Context: Variables that may influence baseline concussion symptoms should be investigated.Objective: To evaluate the effect of physical fitness on selfreport of baseline concussion symptoms in collegiate athletes and students.Design: Controlled laboratory study. Patients or Other Participants: A total of 125 undergraduates, including 95 collegiate athletes and 30 recreational athletes (83 males, 42 females).Intervention(s): Participants completed the Standardized Concussion Assessment Tool 2 (SCAT2; symptom report) at baseline, within 10 minutes of completing the Leger test, and within 24 hours of the initial baseline test. The Leger (beep) test is a shuttle-run field test used to predict maximal aerobic power.Main Outcome Measure(s): The total symptom score on the SCAT2 was calculated and analyzed with a repeatedmeasures analysis of variance. A linear regression analysis was used to determine if 3 variables (sport type, sex, or fitness level) accounted for a significant amount of the variance in the baseline symptom report.Results: Participants reported more symptoms postactivity but fewer symptoms at 24 hours compared with baseline, representing a time effect in our model (F 2,234 ¼ 47.738, P , .001). No interactions were seen among the independent variables. We also found an effect for fitness level, with fitter individuals reporting fewer symptoms at all 3 time intervals. The regression analysis revealed that fitness level accounted for a significant amount of the variance in SCAT2 symptoms at baseline (R 2 ¼ 0.22, F 3,121 ¼ 11.44, P , .01). Conclusions: Fitness level affected the baseline concussion symptom report. Exercise seems to induce concussion symptom reporting, and symptom severity may be a function of an athlete's level of conditioning. Sports medicine professionals should consider an athlete's level of fitness when conducting baseline concussion symptom assessments.

Objective To investigate differences between baseline self-report of concussion symptoms with two commonly used concussion assessment tools. Design Retrospective, cross-sectional. Setting University of Alberta. Subjects One hundred and ninety-four varsity athletes (117 males; 77 females). Intervention Prior to the competitive season, subjects completed baseline testing, including self-report of concussion symptoms, with the Subjective Concussion Assessment Tool (SCAT2) and the on-line computerised Immediate Post-Concussion Assessment of Cognition (ImPACT) test, under supervision of an athletic therapist. Testing was counterbalanced to control for serial position effect. Outcome Measures The 18 shared self-report concussion symptoms were compared, and a general linear model used to identify possible interactions between gender and group type (SCAT2 vs ImPACT). Finally correlations were calculated. Results There was an interaction between gender and group type for 1 symptom (trouble falling asleep). Surprisingly, pairwise comparisons identified differences (p≤ 0.05) on 10/18 paired symptoms, with correlations ranging from 0.08 to 0.58. Conclusions Subjects respond differently when self-reporting concussion symptoms, depending on type of instrument used, and mode of administration. Despite test items being similar in content, there are significant differences in symptom reports in the same subject between SCAT2 and ImPACT tests. Use of similar data collection methods for baseline testing, assessment post-injury and prior to return-to-play is indicated, to increase both the diagnostic and prognostic utility of such tests. This further emphasises current recommendations that these tests not be used in isolation to make therapeutic decisions regarding athletes with concussion; and underscores the importance of serial clinical evaluations by a suitably qualified physician. Competing interests None. All authors have signed the disclosure form.

BackgroundThe diagnosis and management of concussion in sport rely heavily on self-report of symptoms by the athlete. However, many symptoms commonly reported after a concussion (headache, nausea, fatigue, etc.) may be infl uenced by other factors. Fatigue is a frequent complaint, but may actually be a function of level of physical fi tness. Objective To evaluate the role of physical fi tness on self-report of concussion symptoms in collegiate athletes and students, during baseline testing. Design Prospective repeated measures. Participants 125 subjects were recruited, including 95 collegiate athletes and 30 undergraduate students (83 males and 42 females). Athletes were screened for medical and psychological conditions. No athlete had a recent history of concussion. Intervention Subjects completed the Standardised Concussion Assessment Tool (SCAT1) at three time periods: prior to a Leger (Beep) test, within 10 min of test completion, and within 24 h. The Leger test has established validity and reliability to estimate an athlete's V02 maximum and overall fi tness levels. Main outcome measures Estimated V02 max (Leger test) and symptom scores on the SCAT1. Results Subjects were grouped into three levels of fi tness according to criteria established by the American College of Sports Medicine (2010). A 3×3 repeated-measures ANOVA was not signifi cant for the overall model but showed a signifi cant interaction between time and fi tness level (F (2, 121)=3.50, p=0.02). Post-hoc analysis revealed signifi cant differences in report of symptoms among the three fi tness groups at baseline and immediately post-activity, but not at 24 h. Conclusion Results provide evidence of a moderating effect of fi tness level on report of concussion symptoms at baseline, even in healthy adults. Specifi cally, exercise can induce symptom reporting, and may a function of an athlete's level of conditioning. Sport medicine professionals making decisions following concussion need to consider an athlete's level of fi tness when evaluating post-concussion symptoms.