February 15, 2019

Athletic Trainers are Heart Health Advocates

By Amanda Muscatell

February is American Heart Month. Throughout the month, At Your Own Risk will discuss how athletic trainers provide a safer approach to heart health in work, life and sport.

Athletic trainers (ATs) are health care professionals who provide a wide variety of services for their patients. ATs work collaboratively with physicians, coaches and school administrators to reduce the risk of injury in athletes. ATs are also experts in emergency care, injury assessment and rehabilitation. ATs are advocates for patient health – including patient heart health.

The AT’s role in heart health starts before an athlete ever steps foot on the field, stage or court. ATs ensure that athletes receive the appropriate screenings, testing and clearances before they are allowed to participate in physical activity.

Sudden death in sport is largely due to unknown heart conditions or other congenital disorders in patients. A preparticipation physical examination (PPE) is a screening tool used by athletic trainers, physicians and others in the sports medicine community to help identify conditions that may predispose an athlete to injury or sudden death. PPEs are critically important because for 30-88% of children, they are the only medical evaluation the child receives throughout the year. 1,2

PPEs should obtain patient and family medical history, and include a physical examination (consisting of general heart, cardiovascular, neurological, orthopedic, nutritional and mental health specific screening elements).  Ideally, a PPE should occur 4 to 6 weeks before preseason activity occurs to allow for any necessary follow up tests.3

The American Heart Association provides heart specific questions that should be included as part of the cardiovascular screening section of a PPE. Some of these questions include asking if the athlete has experienced chest pain, difficulty breathing or fainting after physical activity, or have family history of heart conditions.

Most athletes will not have any cardiac-related risk factors identified during the PPE. However, some athletes with family history or physical red flags, may require additional screenings before athletic clearance is provided.  An electrocardiogram (ECG) and stress testing are common follow up tests for athletes with abnormal heart or medical history or examination during the PPE. ECGs are not a routine part of PPEs for a variety of reasons including cost, access to resources and mixed research on their overall effectiveness.

Ultimately, the goal of these screenings is to help reduce the risk to athletes and ensure they are safe to participate. It is important to note that as many as 80% of athletes who suffer from sudden cardiac arrest are asymptotic until it occurs, so a screening may not prevent all injuries or catastrophic deaths.

ATs play an important role in advocating for the athlete’s health through the PPE process and referral for additional screenings. Here are a few ways that ATs serve as heart health advocates:

  • ATs work collaboratively with physicians to ensure the PPE process is completed annually for all athletes. ATs work with coaches and school administration to let them know who is and isn’t cleared for play.
  • If additional heart screenings or tests are needed, the AT will work with the family on being referred to a cardiologist. This referral can save money and time for the family, as ATs often have direct connection with area specialists. ATs can also help the family navigate insurance benefits and connect them with relevant programs and resources.
  • ATs educate student athletes, parents and coaches on general heart health information, as well as ensuring they know what to do in case of sudden cardiac arrest (spoiler alert – we will talk more about the AT’s role in CPR and AED use later this month).
  • ATs also collaborate with nutritionists to help ensure that athletes are fueling their bodies with heart friendly food. ATs educate student athletes, coaches and parents on this important information throughout the school year.

Lastly, ATs can advocate for heart education and screening events to occur at their school or in their community. There are a number of non-profit organizations that are dedicated providing education, resources and screen events all related to heart health.  Many of these organizations have started after a parent or family lost a loved on to sudden cardiac arrest and their mission is to ensure people have the knowledge, skill set and resources they need to reduce the risk to other athletes.

Many times, ATs collaborate with these types of organizations to educate, share resources and host events aimed at prioritizing patient heart health. This is just one, of many ways, that ATs continually go above and beyond for the health and safety of their patients.

Later this month, At Your Own Risk will join the Cody Stephens Foundation and athletic trainers Jose Mendez, LAT and Nichola St. James, MS, LAT, ATC, CSCS during a heart-screening event for their middle school and high school students involved in extracurricular activities, including athletics, ROTC, drill team, marching band and cheerleading.

The Cody Stephens Foundation has screened more than 125,000 people in Texas, Louisiana and Washington and more than 90 lives have been saved as a direct result of their program.

If you are looking for more heart resources in your area, visit the following websites for more information:
Screen Across America
Parent Heart Watch Member Programs


  1. Goldberg B, Saraniti A, Witman P, Gavin M, Nicholas JA. Pre-participation sports assessment: an objective evaluation. Pediatrics. 1980;66(5):736–745. https://www.ncbi.nlm.nih.gov/pubmed/7432879
  2. Risser WL, Hoffman HM, Bellah GG. Frequency of preparticipation sports examinations in secondary school athletes: are the University Interscholastic League guidelines appropriate? Tex Med. 1985;81(7):35–39.
  3. Kevin M. Conley, Delmas J. Bolin, Peter J. Carek, Jeff G. Konin, Timothy L. Neal, and Danielle Violette (2014) National Athletic Trainers’ Association Position Statement: Preparticipation Physical Examinations and Disqualifying Conditions. Journal of Athletic Training: Jan/Feb 2014, Vol. 49, No. 1, pp. 102-120. https://natajournals.org/doi/pdf/10.4085/1062-6050-48.6.05

Disclaimer: Athletic trainers are licensed or otherwise regulated in 49 states and the District of Columbia. Athletic trainers must abide by their state practice act and practice within their scope of practice. Please refer to your state regulatory board for specific information. Additionally, the sharing or mentioning of organizations is not an official endorsement or support of their program, product or legislation.     

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