Return to Full Functioning after Graded Exercise Assessment and Progressive Exercise Treatment of Postconcussion Syndrome

Abstract

Exercise assessment and aerobic exercise training for postconcussion syndrome (PCS) may reduce concussion-related physiological dysfunction and symptoms by restoring autonomic balance and improving cerebral blood flow autoregulation. In a descriptive pilot study of 91 patients referred to a university clinic for treatment of PCS, a subset of 63 patients were contacted by telephone for assessment of symptoms and return to full daily functioning. Those who experienced symptoms during a graded exercise treadmill test (physiologic PCS, n = 40) were compared to those who could exercise to capacity (PCS, n = 23). Both groups had been offered progressive exercise rehabilitation. Overall 41 of 57 (72%) who participated in the exercise rehabilitation program returned to full daily functioning. This included 27 of 35 (77%) from the physiologic PCS group, and 14 of 22 (64%) from the PCS group. Only 1 of the 6 patients who declined exercise rehabilitation returned to full functioning. Interpretation of these results is limited by the descriptive nature of the study, the small sample size, and the relatively few patients who declined exercise treatment. Nonetheless, exercise assessment indicates that approximately one third of those examined did not have physiologic PCS.

A Physiological Approach to Prolonged Recovery From Sport-Related Concussion

“…This perspective is also supported by the NATA position statement. 2 In our center, we have demonstrated that the BCTT can reveal physiological dysfunction in patients with concussion, 29,30,55,60 differentiate concussion from other diagnoses (eg, cervical injury, depression, migraines), 79,92 and quantify the clinical severity and exercise capacity of concussed patients. 62 Based on the Balke cardiac protocol, the test begins at a speed of 3.2 to 3.6 mph (5.2-5.8 kph, depending on the patient's age and height) at 0% incline.…”

“…Our nonrandomized studies showed that in PCS patients, individualized subthreshold aerobic exercise treatment improved symptoms, fitness, and autonomic function during exercise, 60 and when compared with no intervention, the rate of safe recovery and restoring function (sport and work) improved. 60,92 Investigators 94 in a recent study used a standard cycle-ergometer protocol (the McMaster All-Out Progressive Continuous Cycling Test) in 54 youths (age range ¼ 8.5-18.3 years) with PCS (mean symptom duration ¼ 6.3 months). A total of 63% of participants had symptoms during exertion; however, the number and severity of symptoms improved significantly over the ensuing 24 hours in most patients.…”

Neurovascular Coupling: A Unifying Theory for Post-Concussion Syndrome Treatment and Functional Neuroimaging

“…Leddy et al have played a major role in investigating exercise in patients with PCS [24,25,[89][90][91]93,[99][100][101][102][103]. They demonstrated the safety and efficacy of a graduated treadmill exercise test in patients with PCS.…”

“…As previously mentioned, Leddy et al [24,25,[89][90][91]93,[99][100][101][102][103] have played major roles in investigating aerobic exercise in patients with PCS. One study investigated the use of sub-symptomatic threshold aerobic exercise in normalizing some of the physiologic disturbances seen in PCS, particularly BP, minute ventilation (VE), PETCO 2 and CBF velocity (CBFV) measured by transcranial Doppler [101].…”

“…Concerning treatment, PCS patients traditionally are educated and prescribed rest, neurocognitive rehabilitation and antidepressants, all without much evidence of success [24]. Some researchers, however, have focused on developing PCS diagnostic and treatment approaches based on the physiologic theory of concussion [25]. However, though individual components of the physiologic dysfunction occurring in PCS have been investigated (such as ANS dysfunction and CD), there lacks a proposed universal theory of the pathologic state of PCS.…”