Citation

Miutz LN, Burma JS, Brassard P, Phillips AA, Emery CA, Smirl JD. Sports Health 2023; ePub(ePub): ePub.

Copyright

(Copyright © 2023, American Orthopaedic Society for Sports Medicine, Publisher SAGE Publishing)

DOI

10.1177/19417381231217744

PMID

38149331

Abstract

BACKGROUND: Sport-related concussions are a complex injury requiring multifaceted assessment, including physical exertion. Currently, concussion testing relies primarily on a treadmill-based protocol for assessing exertion-related symptoms in persons after concussion. This study compared a modified cycle protocol (Calgary Concussion Cycle Test [CCCT]) with the clinically adopted standard, the Buffalo Concussion Treadmill Test (BCTT), across multiple physiological parameters. HYPOTHESIS: Treadmill and cycle matched workload protocols would produce similar results for cerebral blood velocity, mean arterial pressure (MAP), and end-tidal carbon dioxide partial pressure (P(ET)CO(2)), but heart rate (HR) and oxygen consumption (VO(2)) would be higher on the treadmill than the cycle modality. STUDY DESIGN: Crossover study design. LEVEL OF EVIDENCE: Level 3.

METHODS: A total of 17 healthy adults (8 men, 9 women; age, 26 ± 3 years; body mass index, 23.8 ± 2.7 kg/m(2)) completed the BCTT and CCCT protocols, 7 days apart in a randomized order. During both exertional protocols, the physiological parameters measured were middle cerebral artery mean blood velocity (MCAv), MAP, P(ET)CO(2), VO(2), and HR. Analysis of variance with effect size computations, coefficient of variation, and Bland-Altman plots with 95% limits of agreement were used to compare exercise tests.

RESULTS: The BCTT and CCCT produced comparable results for both male and female participants with no significant differences for average MCAv, MAP, and P(ET)CO(2) (all P > 0.05; all generalized eta squared [η(2)(G)] < 0.02 [negligible]; P value range, 0.29-0.99) between stages. When accounting for exercise stage and modality, VO(2) (P < 0.01) and HR (P < 0.01) were higher on the treadmill compared with the cycle. Aside from the final few stages, all physiology measures displayed good-to-excellent agreeability/variability.

CONCLUSION: The CCCT was physiologically similar to the BCTT in terms of MCAv, P(ET)CO(2), and MAP; however, HR and VO(2) differed between modalities. CLINICAL RELEVANCE: Providing a cycle-based modality to exertional testing after injury mayincrease accessibility to determine symptom thresholds in the future.

Language: en

Keywords

aerobic capacity; cerebral blood flow; exertional testing; heart rate