The European approach of preparticipation screening to prevent sudden cardiac deaths in sports consists of anamnesis, physical examination and ECG. The knowledge of training-related ECG alterations reduces false-positive results. In high performance sports in Germany and some other countries, an exercise ECG is additionally performed. The implementation of the exercise ECG is generally recommended for athletes older than 35 years. Under laboratory conditions, ECG at rest and during exercise can be involved in the performance diagnostics. Measurements of lactate and respiratory parameters during bicycle and treadmill ergometry can be combined with ECG.