A Physiologically Based Approach to Prescribing Exercise Following a Sport-Related Concussion

Worts, Phillip R.; Burkhart, Scott O.; Kim, Jeong‐Su

doi:10.1007/s40279-019-01065-1

Cited by 18 publications

(14 citation statements)

References 127 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The initial aerobic prescription (10 minutes, PCERT level 4) is based on the time to symptom exacerbation reported by Gagnon et al [ 28 ] and Dobney et al [ 26 ] among youth initiating active rehabilitation. This prescription is consistent with other study protocols [ 31 , 107 ], as well as recommendations from literature reviews and clinical guidelines for exercise after concussion [ 108 , 109 ]. Previous studies demonstrate the utility of perceived exertion as a method for prescribing exercise to youth with concussion [ 32 , 110 ].…”

Section: Resultssupporting

confidence: 85%

Tele-Active Rehabilitation for Youth With Concussion: Evidence-Based and Theory-Informed Intervention Development

Shore¹,

Nalder²,

Hutchison³

et al. 2022

JMIR Pediatr Parent

View full text Add to dashboard Cite

Background Active rehabilitation involving subsymptom threshold exercise combined with education and support promotes recovery in youth with concussion but is typically delivered in person, which may limit accessibility for families because of a lack of services in their communities or logistical challenges to attending in-person sessions. Objective This paper describes the evidence-based and theory-informed development of the Tele-Active Rehabilitation (Tele-AR) intervention for pediatric concussion, which was specifically designed for remote service delivery. Methods The intervention was designed by clinician-researchers with experience in pediatric concussion rehabilitation following the Medical Research Council guidance for developing complex interventions. Development involved a critical review of the literature to identify existing evidence, the expansion of the theoretical basis for active rehabilitation, and the modeling of the intervention process and outcomes. Results Tele-AR is a 6-week home exercise and education and support program facilitated through weekly videoconferencing appointments with a clinician. Exercise consists of low- to moderate-intensity subsymptom threshold aerobic activity and coordination drills that are individualized to participant needs and interests (prescribed for 3 days per week). Education includes the evidence-supported Concussion & You self-management program, which covers topics related to energy management, nutrition, hydration, sleep hygiene, and return to activity. Elements of self-determination theory are incorporated to support motivation and engagement. We present a logic model describing predicted intervention effects using a biopsychosocial conceptualization of outcomes after concussion. Conclusions The Tele-AR intervention may help to increase access to care that improves recovery and promotes a timely return to activity in youth with concussion. Future research is needed to evaluate the feasibility and efficacy of this approach.

show abstract

Section: Resultssupporting

confidence: 85%

Tele-Active Rehabilitation for Youth With Concussion: Evidence-Based and Theory-Informed Intervention Development

Shore¹,

Nalder²,

Hutchison³

et al. 2022

JMIR Pediatr Parent

View full text Add to dashboard Cite

show abstract

“…After a progressive exertion regimen and recovery period, it is plausible that high-intensity (HR %max : 75%-95%) exertion may provoke symptoms in athletes associated with unresolved SRC and help to inform clinical decision-making. However, it is important to note that these exercise intensities could be detrimental acutely after SRC because of the ongoing neurometabolic cascade 42 and would therefore not be recommended during that time. These findings support the integration of evidence-based exertion prescription recommendations into clinical research.…”

Section: Discussionmentioning

confidence: 99%

The Role of Age, Sex, Body Mass Index, and Sport Type on the Dynamic Exertion Test in Healthy Athletes: A Cross-Sectional Study

Sinnott

Eagle

Kochick

et al. 2022

Clinical Journal of Sport Medicine

View full text Add to dashboard Cite

show abstract

“…The primary objective of concussion testing is to characterise the physiologic response of the injured athlete. The effects of moderate-to-high intensity exercise on physiological function in the concussed state are unknown (Worts et al, 2019), and therefore we explored whether such exercise intensity could be safely maintained for a short duration (increments of 5-min workloads). To our knowledge this is the first study to systematically evaluate the physiological effects of repeated exercise tests using mild-to-intense exercise intensity (HR∼ 110-170 bpm) performed within 2-days (D2) after the medical diagnosis of sport-related concussion in high-performance athletes.…”

