Citation

Cordingley DM, Cornish SM. Appl. Physiol. Nutr. Metab. 2023; ePub(ePub): ePub.

Copyright

(Copyright © 2023, National Research Council of Canada)

DOI

10.1139/apnm-2023-0161

PMID

37222426

Abstract

We would like to thank Wang et al. (2023) for their interest in our narrative review on the efficacy of aerobic exercise in individuals who are symptomatic following a concussion (Cordingley and Cornish 2022). We agree with them that there is evidence suggesting that abnormalities in brain physiology may persist beyond the clinical manifestations after a concussion (Pasternak and Abcejo 2020) and that a biomarker to determine physiological recovery would be a benefit to patients as well as clinicians. However, there is a lack of research investigating the influence of sub-symptom threshold aerobic exercise on physiological biomarkers of recovery following concussion. Additionally, we recognize that although biomarkers and advanced neuroimaging are showing promise in research, the clinical utility of these measures require further investigation (McCrea et al. 2017). Therefore, although sub-symptom threshold aerobic exercise appears to improve symptoms and time to clinical recovery, it is unknown what effect (if any) it has on the recovery of concussion-induced abnormalities in brain physiology that may persist beyond clinical recovery. Therefore, clinical judgment of a medical doctor that considers all medical history and information on follow up should determine when an individual can return to physical activities (McCrory et al. 2017; Reed et al. 2022).

We agree with Wang et al. (2023) that the appropriate treatment, and specifically aerobic exercise treatment, may not be the same for all ages. In our review (Cordingley and Cornish 2022), we note that the majority of research on the effects of aerobic treatment for acute concussions and persistent post-concussion symptoms is primarily in adolescents limiting the generalizability to adults (McIntyre et al. 2020; Markovic et al. 2021). Further research on this topic in adults and older adults is needed to provide evidence of the role aerobic exercise could play in concussion treatment across the lifespan.

We also agree that determining the optimal prescription for active rehabilitation following a concussion is unknown. In the discussion on future directions for research in exercise-based rehabilitation, we highlight the need to determine the optimal frequency, intensity, type, and time for initiation of active rehabilitation (Cordingley and Cornish 2022). Further, understanding the mechanisms associated with aerobic exercise following a concussion and the effects of various exercise prescriptions may assist in the generation of individualized treatment programs (Zhang et al. 2022).

We disagree with the assessment of the Virani et al. (2021) study that Wang et al. (2023) point out in their discussion. This study did not evaluate early exercise resumption for differing age groups with concussions. The study by Virani et al. (2021) evaluated the presence of microbleeds in previously concussed children and adolescents at a minimum of 6 months post injury via magnetic resonance imaging. The study did not assess the response to early exercise resumption for different age groups (Virani et al. 2021). To our knowledge, this research has yet to be done...

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