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Exercise testing in persons with an acute concussion

Does sub-maximal exercise testing impact overall concussion recovery?

Exercise tests, such as using the Buffalo Concussion Treadmill Test (BCTT) are often utilised to find a submaximal level of training in individuals who have suffered a concussion.  

While this information can be helpful, this study investigated whether engaging in such testing procedures quickly after injury delays overall recovery.

It was found that, using a 14-day daily symptom severity score, there was no significant trend towards an increase in time to recovery of symptoms as compared with a control group. This indicates that the BCTT does not impact overall recovery after an acute concussion.

No significant increase in overall symptoms was present after the test in symptomatic subjects versus the control subjects. Neither a short term (within 24 hours) nor a long term (within 14 days) increase was present in overall reporting of symptoms after administering the BCTT within a week of the acute injury.

Furthermore, it was found that the lower the maximal heart rate reached at the end of the BCTT, the greater the level of exercise intolerance and length of time needed for recovery from the concussion injury. It was also found that those who had a maximum heartrate of 135 beats per minute or less at the end of the BCTT are 45 times more likely to have a prolonged recovery period.

This article is useful in identifying a sub-maximal exercise training level to support concussion recovery. Additionally, given that no long-term delays in overall symptom resolution were demonstrated, the authors state that the BCTT can be used early in adolescent populations to support a clinical recovery plan, and predict who will potentially have a prolonged recovery.

> From: Leddy et al., Clin J Sport Med 28 (2018) 13-20 . All rights reserved to The Author(s). Click here for the online summary.

Expert opinion by Jessica Povall

In this study, a young and healthy population (adolescents) was used to investigate whether recovery from concussion is prolonged after early exercise testing. While this is helpful in administering care in this population, caution is still needed when applying the BCTT to older populations with more comorbidities.

Additionally, this study carefully screened out those with cervical spine and vestibular issues from their concussion injury, while exactly these cervical spine and vestibular injuries are very common in people suffering from an acute concussion. Therefore, extra care should be taken when selecting the subject to participate in the BCTT.  

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