The Role of Aerobic Exercise in Reducing Persistent Sport-related Concussion Symptoms

Howell, David R.; Taylor, J. Andrew; Tan, Can Ozan; Orr, Rhonda; Meehan, William P.

doi:10.1249/mss.0000000000001829

Cited by 33 publications

(32 citation statements)

References 34 publications

(67 reference statements)

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“…Sub-Threshold Exercise Program (STEP) (Intervention): Individuals randomized to the intervention were given a 6 week daily home aerobic exercise program. The exercise prescription for participants included specifications for frequency, duration, and intensity as recommended by Howell et al (34) Frequency was set at daily, with the understanding that youth might miss 1–2 days per week due to scheduling conflicts. Duration of exercise was started at 5–10 min per day greater than MVPA at baseline measured with accelerometry, and increased weekly by 5–10 minutes per/day via phone contact with the RA (for a goal of 60 min/day).…”

Section: Methodsmentioning

confidence: 99%

Pilot Randomized Controlled Trial of an Exercise Program Requiring Minimal In-person Visits for Youth With Persistent Sport-Related Concussion

et al. 2019

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Objective: To evaluate feasibility and acceptability of a sub-threshold exercise program with minimal in-person visits to treat youth with persistent sport-related concussion, and explore efficacy for improving concussive symptoms, health-related quality of life, and fear-avoidance. Study design: We conducted a pilot randomized controlled trial comparing a 6 week sub-threshold exercise program requiring only two in-person visits to active control (stretching) for 12–18 year old youth with persistent sport-related concussion. We measured moderate-to-vigorous physical activity pre- and post-intervention using accelerometry, and increased goals weekly via phone contact. We examined feasibility and acceptability using qualitative interviews. We used exponential regression to model differences in trajectory of concussive symptoms by experimental group, and linear regression to model differences in trajectory of health-related quality of life and fear-avoidance of pain by experimental group. Results: Thirty-two subjects randomized, 30 completed the study ( n = 11 control, n = 19 intervention), 57 % female. Youth and parents reported enjoying participating in the study and appreciated the structure and support, as well as the minimal in-person visits. Exponential regression modeling indicated that concussive symptoms declined more rapidly in intervention youth than control ( p = 0.02). Health-related quality of life and fear-avoidance of pain improved over time, but were not significantly different by group. Conclusions: This study indicates feasibility and potential benefit of a 6 week subthreshold exercise program with minimal in-person visits for youth with persistent concussion. Potential factors that may play a role in improvement such as fear-avoidance deserve further study.

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Section: Methodsmentioning

confidence: 99%

Pilot Randomized Controlled Trial of an Exercise Program Requiring Minimal In-person Visits for Youth With Persistent Sport-Related Concussion

et al. 2019

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“…This is somewhat surprising given the known benefits of regular exercise and aerobic fitness for overall health 4,22 and among individuals with concussion. 6,11 While short-term concussion symptoms may resolve even without exercise, aerobic exercise may have a sizable effect on persistent postconcussion symptoms. 29 The focus on short-term (14-21 days) follow-up may be the culprit underlying the apparent lack of effect demonstrated in existing clinical trial reports.…”

