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Wilderness Preparticipation Evaluation and Considerations for Special Populations

Joy, Elizabeth MD, MPH*; Van Baak, Karin MD; Dec, Katherine L. MD; Semakula, Barbara MD§; Cardin, Ashlea D. OTDs, OTR/L, BCP; Lemery, Jay MD; Wortley, George C. MD**; Yaron, Michael MD; Madden, Christopher MD††

Clinical Journal of Sport Medicine: September 2015 - Volume 25 - Issue 5 - p 443–455
doi: 10.1097/JSM.0000000000000251
Care of the Wilderness Athlete

Abstract: Children, older adults, disabled and special needs athletes, and female athletes who participate in outdoor and wilderness sports and activities each face unique risks. For children and adolescents traveling to high altitude, the preparticipation physical evaluation should focus on risk assessment, prevention strategies, early recognition of altitude-related symptoms, management plans, and appropriate follow-up. As the risk and prevalence of chronic disease increases with age, both older patients and providers need to be aware of disease and medication-specific risks relative to wilderness sport and activity participation. Disabled and special needs athletes benefit from careful pre-event planning for the potential medical issues and equipment modifications that may affect their health in wilderness environments. Issues that demand special consideration for female adventurers include pregnancy, contraceptive use, menses, and ferritin levels at altitude. A careful preparticipation evaluation that factors in unique, population-specific risks will help special populations stay healthy and safe on wilderness adventures. The PubMed and SportDiscus databases were searched in 2014 using both MeSH terms and text words and include peer-reviewed English language articles from 1977 to 2014. Additional information was accessed from Web-based sources to produce this narrative review on preparticipation evaluation for special populations undertaking wilderness adventures. Key words include children, adolescent, pediatric, seniors, elderly, disabled, special needs, female, athlete, preparticipiation examination, wilderness medicine, and sports.

*Clinical Outcomes Research, Intermountain Healthcare, Salt Lake City, Utah;

Department of Family Medicine, University of Colorado, Denver, Colorado;

CJW Sports Medicine, Richmond, Virginia;

§Anne Arundel Medical Center, Orthopedic and Sports Medicine Center, Annapolis, Maryland;

Missouri State University, Springfield, Missouri;

Department of Emergency Medicine, University of Colorado, Aurora, Colorado;

**Big Island Family Medicine Center, Lynchburg, Virginia; and

††Longs Peak Sports Medicine, Longmont, Colorado.

Corresponding Author: Elizabeth Joy, MD, MPH, Clinical Outcomes Research, Intermountain Healthcare, 36 South State St, 16th Floor, Salt Lake City, UT 84111 (

The authors report no conflicts of interest.

This article appears in a “Care of the Wilderness and Adventure Athlete” special issue, jointly published by Clinical Journal of Sport Medicine and Wilderness & Environmental Medicine.

Received February 20, 2015

Accepted June 16, 2015

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.