Racket Sports
Badminton, tennis, squash, table tennis and pickleball.
Medically Reviewed By: Dr Paul Lim – MBBS, M.Med (Int Med), MRCP (UK), FAMS (Cardiology)
Cardiology Assessment
Reviewed by Dr Paul Lim Chun Yih
Senior Consultant Cardiologist
Cardiac Clearance Fitness for Surgery, Sport & Work in Singapore
Cardiac clearance is a cardiologist’s assessment of whether your heart can safely take the strain of something specific: an operation, a return to sport, or a physically demanding job. Been asked for a letter? Bring the request to Dr Paul Lim, who is easy to talk to, and you will leave with a written opinion in time for your date.
Reviewed by Dr Paul Lim Chun Yih
Senior Consultant Cardiologist
Assessed by a Cardiologist
22+ Years of Experience
10,000+ Consultations
ECG & Echo On Site
22+
Years of
Clinical Experience
Clinical Experience
Your Cardiologist
Your Assessment Is Carried Out by Dr Paul Lim
Senior Consultant Cardiologist & Cardiac Electrophysiologist
Dr Paul Lim is a Senior Consultant Cardiologist who assesses fitness for surgery, sport and work against the demands of the activity itself rather than a generic checklist. He subspecialises in heart rhythm disorders and implants pacemakers and defibrillators, which is the group most often told to seek clearance and most often left without a clear answer. He completed advanced fellowship training at Barts Heart Centre, London under Singapore’s HMDP award.
UK & SG
Fellowship Training
10,000+
Patient Consultations
1,000+
Ablation & Device Procedures
- MBBS (Singapore)
- M.Med (Int Med)
- MRCP (UK)
- FAMS (Cardiology)
- Fellow, European Society of Cardiology (FESC)
- Fellow, American College of Cardiology (FACC)
- Fellow, Heart Rhythm Society (FHRS)
The Assessment Explained
What Is Cardiac Clearance?
Cardiac clearance, also called cardiology clearance, is a cardiologist’s written opinion on whether your heart is up to something you are about to do: an operation, a sport, or a demanding job.
It is not a single test. There is no scan called a clearance. What happens is a consultation, an examination, an ECG, and any further tests your case needs. The findings go into a letter you can hand to whoever asked for it.
Before Surgery
Your surgeon or anaesthetist has asked for a cardiology opinion before an operation.
For Sport & Exercise
You want to start, return to or step up a sport, and want to know it is safe first.
For Work
An employer has asked whether your heart is up to the physical demands of a role.
Not sure which applies to you? Talk to our friendly cardiologist Dr Paul Lim, who will go through it with you.
Before an Operation
Cardiac Clearance Before Surgery
Surgery and anaesthesia put the heart under strain: blood pressure swings, fluid shifts, blood loss. Most people handle it without trouble. Checking beforehand is about finding the few who would not, in time to do something about it.
When a surgeon or anaesthetist usually asks for it
- You have atrial fibrillation or another irregular heart rhythm
- You have a pacemaker or defibrillator, which needs checking and often reprogramming around surgery
- Known coronary artery disease, or a previous stent, bypass or heart attack
- Heart failure, a cardiomyopathy, or a known problem with a heart valve
- A heart murmur that has never been investigated
- An abnormal ECG picked up during pre-admission checks, which often turns out to be nothing
- Chest pain, breathlessness or blackouts that have not been explained
- Several risk factors stacked together: diabetes, high blood pressure, high cholesterol, smoking, kidney disease
- You are older and not very active, so there is nothing in your daily life to show how your heart copes with exertion
Minor procedures under local anaesthetic rarely need this. It comes up with longer operations, general anaesthesia, or a known heart problem.
What to bring
The Request Letter or Form
From your surgeon, anaesthetist or hospital. It tells us what they are actually asking.
The Date of the Operation
What it involves, and the type of anaesthetic if you know it.
A List of Your Medicines
Including blood thinners, and anything you have already been told to stop.
Previous Heart Reports
ECGs, echocardiograms, stress tests, angiograms and device records.
Your Device Identification Card
If you have a pacemaker or defibrillator, bring the card that came with it.
Been asked for cardiac clearance before an operation? Send us the request letter and we will tell you what is involved and how quickly it can be done.
Sport & Exercise
Fitness-to-Exercise and Sports Clearance
Whether you are starting, returning, or stepping up.
