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The medical examination of fitness

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Almost always asked by clubs, federations for the licensing and mandatory for the competition, the medical certificate of non-cons to the practice of sport is often seen as a consultation uninteresting or useless by the athlete.
So they are the reason for this visit to your doctor?
          it's the law !
r earch of against-indications especially for risk sports.
          prevent sudden death of the athlete.
In the absence of information, the medical certificate may be issued by your GP. Some federations or in the case of top athletes, you will be asked to go specifically to a sports doctor or a doctor approved by the same Federation.
usually different sports "at risk" of others. In this category are:
          motor sports
          combat sports with "KO" authorized
          air sports
          sports underwater
          mountaineering "cutting edge"
          sports using firearms
Skills and qualifications necessary for doctors are specified in the regulation of medical federations concerned.
The course of the consultation will be based on the age of the athlete, the sport practiced and the level of intended practice.
During this visit, the doctor is interested in personal and family history of the sport as well as popular sports and vaccination status. Medication must also be taken into account.
Clinical examination includes measuring height and weight, taking blood pressure and pulse rate at rest; cardiopulmonary auscultation and an examination of the musculoskeletal system adapted to the sport.
In children, one should check the height and weight growth curve and pubertal status. It is particularly interested in the study of the spine in static and dynamic. We often have to discuss upgrade (no problem in general for the simple but require examination and further questioning to double or even triple).
We study the cardiac adaptation to effort by the firm carrying out a test Ruffier-Dickson: 30 crunches 45 '' flat feet and arms outstretched. We take the resting pulse (P1) at the end of the effort (P2) and after a minute of rest (P3). Is then calculated:
 
The Index Ruffier = (P1 P2 P3) - 200/10
Depending on the results, one class diagram:
  • R <0: good adaptation to effort
  • 0 <R <5: good adaptation to effort
  • 5 <R <10: adaptation to the average stress
  • 10 <R <15: adaptation to the insufficient efforts
  • R> 15: poor adaptation to the effort with additional cardiac evaluation to achieve
The index of Dickson = ((P2-70) 2 (P1-P3)) / 10
 
the results are classified into:
  • D <0: excellent
  • 0 <D <2: very good
  • 2 <D <4: good
  • 4 <D <6: Average
  • 6 <D <8: low
  • 8 <D <10: very low
  • D> 10: mismatch with additional cardiac evaluation to achieve
The systematic implementation of an electrocardiogram (ECG) screening does not unanimously in France but is recommended by many sports associations and learned societies of sports medicine. It should be made ??upon delivery of the first sports license, regardless of age, and every 2 years.
It aims to reduce the "sudden death" of athletes seeking electrical signs of heart defects among younger and arrhythmias or cardiac signs of pain in older people. It is recalled that the sudden death affects 1 sports on 50,000 all sports and that's basically the casual rider over 45 years which is the victim ...
If ECG abnormalities or if you have cardiovascular risk factors, your doctor will probably ask other tests (stress test, echocardiography, etc.) and refer you to a specialist before you can issue the certificate.
It is true that all sports are not considered identical in terms of their potential risks but the medical fitness should not be treated as a simple administrative formality. This is an opportunity for the doctor, especially if it's the first time he sees the patient, to take stock, to look for cardiac risk factors and to discuss if necessary the relevance of chosen sport.

Doctor Charles AISENBERG. - 27 mars 2011.

Conflicts of interest: the author or authors have no conflicts of interest concerning the data published in this article.

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