Citation

Corrado C, Willer BS, McPherson JI, Storey E, Sisto SA, Master T, Wiebe D, Grady M, Mannix R, Meehan W, Leddy JJ, Haider MN. J. Neurotrauma 2023; ePub(ePub): ePub.

Copyright

(Copyright © 2023, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2022.0225

PMID

36884297

Abstract

Early targeted heart rate (HR) aerobic exercise has been shown to reduce the duration of recovery from sport-related concussion (SRC) as well as the incidence of Persistent Post-Concussive Symptoms (PPCS). It is not known, however, if more severe oculomotor and vestibular presentations of SRC benefit from a prescription of aerobic exercise. The current study is an exploratory analysis of two published randomized controlled trials (RCTs) that compared aerobic exercise within 10 days of injury with a placebo-like stretching intervention. Combining the two studies yielded a larger sample size to stratify severity of concussion based on the number of abnormal physical examination signs present at the initial office evaluation, which were confirmed with self-reported symptoms and recovery outcomes. The most discriminant cut-off was between those who had ≤ 3 oculomotor and vestibular signs and those who had > 3 signs. Aerobic exercise (Hazard ratio = 0.621 [0.412, 0.936], p = 0.023) reduced recovery times even when controlling for site (Hazard ratio = 0.461 [0.303, 0.701], p < 0.001), severity (Hazard ratio = 0.528 [0.325, 0.858], p = 0.010) and the interaction term of intervention and severity (Hazard ratio = 0.972 [0.495, 1.909], p = 0.935). Adolescents who presented with >3 signs and were assigned to the placebo-like stretching group had a PPCS incidence of 38%, which was the highest of all subgroups (aerobic exercise and ≤ 3 findings: 8%; stretching and ≤ 3 findings: 11%; aerobic exercise and > 3 findings: 21%). This exploratory study provides pilot evidence that prescribed sub-symptom threshold aerobic exercise treatment early after SRC may be effective for adolescents with more oculomotor and vestibular physical examination signs and should be validated in future adequately powered trials.

Language: en

Keywords

TRAUMATIC BRAIN INJURY; REHABILITATION; HEAD TRAUMA