Aerobic Exercise for Adolescents With Prolonged Symptoms After Mild Traumatic Brain Injury: An Exploratory Randomized Clinical Trial

Abstract

Objective To describe the methodology and report primary outcomes of an exploratory randomized clinical trial (RCT) of aerobic training for management of prolonged symptoms after mild traumatic brain injury (mTBI) in adolescents. Setting Outpatient research setting Participants Thirty adolescents between the ages of 12 and 17 years who sustained a mTBI and had between four and 16 weeks of persistent symptoms. Design Partially blinded, pilot RCT of sub-symptom exacerbation aerobic training compared to a full-body stretching program. Main Measures The primary outcome was post injury symptom improvement assessed by the adolescent’s self-reported Post Concussion Symptom Inventory (PCSI) repeated for at least six weeks of the intervention. Parent-reported PCSI and adherence are also described. Results Twenty-two percent of eligible participants enrolled in the trial. Repeated measures Analysis of Variance via mixed model analysis demonstrated a significant group by time interaction with self-reported PCSI ratings, indicating a greater rate of improvement in the sub-symptom exacerbation aerobic training compared to the full-body stretching group (F-value = 4.11, p-value = .044). Adherence to the home exercise programs was lower in the sub-symptom exacerbation aerobic training compared to the full-body stretching group (mean (SD) times per week = 4.42 (1.95) versus 5.85 (1.37), p < .0001) over the duration of the study. Conclusion Findings from this exploratory randomized clinical trial suggest sub-symptom exacerbation aerobic training is potentially beneficial for adolescents with persistent symptoms after mTBI. These findings and other recent research support the potential benefit of active rehabilitation programs for adolescents with persistent symptoms after mTBI. Larger replication studies are needed to verify findings and improve generalizability. Future work should focus on determining the optimal type, timing, and intensity of active rehabilitation programs and characteristics of individuals most likely to benefit.

Rest and treatment/rehabilitation following sport-related concussion: a systematic review

“…Common methodological limitations included lack of a control group, lack of randomisation and lack of control for confounders. One RCT demonstrated positive effects with multimodal physiotherapy21 and two RCTs evaluated the effects of subsymptom threshold aerobic exercise training—one identifying a positive effect22 and the other found no difference with training 23. The other RCT evaluated collaborative care, including advocacy and coordination with schools regarding accommodations and motivational interviewing, cognitive–behavioural therapy (CBT) and psychopharmacological consultation 24.…”

“…Athletes in the submaximal exercise groups typically reported fewer symptoms, recovered to baseline on cognitive and balance scores faster, and in one study34 demonstrated more efficient activation patterns on functional Magnetic Resonance Imaging (fMRI) relative to matched controls. One RCT in adolescents demonstrated a positive treatment effect with subsymptom exacerbation aerobic training on symptom ratings; however, poorer adherence to exercise was reported in the aerobic training group compared with the stretching group 79. The other RCT demonstrated no difference between groups in time to recovery 80…”

Approach to investigation and treatment of persistent symptoms following sport-related concussion: a systematic review

“…One RCT,21 one quasi-experimental study,24 and three small case series16 17 23 demonstrated a reduction in symptoms, improvement in exercise tolerance and return to normal lifestyle and sport participation in patients treated with an individualised subsymptom threshold aerobic exercise programme.…”

Structural Connectivity Related to Persistent Symptoms After Mild TBI in Adolescents and Response to Aerobic Training: Preliminary Investigation

“…5 Structural connectivity analysis has emerged in recent years as a novel approach that quantifies brain connectivity based on the topological characteristics of the entire network. 6 With this approach, the brain network is modelled as a system comprised of functionally associated but spatially segregated grey matter regions integrated by white matter tracts that transfer information critical for the normal functioning of the network.…”