S2k-Guideline Sports Medical Pre-Participation Screening – An Important Step Towards Increased Safety and Prevention

The benefits of regular physical activity are undisputed. These include the prevention of chronic diseases, the promotion of mental health and the maintenance of independence and quality of life in old age (1). In Germany, however, only around 24% of adults meet the World Health  Oganization's (WHO) recommendations (according to the Robert Koch Institute); a trend that has worsened in recent years, not least due to the impact of the global health crisis caused by the SARS-CoV-2 virus. Globally, sedentary Zifestyles – defined as engaging in less than 150 minutes of moderate or 75 minutes of vigorous physical activity – have increased from (23.4% in 2020 to 31.3% in 2022) (7).

Health screenings offer a valuable opportunity to assess lifestyle behaviors and physical activity levels in a safe and controlled environment. They are designed not only to detect potential health risks and to help mitigate them, ideally at little or no cost to the individual. In Germany, statutory health check-ups provide a platform to counsel patients on adopting a more active lifestyle, particularly given the long-standing trust often shared between physicians and their patients. A meta-analysis of 43 studies by Mino et al. showed that “exercise prescriptions” significantly increase physical activity levels, especially when combined with personalized counseling and psychologically grounded behavioral strategies (5). However, individuals with pre-existing or undiagnosed conditions – particularly those who suddenly begin high-intensity exercise – may be at risk for adverse events, such as injuries or, in rare cases, serious cardiac incidents (2). This underlines the importance of promoting physical activity in a safe manner.
As early as 2007, the German Society for Sports Medicine and Prevention (DGSP), led by Prof. Dr. Herbert Löllgen, developed an S1 guideline titled Preventive Medical Check-up in Sports. This has since been comprehensively updated and expanded into an S2k-Guideline, Sports Medicine Preventive Examination, published in April 2024 by the AWMF in collaboration with 16 medical societies and sports associations. The updated guideline is based on a thorough synthesis of existing recommendations. In a standardised development process, 35 international guidelines and consensus papers were analysed, and an expert panel formulated evidence-based recommendations (8). These were subsequently reviewed by sports medicine professionals and potential end-users for feasibility, acceptability, and potential for  implementation. Final recommendations were agreed upon during a consensus conference involving all
participating organizations. The guideline introduces a structured algorithm incorporating a targeted sports medicine history, a physical examination, and, where appropriate, additional diagnostic procedures. Rather than being a nationwide screening tool, it is intended as a risk-oriented assessment that removes barriers to physical activity, alleviates concerns about potential harm, and provides clear guidance on safe and appropriate exercise and prevention. Standardized templates for medical history and examination forms were developed to help clinicians systematically collect and document relevant data.
This guideline addresses a key gap in current practice. It provides practical, consensus-based recommendations for sports medical assessments of healthy adults who are beginning, resuming, or intensifying physical activity. The recommendations consider both cardiovascular and musculoskeletal
risks, which, although rare, can have serious or even fatal consequences.
Its practical relevance is significant. The results of these preventive assessments should be used to provide personalised individualized exercise and training recommendations that not only protect health
but also enhance motivation and enjoyment. The full guideline includes detailed tools and communication
strategies, such as goal setting, overcoming barriers, and motivational interviewing.
We view this guideline as a significant step towards improving sports medical care in Germany, promoting safer exercise practices, and raising public awareness of the importance of preventive screenings. However, its real-world impact must still be scientifically evaluated. For instance, creating a national
cohort of healthy individuals modelled on the US FRIEND Registry, but expanded to include muscular performance, could provide valuable reference data for cardiorespiratory fitness (4). Future research
should explore whether incorporating fitness assessments improves risk stratification and whether this
structured approach effectively encourages greater participation in physical activity.
We would like to express our sincere gratitude to all co-authors, medical societies, sports associations,
and methodological experts whose expertise, commitment, and collaborative efforts were instrumental
in developing this guideline. Together, we have achieved a significant milestone in advancing sports
medicine.