Section: Basis Of Physiological Concussion Testingmentioning

confidence: 99%

“…These laboratory testing protocols have been designed with the intent to differentiate the type of concussion injury (i.e., physiologic, vestibulo-occular, cervicogenic;Ellis et al, 2014Ellis et al, , 2015Leddy et al, 2016a), and to discern the physiological mechanisms (cerebral autoregulation, cerebrovascular reactivity, neurovascular coupling; Ellis et al, 2015Ellis et al, , 2016Ellis et al, , 2018Neary et al, 2019). This research has added to our understanding of the pathophysiological changes that occur following a concussion (Len et al, 2011(Len et al, , 2013Giza and Hovda, 2014;Bishop and Neary, 2017;Bishop et al, 2017b;Worts et al, 2019), and has also provided a greater understanding of how we can apply exercise safely as a treatment strategy. Thus, it appears that evidence supports the therapeutic benefits of mildto-moderate intensity physical exercise (Kozlowski, 2014;Hinds et al, 2016;Leddy et al, 2016aLeddy et al, ,b, 2018 and that prolonged rest may be detrimental during acute recovery post-concussion Thomas et al, 2015;Buckley et al, 2016;Wells et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

“…Because there is mounting research focused on both physiologic changes and the importance of exercise post-concussion (Worts et al, 2019), the focus of our research was to monitor the pathophysiological changes in athletes prospectively in the days following sport-related concussion in response to acute incremental aerobic exercise. It was hypothesised that exercise could be used safely to assess the physiological status of the concussed athlete and that there would be differences in the cerebral hemodynamic response between healthy control vs. mTBI subjects.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pre-frontal Cortex Oxygenation Changes During Aerobic Exercise in Elite Athletes Experiencing Sport-Related Concussion

Neary

Dudé

Singh

et al. 2020

Front. Hum. Neurosci.

View full text Add to dashboard Cite

Aims: Recent research suggests that aerobic exercise can be performed safely within the first week following a concussion injury and that early initiation of exercise may speed recovery. To better understand the physiological changes during a concussion, we tested the hypothesis that mild-to-intense exercise testing can be performed within days immediately following injury, and can be used to discern differences between the concussed and normal healthy state. Thus, the purpose was to observe the cerebral hemodynamic responses to incremental exercise testing performed acutely post-concussion in high-performance athletes.Methods: This study was a within-and between-experimental design, with seven male university ice hockey teams participating. A subgroup of five players acted as control subjects (CON) and was tested at the same time as the 14 concussed (mTBI) players on Day 2, 4, and 7 post-concussion. A 5-min resting baseline and 5-min exercise bouts of mild (EX1), moderate (EX2), and high (EX3) intensity exercise were performed on a cycle ergometer. Near-infrared spectroscopy was used to monitor pre-frontal cortex oxy-haemoglobin (HbO 2 ), deoxy-haemoglobin (HHb), and total blood volume (tHb) changes.Results: ANOVA compared differences between testing days and groups, and although large percentage changes in HbO 2 (20-30%), HHb (30-40%), and tHb (30-40%) were recorded, no significant (p ≤ 0.05) differences in cerebral hemodynamics occurred between mTBI vs. CON during aerobic exercise testing on any day post-injury. Furthermore, there was a linear relationship between exercise intensity vs. cerebral hemodynamics during testing for each day (r 2 = 0.83-0.99). Conclusion:These results demonstrate two novel findings: (1) mild-to-intense aerobic exercise testing can be performed safely as early as Day 2 post-concussion injury in a controlled laboratory environment; and (2) evidence-based objective measures such as Frontiers in Human Neuroscience | www.frontiersin.org 1 February 2020 | Volume 14 | Article 35 Neary et al. Exercise Testing During Acute Concussion cerebral hemodynamics can easily be collected using near-infrared spectroscopy (NIRS) to monitor physiological changes during the first-week post-injury. This research has important implications for monitoring physiological recovery post-injury and establishing new rehabilitation guidelines.

show abstract

A Physiologically Based Approach to Prescribing Exercise Following a Sport-Related Concussion

Cited by 18 publications

References 127 publications

Tele-Active Rehabilitation for Youth With Concussion: Evidence-Based and Theory-Informed Intervention Development

Tele-Active Rehabilitation for Youth With Concussion: Evidence-Based and Theory-Informed Intervention Development

The Role of Age, Sex, Body Mass Index, and Sport Type on the Dynamic Exertion Test in Healthy Athletes: A Cross-Sectional Study

Pre-frontal Cortex Oxygenation Changes During Aerobic Exercise in Elite Athletes Experiencing Sport-Related Concussion

Contact Info

Product

Resources

About