title: Application of pre-participation cardiovascular screening guidelines to novice older runners and endurance athletes.
abstract: OBJECTIVE
  Despite robust growth in participation in marathons and endurance sports among older individuals, guidance regarding pre-participation cardiovascular evaluation of these athletes is lacking. The objective of this study was to assess the utility of currently available pre-participation cardiovascular evaluation guidelines as applied to a cohort of older novice endurance athletes.
  
  
  METHODS
  We applied data from 1457 novice runners and endurance athletes aged 35 years and older to two pre-participation screening tools, the American Heart Association/American College of Sports Medicine Pre-Participation Questionnaire and the 2001 Working Group recommendations for pre-participation screening of masters athletes (2001 Masters).
  
  
  RESULTS
  Application of the American Heart Association/American College of Sports Medicine Pre-Participation Questionnaire identified 42.1% for which pre-participation cardiovascular evaluation was indicated. Of those who met criteria, 51.5% reported completion of a healthcare evaluation. Application of the 2001 Masters guidelines identified 75.2% who qualified for pre-participation electrocardiogram and 34.0% for pre-participation stress testing. Of those who met 2001 Masters criteria for pre-participation testing, 43.7% and 24.6% underwent recommended electrocardiogram and stress testing, respectively. While there was modest concordance with recommendations for pre-participation evaluations based on both American Heart Association/American College of Sports Medicine Pre-Participation Questionnaire and 2001 Masters, only athlete age was independently associated with completion of a pre-participation healthcare evaluation and only athlete age and athlete's participation in marathons were independently associated with pre-participation stress testing.
  
  
  CONCLUSIONS
  Among older novice endurance athletes, application of the American Heart Association/American College of Sports Medicine Pre-Participation Questionnaire and 2001 Masters guidelines identifies a significant percentage of athletes for whom pre-participation evaluation and testing are recommended. Concordance with these guidelines was modest and providers were primarily influenced by athlete age and competitive goals when planning pre-participation testing. Given the rarity of cardiovascular events among older participants in endurance events, the cost-effectiveness of the American Heart Association/American College of Sports Medicine Pre-Participation Questionnaire and 2001 Masters guidelines may be unacceptable for general use.
authors.affiliation: SELECT Program, Morsani College of Medicine, University of South Florida, Lehigh Valley Health Network, Allentown, PA, USA.
authors.forename: Justin R
authors.initials: JR
authors.lastname: Abbatemarco
authors.affiliation: The Cardiovascular Research Institute, Lehigh Valley Health Network, Allentown PA, USA.
authors.forename: Courtney
authors.initials: C
authors.lastname: Bennett
authors.affiliation: The Cardiovascular Research Institute, Lehigh Valley Health Network, Allentown PA, USA.
authors.forename: Adrian J
authors.initials: AJ
authors.lastname: Bell
authors.affiliation: Division of Sports Medicine, Lehigh Valley Health Network, Allentown, PA, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Dunne
authors.affiliation: Division of Cardiology, Richard & Marion Pearsall Heart Hospital, Geisinger Medical Center, Wilkes-Barre, PA, USA.
authors.forename: Martin E
authors.initials: ME
authors.lastname: Matsumura
keywords: Cardiovascular; marathon; pre-participation evaluation; sports medicine; stress testing
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