Sport-related concussions are heterogeneous and require an individualized clinical approach. The use of a comprehensive approach for assessing specific clinical trajectories following a sport-related concussion will help clinicians better conceptualize this injury. Clinicians can then match targeted treatment pathways to specific clinical trajectories to accelerate safe return to play for athletes following a sport-related concussion.
ObjectivesTo (1) determine if wearing a cloth face mask significantly affected exercise performance and associated physiological responses, and (2) describe perceptual measures of effort and participants’ experiences while wearing a face mask during a maximal treadmill test.MethodsRandomised controlled trial of healthy adults aged 18–29 years. Participants completed two (with and without a cloth face mask) maximal cardiopulmonary exercise tests (CPETs) on a treadmill following the Bruce protocol. Blood pressure, heart rate, oxygen saturation, exertion and shortness of breath were measured. Descriptive data and physical activity history were collected pretrial; perceptions of wearing face masks and experiential data were gathered immediately following the masked trial.ResultsThe final sample included 31 adults (age=23.2±3.1 years; 14 women/17 men). Data indicated that wearing a cloth face mask led to a significant reduction in exercise time (−01:39±01:19 min/sec, p<0.001), maximal oxygen consumption (VO2max) (−818±552 mL/min, p<0.001), minute ventilation (−45.2±20.3 L/min), maximal heart rate (−8.4±17.0 beats per minute, p<0.01) and increased dyspnoea (1.7±2.9, p<0.001). Our data also suggest that differences in SpO2 and rating of perceived exertion existed between the different stages of the CPET as participant’s exercise intensity increased. No significant differences were found between conditions after the 7-minute recovery period.ConclusionCloth face masks led to a 14% reduction in exercise time and 29% decrease in VO2max, attributed to perceived discomfort associated with mask-wearing. Compared with no mask, participants reported feeling increasingly short of breath and claustrophobic at higher exercise intensities while wearing a cloth face mask. Coaches, trainers and athletes should consider modifying the frequency, intensity, time and type of exercise when wearing a cloth face mask.
The clinical management of sports-related concussions is a specialized area of interest with a lack of empirical findings regarding best practice approaches. The University of Pittsburgh Medical Center Sports Concussion Program was the first of its kind; 13 years after its inception, it remains a leader in the clinical management and research of sports-related concussions. This article outlines the essential components of a successful clinical service for the management of sports-related concussions, using the University of Pittsburgh Medical Center Sports Concussion Program as a case example. Drawing on both empirical evidence and anecdotal conclusions from this high-volume clinical practice, this article provides a detailed account of the inner workings of a multidisciplinary concussion clinic with a comprehensive approach to the management of sports-related concussions. A detailed description of the evaluation process and an in-depth analysis of targeted clinical pathways and subtypes of sports-related concussions effectively set the stage for a comprehensive understanding of the assessment, treatment, and rehabilitation model used in Pittsburgh today.
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