The Effect of Pretest Exercise on Baseline Computerized Neurocognitive Test Scores

Abstract

Background:Baseline neurocognitive assessment plays a critical role in return-to-play decision making following sport-related concussions. Prior studies have assessed the effect of a variety of modifying factors on neurocognitive baseline test scores. However, relatively little investigation has been conducted regarding the effect of pretest exercise on baseline testing.Purpose/Hypothesis:The aim of our investigation was to determine the effect of pretest exercise on baseline Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) scores in adolescent and young adult athletes. We hypothesized that athletes undergoing self-reported strenuous exercise within 3 hours of baseline testing would perform more poorly on neurocognitive metrics and would report a greater number of symptoms than those who had not completed such exercise.Study Design:Cross-sectional study; Level of evidence, 3.Methods:The ImPACT records of 18,245 adolescent and young adult athletes were retrospectively analyzed. After application of inclusion and exclusion criteria, participants were dichotomized into groups based on a positive (n = 664) or negative (n = 6609) self-reported history of strenuous exercise within 3 hours of the baseline test. Participants with a positive history of exercise were then randomly matched, based on age, sex, education level, concussion history, and hours of sleep prior to testing, on a 1:2 basis with individuals who had reported no pretest exercise. The baseline ImPACT composite scores of the 2 groups were then compared.Results:Significant differences were observed for the ImPACT composite scores of verbal memory, visual memory, reaction time, and impulse control as well as for the total symptom score. No significant between-group difference was detected for the visual motor composite score. Furthermore, pretest exercise was associated with a significant increase in the overall frequency of invalid test results.Conclusion:Our results suggest a statistically significant difference in ImPACT composite scores between individuals who report strenuous exercise prior to baseline testing compared with those who do not. Since return-to-play decision making often involves documentation of return to neurocognitive baseline, the baseline test scores must be valid and accurate. As a result, we recommend standardization of baseline testing such that no strenuous exercise takes place 3 hours prior to test administration.

Effects of exercise on symptoms, vestibular/ocular motor screening and postural stability in a college-aged sample

“…Covassin et al [7] reported that verbal memory neurocognitive scores worsened following maximal exercise, but there were no differences on composite scores of visual memory, motor processing speed or reaction time. Retrospectively, pretest exercise on baseline neurocognitive measures yielded similar results with worse verbal and visual memory, reaction time and a greater prevalence of invalid tests [8].…”

Neurocognitive and Quality of Life Improvements Associated With Aerobic Training for Individuals With Persistent Symptoms After Mild Traumatic Brain Injury: Secondary Outcome Analysis of a Pilot Randomized Clinical Trial

“…Another study demonstrated that strenuous exercise protocols are associated with improved post-concussive symptoms; however, neurocognitive recovery declined from day 2 to day 10 after initiation of the protocol (13). Studies in healthy children, adolescents and adults have shown that strenuous activity immediately to up to 3 h before testing can negatively affect cognitive assessment (34, 35). However, in other healthy and neurologic populations, high-intensity exercise seems to have a greater impact on brain plasticity and brain health (36–44).…”

Concussion Baseline Retesting Is Necessary When Initial Scores Are Low

“…Participants were also not permitted to test if they had exercised within 3 hours of their testing session. 30 Test administration was altered for a few tests to improve accuracy. The average time to complete the coordination task was used because all participants were able to achieve this task in ,4 seconds.…”