Adolescents With More Oculomotor and Vestibular Signs of Sport-Related Concussion Benefit from Aerobic Exercise: An Exploratory Analysis

Effect of combined aerobic and resistance training exercise on Vo2 max and BMI in overweight collegiate population a randomized controlled trial

INTRODUCTION

Obesity and overweight are prevalent within college students and represent a major health concern due to sedentary lifestyles and absence of exercise. This study was intended to ascertain the impact of discrete and combined aerobic and resistance training exercises on maximal oxygen uptake (VO2 max) and Body Mass Index (BMI) among overweight collegiate population.

METHOD

In this study, 30 male college students aged between 18 and 26 years, with a Body Mass Index (BMI) greater than 25 kg/m, were divided at random between three groups: Group 1 (n = 10) engaged in aerobic exercise, Group 2 (n = 10) engaged in resistance training, and Group 3 (n = 10) engaged in combined training regime. BMI was determined using the formula weight/height (kg/m2), and maximal oxygen uptake (VO2 max) was measured using the Queen's College Step Test, both prior to and following the intervention. The efficacy of the interventions was assessed once the fourth week was over.

RESULT

An ANCOVA showed significant effects of intervention type on BMI and VO₂ Max. For BMI, the Combined group had the lowest post-intervention BMI, F(2, 25) = 10.29, p < .001, η2 = 0.04. VO₂ Max also showed a main effect, F(2, 25) = 61.85, p < .001, η2 = 0.01, with the Aerobic and Combined groups demonstrating the greatest improvements, underscoring the effectiveness of these interventions.

CONCLUSION

This study highlights that Combined and Aerobic interventions significantly improve BMI and VO₂ Max, with the Combined group showing the greatest BMI reduction and both Combined and Aerobic groups demonstrating enhanced VO₂ Max.

Quality of Life in Adolescent Athletes With Sport-Related Concussion Prescribed Heart Rate-Targeted Aerobic Exercise Within 10 Days of Injury

Individualized aerobic exercise treatment prescribed within 10 days of injury facilitates recovery in adolescents after sport-related concussion (SRC) and reduces incidence of persisting post-concussive symptoms (PPCSs) beyond 4 weeks. The effect of aerobic exercise treatment on quality of life symptoms is, however, unknown. This planned secondary aim of a published randomized controlled trial found that while adolescents prescribed aerobic exercise recovered faster, there was no difference on the Pediatric Quality of Life (PedsQL) questionnaire scores during the 4-week intervention period. Nevertheless, adolescents who experienced PPCS reported significantly worse initial visit (within 10 days of injury) symptoms on the PedsQL than those who recovered within 4 weeks. Higher scores on the PedsQL correlated with greater initial visit concussion symptom burden and more abnormalities on a concussion-relevant visio-vestibular examination. Thus, the PedsQL captures the clinical severity of concussion and is prognostic of risk for delayed recovery when administered early after SRC in adolescents.

Scoping review: Intervention for ocular motor disorders in children and adults with mild traumatic brain injury

SIGNIFICANCE

Intervention strategies for post-mild traumatic brain injury (mTBI) ocular motor disorders vary across disciplines and include watchful waiting, vestibular rehabilitation, vision rehabilitation/vision therapy, and optical intervention. However, evidence supporting their effectiveness is limited, highlighting the need for high-quality randomized controlled trials with standardized testing, diagnostic criteria, and reassessment of ocular motor function after intervention.

BACKGROUND

Ocular motor disorders occur frequently after mTBI.

OBJECTIVES

This study aimed to conduct a scoping review of interventions for mTBI-related ocular motor disorders in children and adults.

DATA SOURCES

The following electronic bibliographic databases were searched: PubMed, Embase, PEDro, OVID, Clinical Key, Google Scholar, and REHABDATA.

STUDY SELECTION

Intervention studies published in English between 2003 and 2024 involving mTBI participants who had an ocular motor assessment prior to intervention were included in this study.

DATA EXTRACTION AND SYNTHESIS

Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines were followed for reporting. Study population, intervention, and outcomes were extracted and synthesized in tabular and graphical formats.

RESULTS

Sixty-seven eligible studies were included, with only three (4%) judged as low risk of bias. Intervention strategies included watchful waiting (n = 31, 46%), vestibular rehabilitation (n = 13, 19%), vision rehabilitation/vision therapy (n = 10, 15%), optical intervention (n = 4, 6%), and alternative interventions or multifaceted interventions (n = 9, 14%). Among the studies providing statistically supported results, improvements in one or more ocular motor outcome domains were reported in nearly 80% of the studies on watchful waiting (19/24) and 100% of the studies on vestibular rehabilitation (4/4), vision rehabilitation/vision therapy (7/7), or optical intervention (1/1).

