Post-acute Structured Exercise Following Sport Concussion
Keywords
Abstract
Description
A number of physical, cognitive, somatic, and emotional symptoms commonly occur following sports-related concussion. The current return to play (RTP) protocol advises complete physical and cognitive rest following SRC until patients are completely free of these symptoms (i.e. asymptomatic) in order to avoid making symptoms worse and furthering the injury. While this initial, post-injury rest period is generally assumed to be beneficial, there is currently no scientific evidence supporting this recommendation. In fact, a growing body of evidence suggests that prolonged rest may actually hinder the recovery process.
Emerging research is beginning to show that light-to-moderate aerobic exercise (AE) actually provides a positive benefit on the injured brain, thereby helping the recovery process. Research has shown this benefit in concussion and other injuries such as stroke, whiplash, and low back pain. In fact, a standardized aerobic exercise protocol has been shown to improve recovery for individuals with persistent symptoms for an extended period of time. While preliminary human investigations using AE interventions after concussion have shown promise, these studies are either retrospectively designed, or have focused on individuals with persistent symptoms (> 3 weeks).
Therefore, the purpose of this study is to examine the effect of a standardized, subacute AE intervention in adolescents after SRC, on time to recovery compared to usual care. This study will provide meaningful information regarding the utility of AE intervention after concussion. Findings from these works may inform future usual care procedures post-injury, potentially providing the first known treatment to improve recovery after concussion.
Dates
| Last Verified: | 03/31/2018 |
| First Submitted: | 10/31/2016 |
| Estimated Enrollment Submitted: | 11/15/2016 |
| First Posted: | 11/20/2016 |
| Last Update Submitted: | 04/04/2018 |
| Last Update Posted: | 04/08/2018 |
| Actual Study Start Date: | 02/15/2017 |
| Estimated Primary Completion Date: | 12/31/2020 |
| Estimated Study Completion Date: | 03/31/2021 |
Condition or disease
Intervention/treatment
Behavioral: Aerobic Exercise Group
Phase
Arm Groups
| Arm | Intervention/treatment |
|---|---|
| No Intervention: Usual Care Group These individuals will undergo a period of physical rest and standard care until symptoms spontaneously resolve. For the purposes of this study, "rest" will be defined as the avoidance of any activities beyond those of daily living, including participation in sport and physical activity. Once individuals in this group achieve asymptomatic status, they will be directed through the existing return to play guidelines. | |
| Experimental: Aerobic Exercise Group These individuals will begin to exercise at Day 3 post-injury. These participants will be asked to complete a total of eight exercise sessions over the course of 11 days, with one day of rest after two consecutive sessions. Once individuals in this group achieve asymptomatic status, they will be directed through the existing return to play guidelines. | Behavioral: Aerobic Exercise Group The AE protocol will consist of eight sessions that proceed in a stepwise fashion in terms of duration and intensity over 11 days. Exercise will be performed on the Velotron Pro stationary cycle ergometer (RacerMate Inc., WA, USA), which will be digitally connected to a heart rate monitor and programmed to monitor the wattage of the bike based on the participant's heart rate. Exercise duration (15min-20min) and intensity (60%-75% max HR) will increase over the intervention period. |
Eligibility Criteria
| Ages Eligible for Study | 13 Years To 13 Years |
| Sexes Eligible for Study | All |
| Accepts Healthy Volunteers | Yes |
| Criteria | Inclusion Criteria: - Diagnosed with SRC by a physician at the David L. MacIntosh Sport Medicine Clinic - Minimum of 13 years of age and a maximum of 25 years of age - Able to speak and understand English Exclusion Criteria: - Have had a previous concussion within two weeks of the presenting SRC - Have any co-morbid injuries (i.e. musculoskeletal/soft-tissue injuries, vestibular disorders) - Have a pre-existing heart condition - Have any uncontrolled seizure disorders or a history of medical or neurological conditions that affects cognitive functioning |
Outcome
Primary Outcome Measures
1. Clinical recovery - Days to Medical Clearance [Up to 1-year post-injury]
Secondary Outcome Measures
1. Change in Symptoms [28 Days: assessed at Days 7, 14, 21, 28, and 90 post-injury]
2. Change in Heart Rate Variability (HRV) [28 Days: assessed at Days 7, 14, 21, 28, and 90 post-injury]
3. Change in Blood Pressure Variability (BPV) [28 days: assessed at Days 7, 14, 21, 28, and 90 post-injury]
4. Change in Peripheral Blood Biomarkers [28 Days: assessed at Days 7, 14, 21, 28, and 90 post-injury]
5. Change in Cognition [28 Days: assessed at Days 7, 14, 21, 28, and 90 post-injury]
