Postconcussion Exercise Volume Associations With Depression, Anxiety, and Dizziness Symptoms, and Postural Stability: Preliminary Findings

Abstract

Objective: To examine the association between postconcussion exercise volume and changes in depression, anxiety, dizziness, and postural stability. Design: Secondary analysis of a single-site prospective clinical trial. Setting: Cerebrovascular research laboratory. Participants: Participants completed questionnaires and underwent tests of gait and balance within 2 weeks of a concussion (mean = 11 ± 3 days postconcussion) and approximately 1 month later (mean = 41 ± 7 days postconcussion). Exercise volume was tracked by weekly exercise logs. Interventions: On the basis of a previous work classifying exercise volume following concussion, we grouped participants according to self-reported exercise volume between visits as high exercise volume (≥150 min/wk) or low exercise volume (<150 min/wk). Main Outcome Measures: Participants completed assessments evaluating anxiety and depression (Hospital Anxiety and Depression Scale), dizziness (Dizziness Handicap Inventory), and postural stability (tandem gait and modified Balance Error Scoring System). Results: Thirty-eight participants completed the study, of which 22 were in the high exercise volume group (mean = 71 ± 40 min/wk; 16.8 ± 2.1 years; 59% female) and 16 were in the low exercise volume group (mean = 379 ± 187 min/wk; 17.5 ± 2.1 years; 31% female). Although depression symptoms were not significantly different initially (mean difference = 1.5; 95% CI, −0.68 to 3.68; P = .24), the high exercise volume group had significantly lower depression symptom scores at follow-up (mean difference = 3.0; 95% CI, 1.40 to 4.47; P < .001). Anxiety symptoms (mean difference = 2.8; 95% CI, 0.3 to 5.4; P = 0.03), dizziness symptoms (mean difference = 10.9; 95% CI, 0.2 to 21.5; P = .047), single-task tandem gait (mean difference = 3.1 seconds; 95% CI, 0.2 to 6.0; P = .04), and dual-task tandem gait (mean difference = 4.2 seconds; 95% CI, 0.2 to 8.2; P = .04) were significantly better among the high exercise volume group. Conclusion: Greater exercise volumes were associated with lower depression, anxiety, and dizziness symptoms, and faster tandem gait performance. These preliminary findings suggest a potentially beneficial role for exercise within several different domains commonly affected by concussion.

Factors Associated with Symptom Resolution after Aerobic Exercise Intervention in Adolescent and Young Adults with Concussion

“…Aerobic exercise intervention. Consistent with previous research (4,7,23), participants were instructed to exercise 100 min•wk −1 at a heart rate of 80% of their symptom threshold for 4 wk after the initial research assessment. The exercise prescription was performed at home, using self-selected modalities and without guidance or supervision from the study team.…”

“…oncussion is a substantial health concern for adolescent and young adult athletes and nonathletes alike (1). Although universally effective treatments for concussion remain elusive, aerobic exercise has emerged in the last decade as a beneficial rehabilitative approach to reducing postconcussion symptoms and other comorbidities among groups of individuals who are recovering from a concussion (2)(3)(4). Adolescents engaging in early postconcussion aerobic exercise demonstrate faster time to symptom resolution than those adhering to strict rest (5), placebo-like control (6), or standard-of-care instructions (7).…”

Dose-Response Effect of Mental Health Diagnoses on Concussion Recovery in Children and Adolescents

“…The median days for concussion recovery varied by preinjury mental health diagnosis (Table 2). In days to recovery, those with anxiety (32, IQR [17, 73.5] vs 26, IQR [13,56]; P < 0.01), learning disabilities (33.5, IQR [15,81] vs 26, IQR [13,56]; P < 0.01), depression (34, IQR [18,72] vs 26, IQR [13,57]; P < 0.01), and disordered eating (44.5, IQR [21,91] vs 27, IQR [14,58]; P < 0.05) all took significantly longer to recover than pediatric patients without those diagnoses. In addition, children and adolescents with any pre-existing mental health diagnosis generally took longer to recover, with a dose-effect response emerging.…”

“… 20 , 21 As a potential active intervention, exercise may be particularly important for those with pre-existing mental health diagnoses where it has been demonstrated to ameliorate depression, anxiety, and dizziness symptoms in general, as well as after concussion. 15 , 18 It is unknown, however, when pediatric patients with emotional symptoms or pre-existing mental health diagnoses return to exercise after concussion. Identifying and addressing these modifiable risk factors for PPCS represents an important opportunity for improving outcomes for children and adolescents with concussion.…”

Postconcussion Dizziness Severity Predicts Daily Step Count during Recovery among Adolescent Athletes

“…Initiating physical activity within 1 d after injury was associated with faster return to work or school, and progressively worse outcomes were observed with each day that physical activity reintegration was delayed (11). Other recent work observed individuals engaging in exercise for 150 min·wk −1 have lower ratings of dizziness and improved postural stability after concussion compared with those exercising for less than 150 min·wk −1 (12). This evidence collectively supports the benefits of physical activity in promoting concussion recovery and a shift away from rest toward active rehabilitation (13).…”