CONCLUSIONS AND IMPLICATIONS

Although post-mTBI ocular motor deficits improved with watchful waiting strategy, vestibular rehabilitation, vision rehabilitation/vision therapy, and optical interventions, most studies had significant risk of bias. This review emphasizes the necessity for high-quality randomized controlled trials with standardized testing protocols and diagnostic criteria and reassessment of ocular motor functions after intervention to evaluate the effectiveness of these interventions in different age groups and recovery stages.

Association of Cognitive Symptoms and Abnormal Oculomotor Signs With Recovery in Adolescents After Sport-Related Concussion

OBJECTIVE

Sport-related concussion (SRC) affects cognitive and oculomotor function. We evaluated recovery from SRC in athletes with cognitive symptoms and/or oculomotor impairments who were prescribed early aerobic exercise treatment.

DESIGN

Secondary exploratory analysis of a randomized controlled trial.

SETTING

Outpatient sports medicine clinics.

PARTICIPANTS

Male and female adolescents (13-18 years) within 10 days of SRC who were prescribed aerobic exercise and who reported either a low (<12 points) or high (≥12 points) burden of cognitive symptom scores on the Post-Concussion Symptom Inventory at initial assessment.

INTERVENTIONS

Early aerobic exercise treatment.

MAIN OUTCOME MEASURES

Recovery time and incidence of persisting postconcussive symptoms beyond 1 month.

RESULTS

Adolescents with a high burden of cognitive symptoms (n = 24, 16.0 ± 1.3 years old, 50% male, 5.3 ± 2.4 days since injury) took longer to recover (34.4 ± 37.1 vs 15.3 ± 7.6 days) than adolescents with a low burden (n = 32, 14.9 ± 1.4 years old, 69% male, 6.1 ± 2.3 days since injury) and had 6-fold higher odds of developing persisting postconcussive symptoms (odds ratio = 6.17 [1.15-33.15]). Abnormal repetitive saccades and vestibular ocular reflex were independently associated with longer recovery after controlling for multiple comparisons ( P < 0.0125), but only abnormal smooth pursuits were a significant effect modifier for the association between cognitive symptoms and recovery (interaction term hazard ratio = 0.133 [0.035-0.504], P = 0.003).

CONCLUSIONS

Individuals with impaired ability to smoothly track a moving target and whose cognitive symptoms are a significant burden are at substantial risk for delayed recovery from SRC. Early initiation of oculomotor rehabilitation may facilitate recovery in these patients.

TRIALS REGISTRATION

Clinicaltrials.gov ID NCT02959216.

Exercise Tolerance in Pediatric Concussion: An 8-Year Longitudinal Study

OBJECTIVES

To determine the relationship between exercise tolerance and post-concussion symptom deficits, cognitive function, and recovery duration; (2) examine the longitudinal effect of exercise tolerance on symptom burden over the clinical timecourse of a child's recovery from concussion; and (3) explicate whether exercise intolerance is a significant determinant of recovery in pediatric concussion.

SETTING

Pediatric tertiary referral concussion clinic.

PARTICIPANTS

Children and adolescents (aged 6-18 years) presenting to the concussion clinic between January 2015 and December 2022.

DESIGN

Retrospective longitudinal study.

MAIN MEASURES

Graded exercise test (GXT) data, derived from a standardized treadmill test (Bruce Protocol), was used to measure exercise tolerance following concussion. Based on initial GXT times, participants were dichotomized into 2 groups: (1) exercise tolerant (GXT time ≥9 minutes), or (2) exercise intolerant (GXT time <9 minutes). Symptom burden, cognitive function, and recovery duration were compared between groups. A subgroup analysis of participants requiring multiple clinic visitations was conducted to explore the longitudinal effect of post-concussion exercise tolerance over time.

RESULTS

Of the 603 children presenting to the concussion clinic, 313 participants (mean age ± SD: 13 ± 2 years, 79% male) were eligible. Exercise-intolerant participants (mean GXT [95% confidence interval, CI], 6.9 [6.5-7.3] minutes) reported 2 times greater initial symptom severity (P < .001) and performed poorly in visual memory (P = .002) and reaction time (P = .02) cognitive domains compared to exercise-tolerant participants (mean GXT [95% CI], 12.3 [12.0-12.5] minutes). Recovery time was longer in exercise-intolerant participants than exercise-tolerant participants (mean recovery time [95% CI], 94 [71-116] vs 69 [57-81] days, P = .002). Participants requiring multiple clinic visitations showed improvements in exercise tolerance and symptom burden over time (P < .001). Significant predictors of prolonged concussion recovery were delayed presentation time (P < .001), high initial symptom burden (P < .001), and exercise intolerance (P < .001).

