Sports physical: what to expect, the ECG debate, and what clearance means

What it is for

MedlinePlus says the sports physical is done to: (MedlinePlus, sports physical)

• Find out if you are in good health.
• Measure the maturity of your body and your physical fitness.
• Learn about injuries you have now.
• Find conditions you may have been born with that could make you more likely to be injured, or that may increase your chance of having heart problems during exercise.

Six professional societies publish the Preparticipation Physical Evaluation monograph together to guide the evaluation; its 5th edition, published by the American Academy of Pediatrics (AAP) in 2019, is the edition a 2025 review of guidelines cites. (Prim Care, 2024 (abstract)) (Sports Med Open, 2025)

What happens at the visit

Providers may do sports physicals differently, but they always include a conversation about your medical history and a physical exam. (MedlinePlus, sports physical)

The blood pressure reading is the same check covered on child blood pressure check. For the heart part, the American Heart Association has a 14-point checklist that covers recent symptoms, family history of sudden cardiac death or heart conditions, blood pressure and listening for heart murmurs. (UK NSC evidence summary, 2019) The AAP prefers individual examinations over station-based ones, and guidelines say the evaluation should be done early enough to allow more tests if they are needed. (Sports Med Open, 2025)

What to bring

If there is no history form, MedlinePlus suggests bringing: (MedlinePlus, sports physical)

• Allergies and the reactions you have had, and a list of the immunization shots you have had, with dates.
• A list of the medicines you take, including prescription, over-the-counter and supplements.
• Whether you use contact lenses, dental appliances or orthotics, or have piercings.
• Past and current illnesses; injuries, including concussions, broken bones and dislocated bones; and hospital stays or surgeries.
• Times you passed out, felt dizzy, had chest pain, had heat illness or had trouble breathing during exercise.
• Illnesses in your family, including any deaths related to exercise or sports, and your weight loss or gain over time.

How it differs from a well-child or annual visit

The exam is similar to an annual checkup, with added things that relate to playing sports, but a sports physical does not take the place of regular medical care or routine checkups. (MedlinePlus, sports physical) The screenings due at each age, such as vision, hearing and blood pressure checks, are on well-child checkup screenings by age and teen health screenings. There is no single interval for the sports physical itself: some organisations recommend a complete evaluation every two to three years or when the level of participation changes, with a history taken every year. (Sports Med Open, 2025)

Why a routine ECG for young athletes is debated

Screening of athletes usually has up to three parts: medical history, physical exam and a resting ECG (a tracing of the heart's electrical activity). (UK NSC evidence summary, 2019) The aim is to find heart conditions, such as a thickened heart muscle or an electrical problem, that can cause sudden cardiac death in young people. (UK NSC, 2019) There is no international consensus on using the ECG in athlete screening. (UK NSC evidence summary, 2019)

• The case made for it: interest was driven by a 2006 study from the Veneto region of Italy, where screening athletes aged 12 to 35 was followed by a fall in sudden cardiac death from 4.19 to 0.87 per 100,000 person-years, and about 2% of athletes screened were excluded from sport. (UK NSC evidence summary, 2019)
• The concerns: the UK NSC evidence summary notes the study's before and after design, a high starting rate that may reflect chance, and that its findings have not been replicated elsewhere. Research on the tests did not report good accuracy, and a high share of people with positive tests do not have a condition that may cause sudden death. (UK NSC evidence summary, 2019) (UK NSC, 2019)
• Athletes' hearts differ: most research on the tests is in professional athletes, whose hearts have different characteristics from the general population, and ECG criteria built for athletes are applied in athlete screening. (UK NSC, 2019) (UK NSC evidence summary, 2019)
• Possible harms: an incorrect positive result can lead to unnecessary tests, and there are concerns that people may stop taking part in sport after one. (UK NSC, 2019)

The full statements are the AHA and American College of Cardiology statements on the 12-lead ECG in people aged 12 to 25 (2014) and on preparticipation screening of competitive athletes (2015), and the 2020 ESC guidelines on sports cardiology. (AHA/ACC, 2014) (AHA/ACC, 2015) (ESC, 2020) For adults asking about an ECG at a routine visit, see ECG at a checkup.

