Concurrent Validity of a Stationary Cycling Test and the Buffalo Concussion Treadmill Test in Adults With Concussion

Abstract

Context: Following concussion, a multi-faceted assessment is recommended, including tests of physical exertion. The current gold standard for exercise testing following concussion is the Buffalo Concussion Treadmill Test (BCTT); however, there is a lack of validated tests that utilize alternative exercise modalities. Objective: To assess the feasibility and concurrent validity of a novel cycling test of exertion compared to the BCTT. Design: Crossover Study Setting: University Sport-Medicine Clinic Patients: Twenty adults (aged 18–60 years) diagnosed with a Sport-Related Concussion Intervention: Participants completed the BCTT and a cycling test of exertion in a random order, approximately 48 hours apart. Main Outcome Measures: The primary outcome of interest was maximum heart rate [HRmax; beats per minute (bpm)]. Secondary outcomes of interest included whether the participant reached volitional fatigue (yes/no), symptom responsible for test cessation (Post Concussion Symptom Scale), and Symptom Severity on a Visual Scale (/10). Results: Of the 20 participants, 19 (10 male, 9 female) completed both tests. One participant did not return for the second test and was excluded from the analysis. No adverse events were reported. The median HRmax for the BCTT [171 bpm; (IQR: 139–184bpm)] was not significantly different than the median HRmax for the Cycle [173 bpm; (IQR: 160–182)] (z=–0.63, p=0.53). For both tests, the three most frequently reported symptoms responsible for test cessation were Headache, Dizziness, and Pressure in the head. Of interest, the majority of participants (64%) reported a different symptom responsible for test cessation on each test. Conclusion: The novel cycling test of exertion achieved similar HRmax and test duration and may be a suitable alternative to the BCTT. Future research to understand the physiological reason for the heterogeneity in symptoms responsible for test cessation is warranted.

Does oscillation size matter? Impact of added resistance on the cerebral pressure‐flow Relationship in females and males

“…Fourth, future research is warranted to understand how these findings of impaired autoregulation in females relate to the physiological underpinnings of various clinical populations (e.g., cerebrovascular accidents, concussion, etc.). For example, within the realm of concussion, aerobic treadmill and cycle tests (e.g., Buffalo Concussion Treadmill/Bike Test; Graham et al, 2021; Haider et al, 2019) have been developed to assess physiological recovery following concussion and the readiness to perform resistance‐based training exercises as recommended in stage four of the current return‐to‐play concussion guidelines (McCrory et al, 2017). The present methodology and findings may demonstrate a potential and feasible way to assess an individual's readiness to return to resistance training following concussion.…”

Correlation of a Graded Step-Test Protocol to the Buffalo Concussion Treadmill Test in Healthy Population

“…Because excessive aerobic activity can exacerbate post-concussive symptoms, future investigators testing the STP vs the BCTT in a patient population should consider performing the tests on separate days. Graham et al, 9 investigated the concurrent validity of a stationary cycling test compared to the BCTT in adults experiencing concussion and the tests were performed 48 hours apart so that the rst test would not affect performance on the second test.…”

“…The Buffalo Concussion Treadmill Test (BCTT) has been shown to help establish a safe level of exercise for people after a concussion. [7][8][9][10][11][12] The assessment involves the use of a treadmill and graded activity increases to exacerbate symptoms. The heart rate at which symptoms are exacerbated is then used to prescribe an aerobic exercise program for the patient.…”

Cerebral blood velocity during concurrent supine cycling, lower body negative pressure, and head-up tilt challenges: implications for concussion rehabilitation

“…This ultimately would limit their ability to obtain the positive physiological benefits of exercise (Lucas et A potential explanation for this could be the result of impaired autoregulatory capabilities and a disruption of the Monro-Kellie doctrine (Monro 1783, Wilson 2016. This would result in elevated intracranial pressure, greater pressure on the meninges, and may partially explain why previous reports have noted the common symptoms associated with physical exertion are headaches, pressure in the head, and dizziness (Graham et al 2021).…”

“…The brain is encapsulated by the skull, where the Monro-Kellie doctrine states the sum of brain parenchyma, cerebral spinal fluid, and cerebral blood flow (CBF) must remain constant to ensure intracranial pressure homeostasis (Monro 1783, Wilson 2016). However, following concussion, some individuals may experience an exacerbation of physiologically-based symptoms during physical exertion that is absent in healthy populations (Leddy et al 2007, O'Brien et al 2017, Graham et al 2021. This could potentially be attributed to deficits in autoregulatory and autonomic function, which could lead to a greater relative CBF increase during exercise, and further exacerbate these symptoms via the Monro-Kellie doctrine (Tan et al 2014).…”