Exercise is good for your heart, and checking first is not about talking you out of it. It is to catch a rare underlying problem before you push hard, and to give you something specific instead of vague caution. Most people who ask are told to go ahead, and where limits do apply they are usually narrower and shorter-lived than expected.
Sports and activities people ask about
Running
From a first 10K through half marathons, marathons and trail running.
Team Sports
Football, futsal, basketball, netball, floorball, volleyball, hockey, rugby, touch rugby and ultimate frisbee.
Water Sports
Swimming, open-water swimming, dragon boat, kayaking, canoeing, rowing, sailing and stand-up paddleboarding.
Gym & Strength Work
Weight training, powerlifting, CrossFit, calisthenics, HIIT and circuit classes. Lifting heavy while holding your breath spikes blood pressure, which occasionally matters.
Endurance & Outdoors
Road and mountain cycling, spin classes, triathlon, duathlon, hiking, trekking at altitude, rock climbing and obstacle-course racing.
Combat Sports
Boxing, Muay Thai, taekwondo, karate, judo, wrestling and Brazilian jiu-jitsu, where a direct blow to the chest is part of the sport.
Lower-Intensity Activity
Golf, dance, Zumba, aerobics, yoga, pilates, tai chi and brisk walking groups. Worth asking about too.
Masters & Veterans
Competition in any of the above, where the training load is often heavier than the label suggests.
Bring the specifics: how many sessions a week, how hard, how long, and whether anything has felt different lately. Those change the answer more than the name of the sport does.
When it is worth being assessed before you push hard
Stop exercising and seek medical attention
Do not train through any of these:
- You fainted, collapsed or nearly blacked out during or just after exertion
- Exercise brings on chest pain, tightness or pressure
- Sudden severe breathlessness out of proportion to the effort
- A racing or irregular heartbeat during exercise that will not settle afterwards
Worth being assessed before you push hard
Book a consultation if:
- A close relative died suddenly and young, or has an inherited heart condition
- You are returning after a heart attack, a stent, an ablation or heart surgery
- You have a known heart condition and want to know where your limit is
- You are over 40, largely inactive, and about to start something demanding
- Your watch or heart rate keeps showing something that does not match the effort
- Milder palpitations that only appear when you train
Usually fine to build up gradually
No assessment needed first if:
- You feel well and none of the above applies
- No family history of sudden death or inherited heart disease
- You are already active and adding to it steadily
- Our heart rate zones and maximum heart rate guides cover the everyday version of this question
Not sure which applies to you? Speak to a cardiologist rather than guess.
Devices & Activity
Sport and Exercise With a Pacemaker or ICD
Having a pacemaker or an implantable defibrillator is compatible with an active life, and most people go back to recreational sport. “Can I play badminton again?” is usually answered yes, with a timeline attached.
How long that takes, and where the limits sit, depends on your own situation: why the device was put in, the heart condition behind it, how the implant went, and which sport you have in mind. There are a few weeks of shoulder restriction at the start while the leads settle, and contact sports need a separate conversation. After that it is usually the heart condition rather than the device that sets the ceiling.
Dr Paul Lim implants and looks after pacemakers and defibrillators, so this can be worked out against your own device and rhythm history instead of a general rule. Bring your device card and tell us what you want to get back to.
Work & Occupational Fitness
Cardiac Clearance for Work
Some jobs ask more of the heart: heavy lifting, long shifts, working in heat, or wearing protective gear that adds its own load. If an employer has asked for a cardiologist’s view on whether you are up to it, that is a medical question and Dr Paul Lim can assess it and report.
Bring their form or written request, so the assessment answers what they are actually asking rather than making a general statement about your heart.
What any employer, professional body or authority requires is their rule to state, not ours. We will answer the medical question they have put, in writing.
Driving
What About Driving?
This usually comes up after a blackout or a new diagnosis. The medical part is simple: do not drive until you have been assessed and told it is safe.
After that it depends on the cause and whether it has been brought under control. A faint with an obvious trigger and a normal heart is a different situation from an arrhythmia that is still untreated. Discuss your own circumstances at your consultation.
Anything to do with licensing or paperwork sits with the relevant authority rather than with us. If they have given you a form for a doctor to complete, bring it to your appointment.
Not sure whether your situation needs an assessment at all? Ask us before you book anything.
What Happens
What the Assessment Involves
Which tests you need depends on your own condition. There is no fixed set that everyone goes through.
