I was telephoned today by the Granfondo Avesani organizers pointing out that my medical certificate for competitive activity was going to expire by the date of the event. That means that between now and September 16th I must have a physical examination and obtain a letter from a doctor that I am fit.
In general to enter a granfondo you have to have one of two types of medical certificates: a basic health check or a competitive activity check. I obtain the latter as some granfondos will limit you to only doing the short courses with the basic health check. Some other granfondos, such as the Granfondo Italia, are open only to holders of competitive activity certificates. Therefore, if you want flexibility in being able to choose the course length and events it's necessary to go the competitive activity route.
To obtain the competitive activity certificate you must undergo a full stress test every year if you are over 40. Monday I'll be visiting my sports doctor to undergo the test. The most interesting part of the test is being connected to an EKG machine while pedaling away on a stationary cycle. The doctor increases the level of difficulty periodically while monitoring the results. He makes a preliminary evaluation and then sends the results off to a cardiologist for a second reading and opinion. If all is well you receive a letter that indicates that you are fit for competition.
My sports doctor explained to me that, "I am the one responsible if anything happens to you." It's a radically different approach than the USA where anyone can enter, say a Century, by signing a waiver.
And, at 70 Euro, it's an inexpensive way to know you are not putting yourself at risk.