Efficacy of aerobic exercise following concussion: a narrative review

Cordingley, Dean M.; Cornish, Stephen M.

doi:10.1139/apnm-2022-0139

Cited by 7 publications

(4 citation statements)

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“…Though historically, concussed athletes were restricted from activities until symptoms resolved based on the international consensus recommendations, new research has shown light exercise is safe and improves symptom outcomes [ 1 , 27 ], and thus standardized rehabilitation plans have become personalized to include light activity. At this university, light activity included low-intensity and no-resistance cycling.…”

Section: Discussionmentioning

confidence: 99%

Differences in Volatile Organic Compounds Between Concussed and Non-concussed Division I Athletes

Abadie,

McKeag,

Springer

et al. 2024

Cureus

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IntroductionDiagnosing a concussion is challenging because of complex and variable symptoms. Establishing a viable biomarker of injury may rely on physiologic measurements rather than symptomology. Volatile organic compounds (VOCs) such as breath acetone have been identified as potential physiological markers that can capture changes in the utilization of energy substrates post-concussion. Here, we aimed to explore whether differences in VOCs exist between concussed and non-concussed athletes at the initial and later stages of injury recovery. MethodsSix (N=6) non-concussed athletes were enrolled as control participants prior to the competitive season. Control participants' breath acetone, heart rate, and anthropometric measures were obtained at rest and throughout a single exercise challenge by breathalyzer. Six (N=6) athletes diagnosed with concussion during the competitive season had breath acetone measured daily until cleared to return to activity or approximately four weeks following enrollment where they participated in an exit exercise challenge having breath acetone, heart rate, and anthropometric measures obtained. Comparisons were made between at-rest measures of concussed and non-concussed participants at multiple time points during the recovery period. Paired t-test comparisons with individuals serving as their own control were used to determine individual differences in recovery. Visual graphs were used to demonstrate differences in obtained measures amongst individuals and between groups during the exercise challenges. ResultsResults demonstrated statistically significant differences in breath acetone between concussed and control participants when the highest day measured during the first week of concussion was compared to the control participant's resting values (P=0.017). Additionally, when the concussed participants served as their own control and their highest measured day of the first week post-concussion was compared to values when cleared to return to activity or at 26 days post-concussion, there was a significant difference in breath acetone (P=0.028). Comparing breath acetone during exercise between non-concussed and cleared concussed participants or four weeks post-injury, demonstrated no significant differences throughout the challenge or at rest prior. Visual graph comparisons in a single participant before and after concussion suggest differences may appear following exercise during the recovery period. DiscussionThese results suggest VOCs, particularly breath acetone, have the potential to serve as diagnostic markers of concussion. However, longitudinal research within larger cohorts and with equipment able to expel VOCs other than acetone from measures are needed to make informed recommendations.

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Section: Discussionmentioning

confidence: 99%

Differences in Volatile Organic Compounds Between Concussed and Non-concussed Division I Athletes

Abadie,

McKeag,

Springer

et al. 2024

Cureus

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“…Early engagement in physical activity has been associated with reduced symptom burden at 2 weeks postinjury, faster recovery, and a lower risk of developing PSAC. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] However, the optimal volume of daily physical activity for achieving recovery in the general pediatric population remains unclear. 14 The reference standard protocol for identifying the optimal intensity of physical activity postconcussion is the Buffalo Concussion Treadmill Test.…”

Section: Introductionmentioning

confidence: 99%

“…PSAC significantly impairs daily activities and quality of life, underscoring the urgent need to generate and refine best evidence management protocols. Early engagement in physical activity has been associated with reduced symptom burden at 2 weeks postinjury, faster recovery, and a lower risk of developing PSAC . However, the optimal volume of daily physical activity for achieving recovery in the general pediatric population remains unclear …”

Section: Introductionmentioning

confidence: 99%

“…Early engagement in physical activity has been associated with reduced symptom burden at 2 weeks postinjury, faster recovery, and a lower risk of developing PSAC. 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 However, the optimal volume of daily physical activity for achieving recovery in the general pediatric population remains unclear. 14 …”

Section: Introductionmentioning

confidence: 99%

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Optimal Volume of Moderate-to-Vigorous Physical Activity Postconcussion in Children and Adolescents

Ledoux,

Sicard,

Bijelić

et al. 2024

JAMA Netw Open

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ImportanceDetermining the optimal volume of early moderate-to-vigorous-intensity physical activity (MVPA) after concussion and its association with subsequent symptom burden is important for early postinjury management recommendations.ObjectivesTo investigate the association between cumulative MVPA (cMVPA) over 2 weeks and subsequent symptom burden at 1 week, 2 weeks, and 4 weeks postinjury in children and examine the association between cMVPA and odds of persisting symptoms after concussion (PSAC) at 2 weeks and 4 weeks postinjury.Design, Setting, and ParticipantsThis multicenter cohort study used data from a randomized clinical trial that was conducted from March 2017 to December 2019 at 3 Canadian pediatric emergency departments in participants aged 10.00 to 17.99 years with acute concussion of less than 48 hours. Data were analyzed from July 2022 to December 2023.ExposurecMVPA postinjury was measured with accelerometers worn on the waist for 24 hours per day for 13 days postinjury, with measurements deemed valid if participants had 4 or more days of accelerometer data and 3 or fewer consecutive days of missing data. cMVPA at 1 week and 2 weeks postinjury was defined as cMVPA for 7 days and 13 days postinjury, respectively. Multiple imputations were carried out on missing MVPA days.Main Outcomes and measuresSelf-reported postconcussion symptom burden at 1 week, 2 weeks, and 4 weeks postinjury using the Health and Behavior Inventory (HBI). PSAC was defined as reliable change on the HBI. A linear mixed-effect model was used for symptom burden at 1 week, 2 weeks, and 4 weeks postinjury with a time × cMVPA interaction. Logistic regressions assessed the association between cMVPA and PSAC. All models were adjusted for prognostically important variables.ResultsIn this study, 267 of 456 children (119 [44.6%] female; median [IQR] age, 12.9 [11.5 to 14.4] years) were included in the analysis. Participants with greater cMVPA had significantly lower HBI scores at 1 week (75th percentile [258.5 minutes] vs 25th percentile [90.0 minutes]; difference, −5.45 [95% CI, −7.67 to −3.24]) and 2 weeks postinjury (75th percentile [565.0 minutes] vs 25th percentile [237.0 minutes]; difference, −2.85 [95% CI, −4.74 to −0.97]) but not at 4 weeks postinjury (75th percentile [565.0 minutes] vs 25th percentile [237.0 minutes]; difference, −1.24 [95% CI, −3.13 to 0.64]) (P = .20). Symptom burden was not lower beyond the 75th percentile for cMVPA at 1 week or 2 weeks postinjury (1 week, 259 minutes; 2 weeks, 565 minutes) of cMVPA. The odds ratio for the association between 75th and 25th percentile of cMVPA and PSAC was 0.48 (95% CI, 0.24 to 0.94) at 2 weeks.Conclusions and RelevanceIn children and adolescents with acute concussion, 259 minutes of cMVPA during the first week postinjury and 565 minutes of cMVPA during the second week postinjury were associated with lower symptom burden at 1 week and 2 weeks postinjury. At 2 weeks postinjury, higher cMVPA volume was associated with 48% reduced odds of PSAC compared with lower cMVPA volume.

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