Almost always
- A consultation covering your history, symptoms, medicines, family history and what you are being assessed for
- A physical examination, including blood pressure, pulse and listening to the heart
- A resting ECG, which takes a few minutes and is read on the spot
Added if your case needs it
2D Echocardiogram
An ultrasound scan, used when the heart muscle, its pumping strength or a valve needs to be seen. Scans are performed by female professionals.
Treadmill Stress Test
Used when the question is how your heart behaves under exertion. The most useful test for sport and fitness questions.
Holter Monitor
Worn for 24 hours or longer, to catch palpitations or an on-and-off rhythm problem that a resting ECG would miss.
Device Check
For pacemaker and defibrillator patients: reading the settings and the recordings the device has stored.
Blood Tests
Where anaemia, thyroid, kidney function or cholesterol could be affecting things.
CT Calcium Score
Or a CT coronary angiogram, where coronary disease needs ruling in or out directly.
Many assessments need nothing beyond the consultation and the ECG. If a test is recommended, you will be told why, and you can decide from there.
The Outcome
What You Receive
A written opinion addressed to whoever asked for it, setting out what was found and what it means for what you want to do. Copies of any test reports go with it.
- A clear conclusion, though not always a plain yes or no.
- Conditions, where there are any — a medication adjustment, a ceiling on intensity, a period of monitoring, or a review after a set interval.
- Practical notes for the team looking after you: how a pacemaker should be handled during surgery, or how to manage a blood thinner around the date.
- Where something needs treating first, the options and a realistic timeline.
Timing
How Long It Takes
- Where a consultation and an ECG answer the question, the written opinion can usually be issued the same day.
- An echocardiogram or treadmill stress test can generally be done at the same visit.
- A Holter monitor is the exception. It records for at least 24 hours, so the report follows a few days later.
- Working to a surgery date? Say so when you book, and the appointment can be arranged around the deadline.
Why Choose Us
Why Have Your Assessment With Us?
Devices Are a Subspecialty
Dr Paul Lim implants and looks after pacemakers and defibrillators, so activity questions are answered against your own device.
Tests in the Same Visit
ECG, echocardiogram and treadmill stress testing are on site, so most assessments are done in one appointment.
A Written Opinion, Not a Verbal One
A letter your surgeon, employer or sports body can act on, with the test reports attached.
Worked Around Your Date
Tell us your date and the appointment and tests are arranged to meet it.
Transparent Pricing
Consultation and test fees are published below, so you know what the assessment will cost before you book.
Two Locations
Available at our Jurong and Orchard clinics.
Been asked for cardiac clearance, or unsure whether you need it? If you are concerned, or would simply like a second opinion, speak with Dr Paul Lim.
Transparent Pricing
Cardiac Clearance Cost in Singapore
There is no single clearance fee. You pay for the consultation, plus whichever tests your case needs. All fees are inclusive of GST.
| Service | Price |
|---|---|
| Consultation | |
| First Consultation with Cardiologist (Jurong) | S$130.80 |
| Follow-up Consultation with Cardiologist (Jurong) | S$98.10 |
| First Consultation with Cardiologist (Orchard) | S$218 |
| Follow-up Consultation with Cardiologist (Orchard) | S$163.50 |
| Tests, where needed | |
| Electrocardiogram (ECG) Part of almost every assessment | From S$49.05 |
| Treadmill Stress Test Where the question is how the heart behaves under exertion | S$218 |
| 2D Echocardiogram S$436 at Jurong, S$545 at Orchard | S$436 – S$545 |
| Holter Monitor First 24 hours; from S$54.50 per subsequent 24 hours | S$272.50 – S$381.50 |
Many assessments need only the consultation and an ECG.
If you are due a general check as well, the heart screening packages bundle the blood panel, ECG and treadmill stress test from S$368, which can work out cheaper than arranging the same tests individually. Full prices for every test are on the cardiology fees page.
Get in Touch
Book a Cardiac Clearance Assessment
Bring the request letter and your date — most assessments are completed in one visit.
Send Us a Message
Visit Us
Where to Get Cardiac Clearance in Singapore
Opening Hours
| Monday – Friday | 8:30 AM – 5:30 PM |
| Saturday | 8:30 AM – 12:30 PM |
| Sunday & Public Holidays | Closed |
By Appointment Only
Common Questions
Cardiac Clearance FAQ
What is cardiac clearance?
