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Exercise Testing for Primary Care and Sports Medicine Physicians: Essentials for Diagnosis, Preventi



Cleveland Clinic Sports Medicine Center is a group of sports medicine and team physicians working in collaboration with one another and with our allied medical partners in the office, in the training room, on the playing field and in the classroom with a commitment to the pursuit of clinical excellence. Education and research are integral to the commitment.




Exercise Testing for Primary Care and Sports Medicine Physicians



Primary Care Sports Medicine fellows function, with supervision, as team physicians for high school and collegiate athletes. The Fellowship also provides exposure to the care of professional athletes from several different sports teams, including the Cleveland Cavaliers and Cleveland Guardians, and other world-class elite athletes.


Most athletes and active individuals will have to deal with some aches, pains or injuries over the years. Some injuries will require special care for proper diagnosis and treatment. Knowing when to see a health care provider is often one of the most difficult parts of dealing with an injury, but our board-certified sports medicine physicians can help to make sure you receive the appropriate care for your injury.


Lippincott Connect Featured Title Purchase of the new print edition of this Lippincott Connect title includes access to the digital version of the book, plus related materials. The flagship title from the prestigious American College of Sports Medicine, this critical handbook delivers scientifically based, evidence-informed standards to prepare you for success. Providing succinct summaries of recommended procedures for exercise testing and exercise prescription in healthy and diseased patients, this trusted manual is an essential resource for all exercise professionals, as well as other health professionals who may counsel patients on exercise including physicians, nurses, physician assistants, physical and occupational therapists, dieticians, and health care administrators. The extensively updated eleventh edition has been reorganized for greater clarity and integrates the latest Physical Activity Guidelines for Americans.


The Primary Sports Medicine Service is comprised of a group of physicians trained in sports medicine who practice nonsurgical musculoskeletal care. Our team can help patients determine whether their condition requires surgery or can be managed by other types of treatment.


Each physician in the Primary Sports Medicine Service originally started in primary care - family medicine, pediatrics, internal medicine - before going on to further training in sports medicine. All are active members in the American Medical Society for Sports Medicine, the national organization for Primary Care Sports Medicine.


Our sports medicine providers are physicians who have advanced training in the needs of athletes and all individuals who desire to be active, from young children to seniors. They have unique injuries and medical conditions related to sports and active lifestyles. Sports medicine is a field that focuses on the treatment of these injuries.


Our physicians specialize in primary care sports medicine and treat non-surgical, medical, musculoskeletal, and performance issues in sports medicine. All patients are seen by a board-certified sports medicine trained attending physician.


The Sports Medicine Center at Self Regional Healthcare is the home of the Primary Care Sports Medicine Fellowship of the Montgomery Center for Family Medicine. This is a sub-specialty training program for primary care physicians who desire advanced training in the care of athletes.


In addition to being a training program for residents and fellows, we provide team physician services to two area colleges, seven high schools and event coverage for many regional competitive athletic events, including many triathlons. Our fellows graduate as specialists in primary care sports medicine.


Dr. Dan Divilbiss is the Director of the Primary Care Sports Medicine Fellowship and the Sports Medicine Center at Self Regional Healthcare. He is an assistant professor through the Medical University of South Carolina and is board certified by the American Board of Family Medicine in both family and sports medicine. He received his undergraduate degree at Kansas State University, where he played four years of Division I football. He received his medical degree from the University of Kansas School of Medicine. He completed his residency and fellowship in sports medicine at Self Regional Healthcare and has been practicing sports medicine for over ten years.


Dr. Dave Sealy is the founder of the Primary Care Sports Medicine Fellowship and the Sports Medicine Center at Self Regional Healthcare. He has more than 40 years experience as a team physician and treating athletes. He is a full professor through the Medical University of South Carolina, and is board-certified in primary care sports medicine (CAQSM). Dr. Sealy has presented regionally and nationally on many sports medicine related issues and has conducted original research related to sports medicine. He was a college track and field athlete, and now, he is active in many sports, including endurance sports, snow skiing and is a PADI certified divemaster.