CONCLUSION

GXT is a clinically relevant measure to identify children and adolescents at risk of a prolonged concussion recovery.

Parasympathetic Responses to Face Cooling in Adolescents with Sport-Related Concussion and After Clinical Recovery

Face cooling (FC) initiates the mammalian dive reflex, which elicits a parasympathetic autonomic response. In our pilot study, collegiate athletes had a blunted parasympathetic response to FC within 10 days of sport-related concussion (SRC). The objective of the current study was to assess the FC response in adolescent athletes with acute SRC and after clinical recovery. Symptomatic adolescents with SRC (n = 23, 15.48 ± 1.2 years, 52% male) had heart rate (HR) and blood pressure (BP) measured during the FC test (7.83 ± 2.5 days since injury) and again after clinical recovery (46.44 ± 36.4 days later). Controls (n = 24, 15.83 ± 1.6 years, 58% male) performed the same assessments twice (48.00 ± 18.9 days apart). The main outcome measures were the rate of change in HR and HR variability (HRV) during the first 2 min of FC. Throughout FC, we found no significant differences between groups at the initial visit in the rate of change for HR (mean difference = 2.58 [-0.33, 5.50] bpm/min, p = 0.082), mean arterial BP (-0.02 [-3.49, 3.45] mmHg/min, p = 0.990), root mean square of successive differences (-13.46 [-34.02, 7.10] ms/min, p = 0.197) or low to high-frequency ratio (0.24 [-0.77, 1.25], p = 0.637). We also found no differences in our main outcome measures among concussed adolescents with delayed recovery (n = 10) compared with those with normal recovery (n = 13). A history of prior concussion had a significant effect on the HR and HRV responses to FC, suggesting that SRC may have prolonged effects on the autonomic nervous system (ANS). We conclude that acutely concussed adolescents do not differ from controls in parasympathetic response to FC acutely or upon recovery but that a history of concussion affects this response. We recommend that future studies control for concussion history when investigating the ANS in concussed adolescents.

An Exploratory Analysis of Physical Examination Subtypes in Pediatric Athletes With Concussion

OBJECTIVE

Pediatric athletes with concussion present with a variety of impairments on clinical assessment and require individualized treatment. The Buffalo Concussion Physical Examination is a brief, pertinent clinical assessment for individuals with concussion. The purpose of this study was to identify physical examination subtypes in pediatric athletes with concussion within 2 weeks of injury that are relevant to diagnosis and treatment.

DESIGN

Secondary analysis of a published cohort study and clinician consensus.

SETTING

Three university-affiliated sports medicine centers.

PARTICIPANTS

Two hundred seventy children (14.9 ± 1.9 years).

INDEPENDENT VARIABLES

Orthostatic intolerance, horizontal and vertical saccades, smooth pursuits, vestibulo-ocular reflex, near-point convergence, complex tandem gait, neck range of motion, neck tenderness, and neck spasm.

MAIN OUTCOME MEASURES

Correlations between independent variables were calculated, and network graphs were made. k -means and hierarchical clustering were used to identify clusters of impairments. Optimal number of clusters was assessed. Results were reviewed by experienced clinicians and consensus was reached on proposed subtypes.

RESULTS

Physical examination clusters overlapped with each other, and no optimal number of clusters was identified. Clinician consensus suggested 3 possible subtypes: (1) visio-vestibular (horizontal and vertical saccades, smooth pursuits, and vestibulo-ocular reflex), (2) cervicogenic (neck range of motion and spasm), and (3) autonomic/balance (orthostatic intolerance and complex tandem gait).

CONCLUSIONS

Although we identified 3 physical examination subtypes, it seemed that physical examination findings alone are not enough to define subtypes that are both statistically supported and clinically relevant, likely because they do not include symptoms, assessment of mood or cognitive problems, or graded exertion testing.

Does Physiologic Post-Concussion Disorder Cause Persistent Post-Traumatic Headache?

PURPOSE OF REVIEW

One system classifies patients with symptoms after concussion into physiologic, vestibulo-ocular, cervicogenic, and mood/cognition post-concussion disorders (PCD) based upon the preponderance of specific symptoms and physical impairments. This review discusses physiologic PCD and its potential relationship to the development of persistent post-traumatic headaches (PPTH).

RECENT FINDINGS

Headache is the most reported symptom after a concussion. Headaches in physiologic PCD are suspected to be due to abnormal cellular metabolism, subclinical neuroinflammation, and dysfunction of the autonomic nervous system (ANS). These abnormalities have been linked to the development of migraine-like and neuralgia-related PPTH. Physiologic PCD is a potential cause of PPTH after a concussion. Future research should focus on how to prevent PPTH in patients with physiologic PCD.