What cleared, cleared with follow-up and not cleared mean

The AAP's 2019 recommendations frame the decision around a few questions: whether playing puts the athlete at risk of illness or injury beyond the usual hazards of the sport, whether it raises the risk for other players, whether treating the underlying condition would allow safe participation, whether limited participation can be allowed while treatment or evaluation is completed, and, if eligibility is denied for certain sports, whether the athlete can safely do other activities or sports. (Sports Med Open, 2025) In general terms:

• Cleared: the evaluation did not find a reason to restrict participation; the PPE aims to restrict only when necessary for safety. (Prim Care, 2024 (abstract))
• Cleared with follow-up, or limited participation: more evaluation or treatment is needed, and some participation may be allowed while it is completed. Heart findings should be evaluated further before starting or continuing high-intensity exercise. (Sports Med Open, 2025)
• Not cleared: eligibility is denied for certain sports because of medical or safety concerns, and the question becomes whether other activities or sports are safe. (Sports Med Open, 2025)

A positive screening test is not a diagnosis. People whose screening is positive usually need review by a heart specialist and more tests to confirm or rule out a condition. (UK NSC evidence summary, 2019)

Where they differ:

• American Heart Association and Canadian Cardiovascular Society: support screening of competitive athletes, but recommend against the routine use of the 12-lead ECG as a screening tool. (UK NSC evidence summary, 2019) (AHA/ACC, 2015)
• European Society of Cardiology: supports screening of competitive athletes with physical exam, medical history and a 12-lead ECG as core parts. (UK NSC evidence summary, 2019) (ESC, 2020)
• North American guidelines overall: an ECG is more restricted and usually depends on findings in the medical or family history or the exam, on resources, or on shared decision-making. (Sports Med Open, 2025)
• UK National Screening Committee: after its December 2019 review, it does not recommend systematic population screening of people under 39 for heart conditions linked to sudden cardiac death; the next review is estimated for 2026 to 2027. There is guidance on testing family members of people at risk of sudden cardiac death. (UK NSC, 2019)

Your doctor decides what your result means for you.

This page does not give treatment, medicine, training or return-to-play advice. If a sports physical finds something that needs follow-up, see after an abnormal screening result for questions to ask.

Questions people ask

What happens at a sports physical?

Providers do sports physicals differently, but MedlinePlus says they always include a conversation about your medical history and a physical exam. The exam is similar to an annual checkup, with added things that relate to playing sports, and focuses on the lungs, heart, bones and joints. (MedlinePlus, sports physical)

Is a sports physical the same as a well-child or annual checkup?

No. MedlinePlus says sports physicals do not take the place of regular medical care or routine checkups. (MedlinePlus, sports physical)

Does a sports physical include an ECG?

Practice differs. A 2025 review of guidelines found a 12-lead ECG was generally recommended in Europe, while in North America its use is more restricted and usually depends on findings such as risk factors in the medical or family history. The UK NSC evidence summary says the American Heart Association recommends against the routine use of the 12-lead ECG as a screening tool. (Sports Med Open, 2025) (UK NSC evidence summary, 2019)

How often is a sports physical done?

There is no single interval. Some organisations recommend a complete evaluation every two to three years or when the level of participation changes, with a history taken every year. MedlinePlus says most states require a sports physical before children and teens can play. (Sports Med Open, 2025) (MedlinePlus, sports physical)

What if a child is not cleared to play?

The AAP's 2019 recommendations ask whether limited participation can be allowed while treatment or evaluation is completed, and, if eligibility is denied for certain sports, whether other activities or sports are safe. A 2024 review says the purpose is to restrict participation only when necessary for the safety of the athlete. (Sports Med Open, 2025) (Prim Care, 2024 (abstract))

Related

• Well-child checkup screenings by age
• Teen health screenings
• Child blood pressure check
• ECG at a checkup
• Child vision screening
• Child hearing screening
• After an abnormal screening result