Endurance Athlete Circulation screen

Those who participate in endurance sports like marathons, triathlons, rigorous cycling or mountain biking, diving, mountain hiking, Ironman competitions and so on need their heart, lungs and circulation to work to extreme demand. This screen is to assess their readiness for such activity, regardless of age. The screen includes:

Cardiopulmonary exercise testing
Echocardiogram and exercise ankle-brachial index assessment
Vascular assessment and advice to improve athletic performance safely

Undiagnosed conditions affecting the heart, lungs and circulation are a common cause of acute medical complications in those attempting endurance sports. Training conditions in air-conditioned gym environments do differ from those in the open, especially in a tropical country like in Singapore. Hospital admissions from acute kidney injury from muscle damage (myoglobinuria), decompression sickness after diving or mountain biking and the like are not uncommon as the preparation for such events may not have included a full medical assessment. Whilst exercise is undoubtedly a great contributor to good health, extreme exercise that the body has not been conditioned for can be detrimental too.

This screening programme is designed to provide a detailed baseline assessment of the health of an individual as he/she participates in endurance sports. This allows them to be aware of what the challenges to their circulation may be from the extreme sport and physical exertion, understand their physical limitations and make recommendations for tailored exercise regimes to improve their performance at the sport safely. They can then take informed measures to maintain circulation health and prevent acute complications from these circulation issues happening during their sporting journey.

Who is this screen for?

If you participate in endurance sports, are intending to take on a new sporting challenge, or are hitting the gym in midlife having never done so before, then this screening programme is for you.

What tests does this screen contain?

Nurse assessment

For body composition measurements, BP, risk factor and medication record.

Urine test

For blood cells, sugar and protein.

Blood tests

Full blood count – low haemoglobin levels affect the ability of the circulation to carry oxygen; high white cell counts can signify infection
Glycated haemoglobin or HbA1C – a measure of average blood sugar control over 3 months
Kidney function – poor kidney function can develop from a variety of circulation-related mechanisms
Liver function
Thyroid function – poor thyroid function can affect energy levels and mental concentration, sport performance, body weight and muscle mass
Lipid (cholesterol) profile – to assess circulation health.

Cardiopulmonary Exercise Testing (CPET)

CPET measures the ability of your lungs, heart and muscles to function as a composite unit that oxygenates blood, pumps oxygenated blood to the muscles and the ability of the muscles to utilise that oxygen. This allows us to assess if your heart, lung or muscle reserve is compromised, when you move into an anaerobic state during exercise (anaerobic threshold), your VO₂ max (the maximum (max) rate (V) of oxygen (O₂) your body is able to use during exercise) and how well conditioned (or deconditioned) you are.

Echocardiogram

A check to rule out asymptomatic heart valve issues or small undiagnosed holes in the heart that may progress or cause serious complications during sport like diving or snorkelling.

Peripheral Arterial Haemodynamic Study

A non-invasive assessment of the blood pressure and doppler wave forms of the arteries at various levels in both the legs to determine the presence and location of any compression or blockages in the legs from abnormal fibrous or muscular compression bands, which may affect performance or rarely cause acute limb-threatening complications during exercise.

Consultation with a senior specialist vascular surgeon

To discuss results and develop an awareness for preserving circulation health and preventing circulation injury as they step into university and independent lives.

How do I prepare for this screen and how long does it take?

If you have booked this screen, you should have received instructions on what to expect via email or phone. If not, please call the clinic at least 1 day before the screen at +65 64720503 during working hours to confirm the instructions.
The screen is conducted over 2 days. Plan about 4 hours in the clinic on the first day and about 1 hour on the second day.
You will need to come in the morning on Day 1 having fasted (without having had anything to eat) for at least 6 hours. You may have clear non-sugary drinks and hydrate well. Avoid alcohol, smoking or caffeine for at least 4 hours before the test.
Come prepared for a brisk walk on the treadmill. Bring along a water bottle, t-shirt and shorts or gym attire, and running shoes on Day 1.

What can I expect on the screening days?

On Day 1 of the screen, you will first be registered for the screening.
You will then be asked to provide a mid-stream urine sample and have your blood tests as you are fasting.
You may then go and have breakfast and return to the clinic, where you will have the nurse assessment.
All remaining tests will be done after that and should usually be completed on Day 1, unless CPET is not available on the day or needs you to go to a different site. Day 1 may need up to 4 hours to complete.
On Day 2 (which can be scheduled to your convenience but would be at least 5 days after Day 1 to allow for all test results to come back in), you will see the specialist vascular surgeon for a consultation and discussion. Day 2 may need up to 1 hour to complete. Please eat and drink as normal on Day 2. Of course, this may be day 3 if CPET is on a different day from the first day.

What if my screening detects a problem?

We will give you a detailed report and recommendations in writing to take away.
We will also discuss the exercise goals you hope to achieve, your current circulatory fitness to get there and how best to modify training routines to achieve your goals.
If screening results suggest you need further investigations or treatment, you will also be given a note for you to show your family doctor to make a formal referral to us. Further treatments or tests may not be covered by insurance if there is not a formal referral.
Your screening results and reports are NOT shared by us with your doctor or any third party including your insurers or employers. Sharing your report results with other doctors, insurers or employers is for you to do as you deem fit but is recommended.

How often is an endurance athlete’s circulation fitness screen needed?

This comprehensive screen is needed before embarking on a strenuous fitness regime or preparation for an endurance event, and perhaps at two to three yearly intervals if you wish to maintain and enhance that fitness as part of follow-up, or are embarking on a new sporting and endurance challenge. Any further follow-up and treatment, if required, will depend on what the initial screening tests show.

you are covered

We are on the panel with most insurers in Singapore and with many international insurers; We also offer convenient options for self-paying patients.