Sports Physicals and Teen Nutrition: What Published Guidance Supports

Key takeaways

• Best timing for the exam: at least 6 weeks before the season, ideally at a yearly well visit
• Daily physical activity, ages 6 to 17: 60 minutes or more
• Most useful single change: Fill out the family heart history questions honestly, including any relative who died suddenly before age 50.
• Commonest mistake: Cutting food or fluids to "make weight" or lose weight quickly.
• See a doctor if any of the signs under "When to speak to a doctor" below apply to you.

What it is

The preparticipation physical exam many schools require before sports, and the eating and drinking habits that support young athletes. It sits within Teen Health. What follows are the published numbers, not the ones that get passed around.

The numbers, in one place

What helps

These are the changes with the clearest evidence behind them. Start wherever it is easiest to start.

• Fill out the family heart history questions honestly, including any relative who died suddenly before age 50
• Eat regular meals with whole grains, protein, fruit and vegetables, and have a snack before practice
• Drink water before, during and after exercise; sports drinks are mainly useful for long, intense sessions
• Include dairy or fortified alternatives for calcium and vitamin D

What to avoid

The common mistakes, including the ones that sound sensible.

• Cutting food or fluids to "make weight" or lose weight quickly
• Supplements sold for muscle gain or performance, which are not checked by the FDA for safety or effectiveness before sale
• Playing through pain or after a hit to the head

In depth

The preparticipation physical evaluation, often called a sports physical, is designed to identify conditions that could make sports unsafe and to find ways for young people to take part safely. Its most important part is not the physical examination but the history questionnaire, which asks about fainting, chest pain, shortness of breath, past injuries, concussions, asthma and family history of heart problems. Many serious conditions are first suspected from these answers, so it helps to fill them out together and honestly.

Sudden cardiac arrest in young athletes is rare but devastating, and it is often linked to inherited heart conditions or electrical problems that cause no symptoms until an event occurs. Warning signs such as fainting during exercise, chest pain with exertion or a relative who died suddenly at a young age prompt further evaluation. Routine electrocardiograms are not currently required for every US athlete, but your doctor may order one or refer to a cardiologist when the history raises concern.

Teen athletes have high nutritional needs because they are fueling both growth and training. Undereating, whether from a busy schedule, a desire to change body shape, or pressure in weight-class or appearance-focused sports, can lead to fatigue, injuries, missed periods, weaker bones and slowed growth. This pattern is described as relative energy deficiency in sport, which builds on what was once called the female athlete triad and can affect athletes of any gender.

Signs and symptoms

• Fainting or near-fainting during or right after exercise
• Chest pain, racing heartbeat or unusual breathlessness with exertion
• Fatigue, frequent illness or declining performance despite training
• Stress fractures or injuries that heal slowly
• Missed or irregular periods in athletes who previously had regular cycles
• Lightheadedness, cramps or headaches during practice, which can signal dehydration or underfueling

Causes and risk factors

• Inherited heart conditions that may not show symptoms before exercise
• Not eating enough to match training, sometimes without realizing it
• Pressure to reach a weight class or body type
• Low iron, especially in menstruating athletes, vegetarians and endurance athletes
• Training in heat without enough fluids or acclimatization
• Year-round single-sport training without rest, which raises overuse injury risk

How it is checked

A sports physical includes a review of the history form, measurement of height, weight, blood pressure and pulse, a vision check, and examination of the heart, lungs, abdomen, skin and musculoskeletal system. The doctor listens for heart murmurs, including while the athlete stands or squats, and looks at flexibility, strength and old injuries. Ideally this is done by the teen's regular doctor as part of a yearly well visit.

Depending on what is found, the doctor may clear the athlete fully, clear them with recommendations, ask for more tests, or advise against certain sports until evaluated further. Further tests might include an electrocardiogram or echocardiogram for possible heart concerns, blood tests for anemia or low iron, or a bone density scan in athletes with repeated stress fractures and missed periods.

Treatment and support options

Fuel before, during and after

A meal containing carbohydrates and some protein two to three hours before practice, or a small snack such as fruit, yogurt or a granola bar closer to the start, helps sustain energy. After exercise, a meal or snack with carbohydrates and protein, such as a sandwich, a smoothie or chocolate milk, helps muscles recover. Regular meals throughout the day matter more than any single pre-game food.

Hydrate sensibly

Encourage athletes to start practice well hydrated and to drink water at regular breaks. Checking urine color is a simple guide: pale yellow suggests good hydration. Sports drinks with electrolytes can help during long or very hot sessions or tournaments, but for most practices water is enough. Gradually increasing training in hot weather over one to two weeks helps the body adapt to heat.

Address low iron and underfueling

If blood tests show low iron or anemia, your teen's doctor may suggest dietary changes and possibly a supplement for a set period, followed by rechecking. If an athlete is not eating enough, a sports dietitian can design a practical eating plan. When disordered eating is suspected, care from a team including a doctor, dietitian and mental health professional works best.

Return to play after injury or concussion

Any athlete with a suspected concussion should be removed from play and not return the same day. Most US states have laws requiring written clearance from a health care provider before returning. Recovery follows a stepwise plan, starting with relative rest and light activity and gradually increasing exercise, with a pause or step back if symptoms return.

