Abstract Details

Female sex, history of mood disorder, migraine, ADHD, and prior concussion have been associated with prolonged recovery in concussed adolescents. Early sub-symptom threshold exercise has been shown to improve recovery times, but many of these studies have excluded patients with potential risk factors for prolonged recovery. Therefore, further study on these patient sub-groups is needed to optimize the use of exercise following concussion.

To evaluate tolerance of supervised exercise in concussed adolescents with risk factors for prolonged recovery.

Patients evaluated at a tertiary sports concussion clinic between 2016-2020 were retrospectively studied. Inclusion criteria included patients age≤21 who completed a supervised exercise challenge (SEC)<30 days after injury. Each SEC consisted of aerobic and/or dynamic exercise of gradually increasing intensity. Heart rate (HR) and symptoms scores were recorded at 2-minute intervals. Outcomes included symptom provocation, maximum symptom scores, peak and average HR, and exercise duration. Symptom provocation was defined as development of a new symptom or a >3 point increase of an existing symptom during exercise. Associations between risk factors and outcomes were assessed with repeated measures ANOVA and multivariate linear and logistic regression.

403 patients met inclusion criteria. Female sex (OR 0.60, p=.020), history of mood disorder (OR 0.51, p=.014), and a lack of history of ADHD (OR 2.06, p=.024) were associated with the presence of symptom provocation during the SEC. Female sex was associated with a greater total number of symptoms reported (p<0.001) and a greater increase in symptom scores compared to males (p<0.001). History of mood disorder was associated with lower average (p=.013) and peak HR (p=.009) during the SEC.

Concussed adolescents with risk factors for prolonged recovery demonstrated differences in symptom provocation and intensity of exercise during SECs. These factors should be considered when providing physical activity guidance to patients during concussion recovery.