A Joint Task Force for defining practice parameters for the management of EIB (2016) suggested physicians can also consider cardiopulmonary exercise testing to determine if symptoms are resulting from exercise-induced dyspnoea and hyperventilation, particularly in children and adolescents.43 Shortness of breath during exercise can also be associated with underlying conditions such as chronic obstructive pulmonary disease or restrictive lung conditions (e.g., obesity).43 A history of shortness of breath alongside other systemic symptoms (e.g., pruritus, urticaria and hypotension) may rarely be indicative of exercise-induced anaphylaxis.43 Finally, if EIB has been ruled out, referral to a specialist should be considered for patients who present as breathless when exercising (with or without chest pain) and for whom heart disease or other conditions are suspected.43


Overall, current estimates reveal that approximately 70% of patients with asthma and EIB are diagnosed based on history and symptoms alone, and only 18% following exercise, medication or lung function testing (Table 165). A survey indicates that family physicians, in particular, are significantly less likely than pulmonologists to utilise objective testing for EIB.66 This is likely to be due, at least in part, to access issues. Among family practitioners in England, 85% reported that they had no access to bronchoprovocation testing; 11% had access to laboratory-based exercise testing; and 4% had access to EVH, methacholine or mannitol provocation testing.67


EIB can occur in both patients with and without asthma, with the prevalence in patients with asthma estimated at approximately 90%.12 EIB may lead to a substantial emotional burden on patients, and restrict exercise and sports participation. This potentially leads to long-term QoL and physical health consequences in patients with EIB, with or without asthma. Increased awareness among patients and physicians of the symptoms and risk factors for EIB and increased use of objective diagnostic tests is key to the holistic management of patients with EIB. As such, there is a pressing need for more research into EIB in patients with and without asthma, and the development of validated and widely acceptable screening methods and/or accurate diagnostic methods, which can be made accessible to family physicians.


Dr. Dennis A. Cardone leads a team of primary care sports medicine doctors who provide active people with not only diagnosis and treatment of injuries and illness, but also advice and support for their athletic endeavors.


An injury or a health concern can keep you from getting back in the game, whether as part of a team or an elite sport or simply a recreational activity like running or working out at the gym. You may think your regular doctor or a visit to an orthopedic surgeon are your only options, but this is where sports medicine comes into play. A primary care sports medicine doctor provides specialized and comprehensive care catered specifically to athletes, active people, and those who want to be more active.


There are athletes at the highest levels of sports who compete while also managing conditions such as asthma, hypertension, atrial fibrillation, and type 1 or type 2 diabetes. Each of them receives specialized care for their condition that focuses not only on maximizing their athletic potential but also their overall health and wellbeing. That is exactly what a primary care sports medicine doctor does for you.


Our comprehensive sports medicine team consists of primary care sports medicine physicians, orthopedic sports medicine surgeons, athletic trainers, physical therapists, concussion specialists and physician assistants. Our team approach to providing sports injury treatment care means we will work together to help you recover from any sports injury. No matter what sport you play or activity you do, the experts at Banner Health are ready to help get you back on your feet with our wide array of services.


Sports medicine primary care physicians treat anyone who is physically active help them improve performance, enhance overall health, prevent injury and maintain their physical activity throughout their lives. Some work with professional and amateur sports teams.


Sports medicine is not a recognized residency training specialty. However, a physician can achieve special qualifications in sports medicine after completing a residency program in another specialty. Most primary care sports medicine physicians choose family medicine. Many also choose to specialize in pediatrics, internal medicine, emergency medicine, neuromusculoskeletal and rehabilitation medicine.


This field is expanding beyond the traditional realm of professional and college athletics. More and more Americans are seeking primary care sports medicine physicians to improve health, maintain strength and endurance and sustain an active lifestyle. 2ff7e9595c


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