Early aerobic exercise among adolescents at moderate/high risk for persistent post-concussion symptoms: A pilot randomized clinical trial. (May 2022)

• Record Type: Journal Article
• Authors: Howell, David R.; Wingerson, Mathew J.; Kirkwood, Michael W.; Grubenhoff, Joseph A.; Wilson, Julie C.
• Is Part Of: Physical therapy in sport. Volume 55(2022)
• Page Start: 196
• Page End: 204
• Publication Date: 2022-05
• Subjects: Mild traumatic brain injury -- Treatment -- Intervention -- Youth -- Exercise -- Actigraphy; Sports physical therapy -- Periodicals; Sports injuries -- Patients -- Rehabilitation -- Periodicals; Athletic Injuries -- diagnosis -- Periodicals; Athletic Injuries -- therapy -- Periodicals; Physical Therapy -- Periodicals; Sports Medicine -- Periodicals; 615.82088796
• DOI: 10.1016/j.ptsp.2022.04.010
• Languages: English
• ISSNs: 1466-853X

Abstract

Abstract: Purpose: To determine the proportion of adolescents at moderate/high risk for Persistent Postconcussion Symptoms (PPCS) who develop PPCS when randomized to early aerobic exercise or standard-of-care and examine exercise volume/intensity between groups. Methods: Using a randomized clinical trial design, we enrolled patients 10–18 years of age who obtained a "Predicting/Preventing Postconcussive Problems in Pediatrics" (5P) risk score ≥6 and enrolled/tested ≤ one-week post-concussion (mean = 5.5 ± 1.5 days post-concussion). Participants were randomized to "Exercise" (5 days/week, 20 min/day aerobic exercise at individualized intensity [80% HR at exercise test cessation]) or "Standard-of-Care" (no exercise recommendations). They returned for re-testing one-month post-concussion, and we remotely monitored exercise between assessments. Results: Sixteen participants enrolled (intervention: n = 9, 56% female, 14.2 ± 2.1 years; standard-of-care: n = 7, 57% female, 13.6 ± 1.7 years). A smaller proportion of the early aerobic exercise group developed PPCS when compared to the standard-of-care group (44% vs. 86%; relative risk = 0.52; 95% confidence interval = 0.34–1.36; number-needed-to-treat = 2.4). Conclusion: We observed that participants randomized to early aerobic exercise had a lower risk of PPCS compared to standard-of-care. Although not statistically significant, these results suggest early/individualized aerobic exercise among those at moderate/high PPCS risk may be effective at reducing that risk, and early aerobic exercise is not detrimental to recovery outcomes. Highlights: Early aerobic exercise led to a lower risk of PPCS than standard-of-care. Those at moderate/high risk of PPCS may benefit from early aerobic exercise. A post-concussion aerobic exercise recommendation resulted in higher exercise intensity. Early aerobic exercise was not associated with adverse outcomes.