Prevention

• Schedule the physical early enough to allow follow-up tests before the season
• Make sure coaches know about asthma, allergies, diabetes or other conditions
• Bring rescue inhalers and epinephrine auto-injectors to every practice and game
• Encourage at least one or two rest days a week and time off from a single sport each year
• Check that the school or league has an emergency action plan and an AED on site

Day to day

Busy athletes often skip meals simply because of timing. Packing portable foods, such as sandwiches, fruit, trail mix, cheese sticks and milk, makes it easier to eat between school and practice. Families can plan quick dinners for late evenings and keep simple breakfasts on hand. Talking about food as fuel for performance and growth, rather than in terms of weight, supports a healthy relationship with eating.

Coaches, athletic trainers and parents all play a role in spotting problems. Watch for an athlete who is constantly tired, frequently injured, losing weight or becoming preoccupied with food or training. Encourage teens to speak up about symptoms such as chest pain or dizziness rather than pushing through, and make it clear that reporting concussion symptoms is the right thing to do, not a sign of weakness.

For specific groups

Athletes with asthma

Exercise can trigger asthma symptoms. The doctor may recommend using a rescue inhaler before activity and adjusting long-term treatment so the athlete can train fully. Coaches should know where the inhaler is kept.

Athletes in weight-class or appearance sports

Wrestling, gymnastics, dance, running and similar sports carry higher risks of rapid weight loss and disordered eating. Many state athletic associations regulate weight cutting. Focus on fueling, and seek help early for signs of restriction.

Athletes with diabetes

Teens with type 1 diabetes can play any sport with planning. Checking blood glucose before, during and after activity, carrying fast-acting sugar and making a plan with the care team for adjusting insulin and food help prevent lows.

Questions to ask your doctor

• Does anything in our family history mean my teen needs a heart evaluation?
• Is my teen eating enough for their level of training?
• Should my teen be tested for low iron or anemia?
• How should we manage asthma or allergies during sports?
• What is the plan for returning to play after this injury or concussion?
• Are any supplements my teen is considering safe or useful?

More questions, answered

Can a sports physical replace a yearly checkup?

A sports physical focuses on safety for sports and may not cover everything a well visit does, such as vaccines, mental health screening and other preventive care. Combining the sports physical with a yearly well visit at your teen's regular doctor gives the most complete care.

Does my teen need protein shakes or supplements?

Most teen athletes can meet their protein needs from food such as meat, fish, eggs, dairy, beans and nuts. Supplements are not reviewed by the FDA for safety or effectiveness before sale and may contain ingredients not listed on the label. Talk to the doctor before using any.

Are sports drinks better than water?

For most practices, water is enough. Sports drinks can help during long, intense or very hot sessions by replacing carbohydrates and electrolytes, but they add sugar and calories that most teens do not need day to day.

Is it normal for a female athlete to miss periods?

No. Missing periods is often a sign that the body is not getting enough energy for training and growth, which can weaken bones. It should be checked by a doctor rather than seen as a normal part of training.

Why does the form ask about relatives who died suddenly?

Some heart conditions that can cause sudden cardiac arrest during exercise run in families. A relative who died suddenly or unexpectedly before age 50 may point to an inherited condition that the doctor would want to check for.

Does my teen need a sports physical every year?

Requirements are set by states, school districts and athletic associations, and many require a physical every year. Even when not required, a yearly well visit is recommended for teens and allows the doctor to check for new concerns.

Related topics

• Sports Concussion: What the Evidence Actually Says (Injury Prevention)
• Sports Injuries: What Published Guidance Supports (Bone and Joint)
• Concussion: What Published Guidance Supports (Brain Health)
• Childhood Activity: What the Evidence Actually Says (Children's Health)

Where to go next

• Sports Physicals and Teen Nutrition: Common Questions Answered
• Sports Physicals and Teen Nutrition: Just the Figures
• Sports Physicals and Teen Nutrition — the reference entry
• Teen Health: The Complete Guide
• Teen Acne: Sorting the Evidence From the Noise
• Vaping and Teens: What the Evidence Actually Says

When to speak to a doctor

See your doctor before returning to sports if a teen has chest pain or unusual shortness of breath with exercise, misses periods, loses weight without trying or has a suspected concussion. Call 911 if an athlete collapses or faints during exercise, has a seizure, or seems confused after heat exposure, and start CPR if they are not breathing normally.

Where this comes from

• American Academy of Pediatrics — Preparticipation Physical Evaluation
• NIH Office of Dietary Supplements — Calcium Fact Sheet for Consumers
• Office of Disease Prevention and Health Promotion — Physical Activity Guidelines for Americans

How this page was put together

Every figure, recommendation and warning above is taken from the guidance named in Where this comes from. Nothing on this page is inferred, summarized or generalized beyond what those bodies publish: where they give a number, it is their number, and where they are silent, so are we. Pages are rebuilt whenever the underlying record changes. Sign-off by a named clinician, where it has happened, is shown at the top of the page along with the date.

Medical disclaimer

This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to your doctor, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 911.