, and the wait for screening results.
- Many athletes expressed uncertainty about PPS procedures and desired clearer guidance on what to expect and how results might impact their participation.
- Athletes highlighted themes of preparation uncertainty, trust in medical evaluation, and post-screening relief. Some athletes felt underprepared for the process, while others felt reassured of their cardiovascular health following screening.
How does this change what clinicians do?
The findings suggest that while PPS does not cause significant distress for most athletes, key areas for improvement include:
- Improved communication: Provide athletes with clear and accessible information about the PPS process.
- Timing and planning: Conduct screenings earlier in the season to reduce stress associated with last-minute assessments.
- Integrated support: Offer mental health resources and follow-ups, especially to athletes flagged for further testing.
By implementing these suggestions, clinicians can ensure that PPS is a reassuring, minimally distressing, and beneficial experience for athletes.
What’s next?
- Long-term psychological impact: Future research should explore the long-term psychological effects of PPS, especially for athletes flagged for additional testing or those with a cardiovascular condition uncovered during screening.
- Mental health integration: To enhance screening effectiveness, organizations should integrate standardized educational materials, and mental health supports into their screening protocols. This will ensure athletes understand the purpose and process of PPS, while providing clear follow-up pathways for athletes requiring further evaluation.
Key Takeaway
Cardiovascular PPS can be uncomplicated and minimally distressing to athletes when communication, support, and education are prioritized.
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