Cardiac clearance is a cardiologist’s written opinion on whether your heart is up to something you are about to do: an operation, a return to sport, or a physically demanding job. It is not a single test. There is no scan called a clearance. What happens is a consultation, an examination, an ECG, and any further tests your case needs, followed by a letter you can hand to whoever asked for it. The word clearance makes it sound like a stamp. It is really an opinion, and it sometimes comes with conditions attached.
Do I need cardiac clearance before surgery?
Most people having minor surgery do not. It is usually asked for when the operation puts some strain on the heart and you have a heart condition or risk factors. Surgeons and anaesthetists commonly request it if you have known coronary disease, an arrhythmia, a pacemaker or defibrillator, heart failure, a heart murmur, a previous stent or bypass, or an abnormal ECG picked up during pre-admission checks. If you have been asked for it, that is the reason. Bring the letter and the details of the operation to your appointment. More on pre-operative clearance above.
What tests are done for cardiac clearance?
Almost always a consultation, an examination and a resting ECG. Beyond that it depends on your own condition. An echocardiogram is added when the heart muscle or a valve needs to be checked, a treadmill stress test when the question is how your heart behaves under exertion, and a Holter monitor when palpitations or an on-and-off rhythm problem need to be caught. There is no fixed set everyone goes through, and a straightforward case may need nothing beyond the ECG.
How long is cardiac clearance valid for?
There is no fixed expiry date. In practice a written opinion is treated as current for a few months, provided nothing has changed. It stops being current the moment something does: new chest pain, breathlessness, palpitations, a blackout, a change to your heart medication, or a new diagnosis. Some hospitals and employers set their own limit, so check what has been asked of you before booking. If your surgery is pushed back by several months, expect to be reassessed.
How long does it take to get cardiac clearance?
Where a consultation and an ECG settle it, the written opinion can usually be issued the same day. An echocardiogram or treadmill stress test can generally be done at the same visit. A Holter monitor is the exception, since it records for at least 24 hours and the report follows a few days later. If you are working to a surgery date, say so when you book.
How much does cardiac clearance cost in Singapore?
There is no single clearance fee. You pay for the consultation plus whichever tests are needed. A first consultation with Dr Paul Lim is S$130.80 at Jurong and S$218 at Orchard, inclusive of GST. An ECG is from S$49.05, a treadmill stress test is S$218, and a 2D echocardiogram is S$436 at Jurong or S$545 at Orchard. Many people need only the consultation and an ECG. See the fee table above.
Can I play badminton or other sport with a pacemaker?
Most people with a pacemaker return to recreational sport, including badminton. The question is usually when rather than whether. There are a few weeks of shoulder restriction after implantation while the leads settle. After that the limits depend on why the device was put in and the heart condition behind it, rather than on the pacemaker itself. Contact sports need a separate conversation, since a direct blow to the device site is the specific risk. Dr Paul Lim implants and looks after pacemakers and defibrillators, so this can be worked out against your own device and rhythm history.
Do I need a referral letter from my surgeon?
No, a referral is not required to book. It helps, because a letter stating the operation, the anaesthetic and the specific concern lets the assessment answer the actual question. If you have a form or a request letter from a surgeon, employer or sports body, bring it. If you have nothing in writing, bring the details you do have.
What happens if the assessment finds a problem?
The written opinion says what was found and what it means for what you want to do. That is not always a straight yes or no. It may set conditions, suggest a medication change or a further test, or recommend a delay until something is under control. Better found before an operation than during one. Where something needs treating, Dr Paul Lim will set out the options and the likely timeline.
Can I get cardiac clearance for work or a physically demanding job?
Yes. If a job involves heavy lifting, long shifts, heat or sustained exertion, and someone has asked for a cardiologist’s view on whether your heart is up to it, Dr Paul Lim can assess it and report. What any particular employer, body or authority requires is their rule to state, not ours, so bring their form or written request and it will be answered directly.
I have been told not to drive. When can I drive again?
Do not drive until you have been assessed and told it is safe. After that it depends on the cause and whether it has been brought under control: a faint with a clear trigger and a normal heart is a different situation from an arrhythmia that is still untreated. Discuss your own circumstances at your consultation. Anything to do with licensing or paperwork sits with the relevant authority rather than with us; if they have given you a form for a doctor to complete, bring it.