Quantifying Activity Levels After Sport-Related Concussion Using Actigraph and Mobile (mHealth) Technologies

Abstract

Context Interest in identifying the effects of physical and mental activity on recovery after sport-related concussion is growing. Clinical studies of concussed athletes' activities require well-validated methods for tracking their intensity and timing. Objective To develop and validate a novel multimodal approach to monitoring activity postconcussion using mobile (mHealth) technologies. Design Cohort study. Setting Translational research unit. Patients or Other Participants A total of 40 high school and collegiate football players were evaluated at preseason and followed longitudinally after either concussion (n = 25; age = 17.88 ± 1.74 years, height = 182.07 ± 8.08 cm, mass = 98.36 ± 21.70 kg) or selection as a nonconcussed control (n = 15; age = 18.27 ± 1.83 years, height = 180.01 ± 7.19 cm, mass = 93.83 ± 24.56 kg). Main Outcome Measure(s) Participants wore a commercial actigraph and completed a daily mobile survey for 2 weeks. Analyses focused on comparisons between groups for actigraph-based physical activity and self-reported physical and mental activity during the follow-up period. Results For the first 2 days postinjury, objective measures showed fewer daily steps in concussed (6663 ± 2667 steps) than in control (11 148 ± 3381 steps) athletes (P < .001), and both objective and self-reported measures indicated less moderate to vigorous physical activity in concussed (27.6 ± 32.6 min/d and 25.0 ± 43.6 min/d, respectively) than in control (57.3 ± 38.6 min/d and 67.5 ± 40.1 min/d, respectively) athletes (both P values < .05). Correlations between objective and self-reported measures of moderate to vigorous physical activity were moderate across select 1-week and 2-week averages. We observed no group differences in self-reported mental activities. Conclusions Physical activity after sport-related concussion varied widely across athletes but on average was reduced during the acute and early subacute postinjury periods for both objective and self-reported measures. The lack of differences in mental activities between groups may reflect limited change in mental exertion postconcussion or difficulty accurately measuring mental activities. Assessing concussed athletes' activities using actigraphy and self-reported scales may help monitor their compliance with activity recommendations and be useful in studies aimed at better understanding the effects of physical activity on concussion recovery.

More Physical Activity after Concussion Is Associated with Faster Return to Play among Adolescents

“…A time period of two weeks was selected as the participants were most compliant in wearing the device in the first two weeks after the initial assessment. Additionally, this time period is consistent with another study in a similar population [ 23 ]. We then used a Receiver Operating Characteristic (ROC) and Area under the Curve (AUC) analysis to identify different cutpoint thresholds to distinguish between groups for each exercise/activity variable.…”

“…The median step count per day over the two-week period was 10,893 for those who received clearance <28 days and 7571 for those who took ≥28 days to receive RTP clearance. Interestingly, the values obtained for those who took ≥28 days to receive RTP clearance are similar to a past study, where researchers observed an average count of approximately 6600 steps/day in the days following a concussion [23]. Furthermore, a systematic review reported normative values among boys and girls to range on average 12,000 to 16,000 steps/day and 10,000 to 13,000 steps/day, respectively [25].…”

Relationship between Sport-Related Concussion and Sleep Based on Self-Report and Commercial Actigraph Measurement

“…For this sleep-monitoring sub-study, participants were given a commercially available actigraph (CA) and a mobile application developed for the purpose of this study. 13 Previous literature has reported high concordance between data recorded by the Fitbit Charge HR and clinical actigraphs in young adults and adolescents. 14,15 The general methodology for this study and the mobile application development has also been described (focused on physical activity metrics) in a prior publication.…”

“…14,15 The general methodology for this study and the mobile application development has also been described (focused on physical activity metrics) in a prior publication. 13 Participants were asked to wear the actigraph as often as possible (day and night) for 2 weeks to provide daily sleep and activity metrics. The mobile survey (MS), delivered nightly, asked about total amount of sleep and total time spent in bed the night before.…”

Comparison of Night, Day and 24 h Motor Activity Data for the Classification of Depressive Episodes

“…The motor activity corresponds to a weighting voltage collected with an actigraph watch (Actiwatch, Cambridge Neurotechnology Ltd., England, model AW4) located in the right wrist, which records movements over 0.5g in a sampling frequency of 32 Hz. Some advantages of actigraphs accelerometers is that they are inexpensive and well-known activity trackers [19] and, in addition, they are easy to wear and allow collecting data from day and night [20].…”