Randomized Controlled Trial Evaluating Aerobic Training and Common Sport-Related Concussion Outcomes in Healthy Participants

Abstract

Context Aerobic exercise interventions are increasingly being prescribed for concussion rehabilitation, but whether aerobic training protocols influence clinical concussion diagnosis and management assessments is unknown. Objective To investigate the effects of a brief aerobic exercise intervention on clinical concussion outcomes in healthy, active participants. Design Randomized controlled clinical trial. Setting Laboratory. Patients or Other Participants Healthy (uninjured) participants (n = 40) who exercised ≥3 times/week. Intervention(s) Participants were randomized into the acute concussion therapy intervention (ACTIVE) training or nontraining group. All participants completed symptom, cognitive, balance, and vision assessments during 2 test sessions approximately 14 days apart. Participants randomized to ACTIVE training completed six 30-minute exercise sessions that progressed from 60% to 80% of individualized maximal oxygen consumption (V˙o2max) across test sessions, while the nontraining group received no intervention. Main Outcome Measure(s) The CNS Vital Signs standardized scores, Vestibular/Ocular Motor Screening near-point convergence distance (cm), and Graded Symptom Checklist, Balance Error Scoring System, and Standardized Assessment of Concussion total scores. Results An interaction effect was found for total symptom score (P = .01); the intervention group had improved symptom scores between sessions (session 1: 5.1 ± 5.8; session 2: 1.9 ± 3.6). Cognitive flexibility, executive functioning, reasoning, and total symptom score outcomes were better but composite memory, verbal memory, and near-point convergence distance scores were worse at the second session (all P values < .05). However, few changes exceeded the 80% reliable change indices calculated for this study, and effect sizes were generally small to negligible. Conclusions A brief aerobic training protocol had few meaningful effects on clinical concussion assessment in healthy participants, suggesting that current concussion-diagnostic and -assessment tools remain clinically stable in response to aerobic exercise training. This provides normative data for future researchers, who should further evaluate the effect of ACTIVE training on clinical outcomes among concussed populations. Trial Registration Number ClinicalTrials.gov: NCT02872480

Practical Management: A Standardized Aerobic Exercise Program for Adolescents With Concussion in the Absence of Graded Exercise Testing

“…The bulk of the evidence supports the use of controlled aerobic exercise to safely treat concussion, [2][3][4][5][6] but there is little evidence to indicate which mode of aerobic exercise is the most effective. Patients are allowed to use the form of aerobic exercise they prefer as long they adhere to the target HR prescription intensity.…”

“…3,4 Thus, a personalized exercise prescription for SRC treatment is derived ideally from the results of systematic graded exercise testing. [3][4][5][6] The target HR for the subsymptom threshold exercise training/treatment program is set at 90% of the HRt and is modified regularly (every few days to once a week) by retesting to establish a new HRt or by using clinical acumen to increase the target HR systematically according to the individual's level of exercise tolerance.…”

Review of clinical trials on the effectiveness of cognitive rehabilitation in patients with traumatic brain injury

“…On the other hand, there were techniques that have not shown effectiveness in this context. For example, the study by Teel et al (16) showed that aerobic training had no significant effect on the clinical assessment of sports-related concussions in healthy participants. In the case of Brandt et al (36) , goal management training (GMT) tailored for children was not shown to be more effective than a psychoeducational control in improving parent-reported executive function.…”

“…Intensive rehabilitation training combined with hyperbaric oxygen therapy improved functional disorders and prognosis in patients with traumatic brain injury 6 Teel et al (16) , 2018…”

“…Results not yet available 16 Séguin et al (26) The NeuroDRIVE intervention was associated with significant improvements in working memory and visual selective attention. No significant changes were observed in untrained cognitive areas, neurobehavioral symptoms, or driving skills 28 Cho et al (38) , 2018…”