Why is medical clearance necessary?

Physical activities of a strenuous nature (sports, outdoor activities, endurance events) involve an element of risk. An integral part of the overall risk management approach taken by responsible activity managers is the conduct of a medical clearance or screening, Proper medical clearance has ethical and legal implications related to responsibility of and management of risk by activity planners/managers.

When is it carried out?

The medical clearance is commonly carried out within a month before the intended physical activity. This provides sufficient time for corrective or preventive measures to be acted upon if a medical or physical condition is detected. In the case of individual and team sports, a pre-participation health appraisal or screening is conducted prior to the commencement of physical training. The latter may be in the off-season of a particular sport, allowing treatment or corrective management to be started.

What is involved in medical clearance?

Medical clearance may involve screening for medical conditions, physical assessments, and fitness appraisal. The main aims of medical clearance are:

(1) To detect any medical or physical condition which may endanger or limit a person’s participation in a physical activity. Such conditions may lead to the exclusion of the individual from the activity, modification of the activity or the individual participation, or inclusion of preventive measures to reduce the likelihood of injury or illness.

(2) To assess the current level of physical fitness and state of preparation (mental and physical) related to the intended physical activity. This may assist in determining the level of physical participation and challenge advisable for each person, avoiding over-loading the individual to the point of injury or illness.

 

Who conducts the medical clearance?

It is advisable that an appropriately qualified person such as a medical practitioner conducts the medical clearance. The clearance procedure usually comprises a self-filled questionnaire which asks the person being screened to report any medical conditions of significance. This is verified by the screening doctor who may seek more details of any conditions. A medical examination is carried out that may involve assessment of the heart, lungs, abdomen, and any other areas that may be indicated by a reported medical condition. A sample of a medical clearance format is that used for activities and courses run by the Outward Bound organizations.

 

What are the important conditions to be screened for?

Certain medical conditions have a more significant bearing on physical activity, particularly those involving strenuous or prolonged exercise and in outdoor environmental settings. These conditions include:

(1) Potentially life-threatening: cardiac (heart), fits & seizures (including epilepsy), allergies (eg. bee sting)

(2) Important illnesses: asthma, major organ illness (eg. kidney disease), disorders of eyesight or hearing, psychological conditions or psychiatric illness

(3) Significant conditions: skin disorders (eg. eczema), past heat injury, musculoskeletal injuries (eg. shoulder dislocation, knee ligament tears with joint instability).

In addition to identifying the medical conditions, details of the current status of the condition, types of medication being used, and contact of the person’s doctor are important to note.

What situations may make medical conditions worse?

Certain situations may increase the risk of development of certain medical conditions. Some examples include:

 

Medical Condition	Exacerbating Factors
Asthma	Fatigue, poor sleep, physical & mental stress, recent respiratory illness, dust, high pollen count, dry air, outdoor pollution (eg. haze)
Heat injury	Recent illness with fever, insufficient hydration, environmental heat load (high temperature & humidity)
Some types of fits	Fatigue, poor sleep, physical & mental stress
Sprains & strains	Poor fitness, lack of interest, fatigue

 

Failure to take prescribed medication may exacerbate certain medical conditions. It is important to ensure that individuals who may require regular or occasional medication (eg. asthma aerosol spray, allergy auto-injector) be reminded to bring this along for the duration of the physical activity. Checks should be conducted for this as well as ensuring suitable storage of the medication (eg. crush-proof container, waterproof, etc).

 

How should medical clearance information be managed?

Information obtained during a medical clearance screening is very useful for the overall safe and effective management of a physical activity. Some suggested practices include:

(1) Treat all information pertaining to medical conditions as confidential. Only those individuals involved in the conduct of the physical activity and who have direct interaction with the person with the medical condition should be given this medical information. Participants involved in medical screening should be informed of their medical confidentiality rights, and that key information will be made known to activity organizers. The participants have the right to not allow the information to be made known.

(2) Create a master list of persons in your activity with medical conditions, and use this to brief the respective activity managers who are in charge of the individuals with the conditions. The master list should contain the individual details, name of medical condition, preventive measures (eg, name of medication, type of joint support), contact details of the person’s doctor.

(3) Ensure that all individuals who have medical conditions that require medication or some form of joint support (for joint instability) are reminded to bring their medication along with them. A personal check on this will ensure that the correct medicine is available for use in the event that the medical condition develops or worsens.

(4) Above the usual vigilance practiced during the physical activity, particular care should be taken to watch out for signs that those with medical conditions are not doing well. Signs of excess fatigue, falling performance, inability to keep up, and poor response to encouragement in physical pursuits may be indications that the individual is not feeling well. While it is good to help individuals develop a sense of accomplishment in meeting challenges in physical activities, caution should be practiced in those with medical conditions.

 

Where can I find more information on medical clearance & conditions?

Regularly updated information on sports medicine and sports science topics is available at www.sportzdoc.com where monthly articles addressing physical exercise-related issues are featured. You may address questions through the website contact details as well.