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confidence: 99%

Influence of Aerobic Exercise Volume on Postconcussion Symptoms

et al. 2021

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Background: Aerobic exercise has emerged as a useful treatment to improve outcomes among individuals who experience a concussion. However, compliance with exercise recommendations and the effect of exercise volume on symptom recovery require further investigation. Purpose: To examine (1) if an 8-week aerobic exercise prescription, provided within 2 weeks of concussion, affects symptom severity or exercise volume; (2) whether prescription adherence, rather than randomized group assignment, reflects the actual effect of aerobic exercise in postconcussion recovery; and (3) the optimal volume of exercise associated with symptom resolution after 1 month of study. Study Design: Cohort study; Level of evidence, 2. Methods: Individuals randomized to an exercise intervention (n = 17; mean age, 17.2 ± 2.0 years; 41% female; initially tested a mean of 11.3 ± 2.8 days after injury) or standard of care (n = 20; mean age, 16.8 ± 2.2 years; 50% female; initially tested a mean of 10.7 ± 3.2 days after injury) completed an aerobic exercise test within 14 days of injury. They returned for assessments 1 month and 2 months after the initial visit. The aerobic exercise group was instructed to exercise 5 d/wk, 20 min/d (100 min/wk), at a target heart rate based on an exercise test at the initial visit. Participants reported their exercise volume each week over the 8-week study period and reported symptoms at each study visit (initial, 1 month, 2 months). Because of low compliance in both groups, there was no difference in the volume of exercise between the 2 groups. Results: There were no significant symptom severity differences between the intervention and standard-of-care groups at the initial (median Post-Concussion Symptom Inventory, 15 [interquartile range = 10, 42] vs 20 [11, 35.5]; P = .26), 1-month (4 [0, 28] vs 5.5 [0.5, 21.5]; P = .96), or 2-month (6.5 [0, 27.5] vs 0 [0, 4]; P = .11) study visits. Exercise volume was similar between groups (median, 115 [54, 225] vs 88 [28, 230] min/wk for exercise intervention vs standard of care; P = .52). Regardless of group, those who exercised <100 min/wk reported significantly higher symptom severity at the 1-month evaluation compared with those who exercised ≥100 min/wk (median, 1.5 [0, 7.5] vs 12 [4, 28]; P = .03). Exercising ≥160 min/wk successfully discriminated between those with and those without symptoms 1 month after study commencement (classification accuracy, 81%; sensitivity, 90%; specificity, 78%). Conclusion: Greater exercise volume was associated with lower symptom burden after 1 month of study, and an exercise volume >160 min/wk in the first month of the study was the threshold associated with symptom resolution after the first month of the study. Because our observation on the association between exercise volume and symptom level is a retrospective and secondary outcome, it is possible that participants who were feeling better were more likely to exercise more, rather than the exercise itself driving the reduction in symptom severity.

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“…However, there is limited empirical evidence to support such a position, especially related to introducing light physical activity for acute recovery or prevention of long-term impact. 3,12,36,63,65,[75][76][77][78] It must also be noted that during the acute recovery from head impacts, the focus of treatment should be on returning normal hydration within the tissues to minimize the compounding effects of the inflammatory biomarkers triggered by dehydration. The focus on rehydration will also provide mechanisms to clear the neurofilament fragments before they are able to form tangles and the tau or amyloid plaques.…”

Section: Implications For Acute Recovery and Long-term Preventionmentioning

confidence: 99%

“…Athletes who are active and hydrated appear to improve earlier in overall function and have a reduced recovery time due to earlier resolution of inflammatory signals acutely which may also reduce the long-term functional loss associated with concussive injuries. 42,74,76,78,79 One investigation 77 has directly shown that the level of fitness directly relates with the symptoms shown by an athlete following concussive injuries. While at the same time, other studies have both indicated that increased activity is safe and may assist in recovery from concussions.…”

Section: Implications For Acute Recovery and Long-term Preventionmentioning

confidence: 99%

“…While at the same time, other studies have both indicated that increased activity is safe and may assist in recovery from concussions. 74,76,79 Factors that must be remembered in the development of fitness regimens meant to improve athletic prowess. As the training regimens may create athletes (especially those that are larger or participate in weight-class sports) that are unable to offset any degree of fluid shift that occurs during play.…”

Section: Implications For Acute Recovery and Long-term Preventionmentioning

confidence: 99%

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The possible role of hydration in concussions and long-term symptoms of concussion for athletes. A review of the evidence

Clark¹,

Sirois²

2020

Journal of Concussion

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The purpose of this review is to address what is known, speculated, and hypothesized regarding the issue of hydration and concussions. Based on the question, “What impact does hydration have on the relative risk for suffering concussive injuries along with long-term ramifications that have been associated with concussive (and repeated subconcussive) traumas to the cerebral cortex?,” a search of available literature was performed through June 2019. Deducing from the available literature, we can stipulate that changes in hydration within the cerebral cortex increase the likelihood for disruption of neurofilament proteins, dysregulation of membrane dynamics of the neurons and exacerbate inflammation responses following head trauma. As such, it can be speculated that differences in incidence rates may be attributed to difference in tissue fluid based on athlete demographics, level of whole-body water balance, and degree of tissue dehydration more than selection of sport. Moreover, tissue hydration in combination with other inflammation factors provides the scaffolding for the development of long-term issues (e.g. chronic traumatic encephalopathy) associated with repetitive head trauma in athletes.

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The Role of Aerobic Exercise in Reducing Persistent Sport-related Concussion Symptoms

Cited by 33 publications

References 34 publications

Pilot Randomized Controlled Trial of an Exercise Program Requiring Minimal In-person Visits for Youth With Persistent Sport-Related Concussion

Pilot Randomized Controlled Trial of an Exercise Program Requiring Minimal In-person Visits for Youth With Persistent Sport-Related Concussion

Influence of Aerobic Exercise Volume on Postconcussion Symptoms

The possible role of hydration in concussions and long-term symptoms of concussion for athletes. A review of the evidence

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