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Review
. 2025 Aug;55(8):1827-1851.
doi: 10.1007/s40279-025-02230-5. Epub 2025 Jul 3.

Sports Preparticipation Evaluation for Healthy Adults: A Consensus-Based German Guideline

Christine Joisten #  1   2 , Anja Hirschmüller #  3   4   5 , Pascal Bauer  6   7 , Erika Baum  8   9 , Meinolf Behrens  10   11 , Susanne Berrisch-Rahmel  7   12 , Gregor Berrsche  13   14 , Anja Carlsohn  15   16 , Michael Cassel  15   17 , Justus DeZeuuw  18   19 , Gesine Dörr  20   21 , Michael Dreher  19   22 , Frank Edelmann  23   24 , Katrin Esefeld  7   25 , Michael Freitag  9   26 , Mathias Grebe  21   27 , Casper Grim  28   29 , Pia Janßen  15   30 , Rolf Kaiser  31   32 , Thomas Katlun  15   33 , Maximilian Köppel  34   35 , Charlotte Kreutz  15 , Karsten Krüger  15   36 , Christoph Lutter  14   37 , Frank Mayer  15   38 , Othmar Moser  11   39 , Andreas Nieß  15   30 , Hans-Georg Predel  40   41 , Stefan Peters  35   42 , Petra Platen  15   43 , Dorothea Portius  44   45 , Claus Reinsberger  15   46 , Nils Reiss  47   48 , Kai Röcker  15   49 , Thomas Schmidt  40   48 , Arno Schmidt-Trucksäss  15   50 , Holger Schmitt  15   13 , Thomas Schramm  15   51 , Christian Sturm  52   53 , Hans Vater  32   54 , Alina Weise  55 , Burkhard Weisser  41   56 , Götz Welsch  57   58 , Andreas Winkelmann  53   59 , Alfred Wirth  45   60 , Bernd Wolfarth  15   29   61 , Käthe Goossen  55
Affiliations
Review

Sports Preparticipation Evaluation for Healthy Adults: A Consensus-Based German Guideline

Christine Joisten et al. Sports Med. 2025 Aug.

Abstract

The benefits of physical activity are undisputed. However, adverse events can occur in rare cases, particularly during high-intensity or prolonged exercise. During physical activity, at-risk patients can experience major cardiac events, whereas adverse events affecting the musculoskeletal system are more common but less severe. A sports preparticipation evaluation (PPE) for apparently healthy adults is designed to detect at-risk individuals and prevent potentially fatal events. This guideline for conducting PPEs was developed by consensus among 16 medical societies and sports associations and is based on previously published guidelines and consensus papers. Sports medicine physicians and potential participants were also surveyed to assess the recommendations' content, feasibility, and implementation. On the basis of the 20 recommendations developed and agreed upon by the abovementioned entities, PPE comprises individuals' personal, family, and sports histories, as well as a physical examination. The need for additional examinations (e.g., laboratory parameters, echocardiograms, or stress tests) is determined on the basis of the PPE findings. This approach's feasibility in various regions, including resource-limited settings, and the extent to which it prevents adverse or potentially fatal events, should be examined in future research.

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Conflict of interest statement

Declarations. Funding: Open Access funding enabled and organized by Projekt DEAL. The authors have not received a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. The guideline-development process was not supported financially; all members of the working groups were volunteers. The IFOM received funding from the lead professional organization (DGSP) for the preparation of the synopsis and the implementation of the surveys, but there was no further financial support. Conflict of interest: Information on the management of potential conflicts of interest is listed in the Supplementary Material (S1). Below, only relevant competing interests are listed: C.J., B.W., A.N., and T.S. are members of the DGSP executive board. C.K. is the head of the DGSP office. A.H., M.C., T.K., K.R., A.N., F.M., H.S., C.R., F.M., K.K., P.P., and A.C. are members of the DGSP scientific board/experts. K.R. is the owner of a software company for metabolic endurance diagnostics (Ergonizer Software e.K., Germany). T.S. received research funding from an ergometer manufacturer (Ergoline GmbH, Germany). All other authors declare that they have no competing interests. Data availability: The data presented in this study are available on reasonable request from the corresponding author. Patient consent for publication: Not applicable. Ethics approval: Not applicable. Author contributions: C.J. conceived the idea for the consensus statement. C.J., A.H., A.N., and B.W. formed the consensus groups. C.J., B.W., A.N., A.H., A.C., C.R., and K.K. led the working groups. K.G. and A.W. ensured compliance with the predefined guideline methodology. All authors were included in the development of the recommendations. They contributed to reviewing and giving feedback on each iteration of the consensus draft. All authors read and approved the final version of the manuscript.

Figures

Fig. 1
Fig. 1
The guideline development process based on the Guidance Manual of the German Association of Scientific Medical Societies (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften [AWMF]) [20], with timelines
Fig. 2
Fig. 2
A systematic review of guidelines and consensus statements. The characteristics of the 35 included documents, sorted by A geography and B population, and the characteristics of the recommendations made within them, sorted by C health topic and D link to primary study evidence (n = 305 recommendations citing 55 primary studies) [9]. ECG electrocardiogram, RED-S relative energy deficit in sport
Fig. 3
Fig. 3
The new consensus-based algorithm for the PPE for healthy adults. *Including symptoms, presence of diseases, and risk factors (e.g., a Systematic Coronary Risk Evaluation 2 [SCORE2] > 10%); **including the sudden cardiac death of close relatives aged < 60 years; ***if no recent resting ECG is available or if the medical history and/or physical evaluations indicate a need for one. ECG electrocardiogram, CPET cardiopulmonary exercise testing
See this image and copyright information in PMC

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