Getting a Physical in Preparation for Strenuous Training

author : AMSSM

comments : 2

Males should be screened from their twenties onward with a fasting lipid profile to assess overall cardiovascular disease risk.

Question from Motivated:

I have a full physical scheduled for February 8 with my GP. I am 42 and will be attempting my first Ironman in Nov. 2005. I've scheduled this physical just to make sure everything is in proper working order in advance of the strenuous training. Can you please tell me what kind of tests I should request of my physician aside from the routine blood work?
 

Answer:

To answer this question, I’ll be making some assumptions and some generalities. First, I am assuming that even though you are about to attempt your first triathlon, you are not “new” to rigorous exercise. If so, then you already have an idea of how your body responds when it approaches the outer limits of the challenges you have subjected it to. If you have specific concerns based on symptoms that you may have experienced while exercising, then those symptoms should be followed-up. If you are already tolerating high levels of exercise, there is no reason to think that with a reasonable progressive training increase, you won’t do just fine.

Males should be screened from their twenties onward with a fasting lipid profile to assess overall cardiovascular disease risk. If there is a specific family history of early heart disease in your family, then your doctor may want to order more specific blood tests such as a CRP (a marker for inflammation-related cardiac risk), or homocysteine level (which can indicate increased risk of clots). It should be noted though, that none of these tests predict an individual’s ability to tolerate an exercise program – they’re simply markers for overall risk of development of cardiac disease; and since exercise is the supreme preventative for heart disease, exercise is not going to be contraindicated, especially if you are already exhibiting tolerance to high-level workouts.

A negative exercise stress test done maximally to exhaustion is reassuring, but it only provides a window of your exercise tolerance on the day of the test. Remember that most heart attacks occur because a previously stable heart vessel becomes occluded by a ruptured clot – something a stress test would never pick up unless the artery had already been dangerously narrowed, and if that were the case, then presumably symptoms would exist with maximal exercise. And that is a long way of saying that if you already are tolerating exercise at a high level, and don’t have specific medical problems that need to be followed, you probably don’t need any specific testing done to assist in clearance. One thing that might be useful for training, however is to have exercise testing for VO2MAX (fitness level) at baseline and then later during training to assess the effectiveness of your training routine. Most insurance companies will not cover this however, so it’s cost would be out-of-pocket for you.

Chad Carlson, MD
Member AMSSM

www.amssm.org
 

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date: April 9, 2005