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As reported in this space on numerous occasions, Italy has been screening its athletes annually via EKG for decades. As a result, the Italians claim that heart-related deaths in sports have been reduced by 89 percent.

Consequently the European Society of Cardiology issued a consensus statement in 2005 endorsing the Italian policy. However, the American College of Cardiology has not, adhering to a screening policy of obtaining a thorough history and performing a complete physical annually.

The Italians claim that this method catches only 5 percent of potentially fatal cardiac conditions while theirs catches 70 percent. The Americans counter that a high false positive rate of 16 percent makes annual EKG screenings impractical.

A study done in Israel — but published in the Journal of the American College of Cardiology in 2011 — would seem to come down on the side of the Americans. Based on the Italian experience, Israel followed suit in 1997. After 10 years, Israeli scientists looked at the data but also looked at the numbers for the 10 years prior to the policy change. In sharp contrast to the Italians, the Israelis found that preseason EKG screening has absolutely no effect on the rate of sports-related cardiac deaths.

How could the numbers be so different? The lead author of JACC report explained the difference by pointing out the Italians had only looked back two years.

A study published last month in the New England Journal of Medicine further favors the American policy. Authored by researchers in Ontario, Canada, the study found that cardiac arrest among athletes was extremely rare, with 74 cases between 2009 and 2014 in the province. Of those, 16 occurred during competition and 58 in non-competitive situations. Of the 16 that took place during competition, an EKG would have identified only three.

Ultimately, among 100,000 athletes over the course of four years, the researchers concluded that “only” three would die. For all those reasons, the study’s conclusion was that EKG screening was both ineffective and too expensive.

While EKGs may be ineffective at predicting potentially fatal events in sports, an MRI does an excellent job of finding heart damage caused by overuse, and a study presented last week in Chicago demonstrated such overuse among male triathletes.

German researchers speaking at the Radiological Society of North America’s annual meeting looked at the hearts of 55 (average age 44) and 30 women (average age 43). They found that 10 of the men (18 percent) and none of the women had evidence of scarring in their left ventricle. However, the researchers also noted that the women averaged significantly fewer triathlons than the men — and so did the men without scarring versus those with.

For years, “Exercise is Medicine” has been the theme of the journal The Physician and Sportsmedicine. This latest German study proves that like any other medicine, too much exercise is harmful.

When it comes to any potential heart problem, the best strategy is preparation for the unexpected. Events on Saturday at North Carolina State offer a perfect illustration. During a first-half timeout, Tyvoris Solomon of visiting South Carolina State collapsed on the sideline but was resuscitated thanks to the immediate action of SC State athletic trainer Tyler Long, who was assisted by local EMS in attendance. Had there not been an athletic trainer with an AED there, the outcome may have been entirely different.

Does your child’s team have a properly equipped athletic trainer on hand if the unthinkable happens?

John Doherty is a licensed athletic trainer and physical therapist. This column reflects solely his opinion. Reach him at Follow him on Twitter @JDohertyATCPT.