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Wingerson MJ, Hunt DL, Wilson JC, Mannix RC, Meehan WP, Howell DR. Factors Associated with Symptom Resolution after Aerobic Exercise Intervention in Adolescent and Young Adults with Concussion. Med Sci Sports Exerc 2024; 56:783-789. [PMID: 38109187 PMCID: PMC11018463 DOI: 10.1249/mss.0000000000003358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
BACKGROUND Aerobic exercise facilitates postconcussion symptom resolution at the group level, but patient-level characteristics may affect the likelihood of treatment efficacy. PURPOSE This study aimed to investigate demographic and clinical characteristics, which differentiate postconcussion aerobic exercise treatment efficacy from nonefficacy in the intervention arm of a randomized clinical trial. METHODS Adolescent and young adult participants initiated a standardized aerobic exercise intervention within 14 d of concussion, consisting of self-selected exercise for 100 min·wk -1 at an individualized heart rate (80% of heart rate induced symptom exacerbation during graded exercise testing). Treatment efficacy was defined as symptom resolution within 28-d postconcussion. Treatment efficacy and nonefficacy groups were compared on demographics, clinical characteristics, intervention adherence, and persistent symptom risk using the Predicting Persistent Postconcussive Problems in Pediatrics (5P) clinical risk score. RESULTS A total of 27 participants (16.1 ± 2.3 yr old; range, 11-21 yr; 52% female) began the intervention, with a mean of 9.5 ± 3.7 d after concussion; half ( n = 13; 48%) demonstrated treatment efficacy (symptom resolution within 28 d postconcussion). Those whose symptoms resolved within 28 d had significantly lower preintervention postconcussion symptom inventory scores (21.2 ± 13.2 vs 41.4 ± 22.2; P < 0.01), greater adherence to the intervention (77% vs 36%; P = 0.05), and longer average exercise duration (median [interquartile range], 49.7 [36.8-68.6] vs 30.4 [20.7-34.7] min; P < 0.01) than those whose symptoms lasted more than 28 d. Groups were similar in age, sex, timing of intervention, and preintervention 5P risk score. CONCLUSIONS A standardized aerobic exercise intervention initiated within 14 d of concussion demonstrated efficacy for approximately half of participants, according to our definition of treatment efficacy. This multisite aerobic exercise intervention suggests that lower symptom severity, higher intervention adherence, and greater exercise duration are factors that increase the likelihood of symptoms resolving within 28 d of concussion.
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Affiliation(s)
- Mathew J. Wingerson
- University of Colorado School of Medicine, Department of Orthopedics, Aurora, CO
- Children’s Hospital Colorado, Sports Medicine Center, Aurora, CO
| | - Danielle L. Hunt
- Boston Children’s Hospital, Micheli Center for Sports Injury Prevention, Boston, MA
| | - Julie C. Wilson
- University of Colorado School of Medicine, Department of Orthopedics, Aurora, CO
- Children’s Hospital Colorado, Sports Medicine Center, Aurora, CO
- University of Colorado School of Medicine, Department of Pediatrics, Aurora, CO
| | - Rebekah C. Mannix
- Boston Children’s Hospital, Micheli Center for Sports Injury Prevention, Boston, MA
| | - William P. Meehan
- Boston Children’s Hospital, Micheli Center for Sports Injury Prevention, Boston, MA
| | - David R. Howell
- University of Colorado School of Medicine, Department of Orthopedics, Aurora, CO
- Children’s Hospital Colorado, Sports Medicine Center, Aurora, CO
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Master CL, Corwin DJ, Fedonni D, Ampah SB, Housel KC, McDonald C, Arbogast KB, Grady MF. Dose-Response Effect of Mental Health Diagnoses on Concussion Recovery in Children and Adolescents. Sports Health 2024; 16:254-268. [PMID: 38349046 PMCID: PMC10916772 DOI: 10.1177/19417381241228870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Pre-existing mental health diagnoses may contribute to greater emotional symptom burden and prolonged recovery after concussion. HYPOTHESIS Youth with pre-existing mental health diagnoses will have greater emotional symptom burden, greater risk for delayed return to exercise, and more prolonged recovery from concussion than those without those diagnoses. STUDY DESIGN Prospective cohort. LEVEL OF EVIDENCE Level 3. METHODS A prospective registry of youth concussion was examined for differences in emotional symptom burden after injury to develop a predictive risk model for prolonged recovery. The impact of individual and total number of pre-existing mental health diagnoses (0, 1, 2, and 3+) was assessed, and multivariable logistic regression was performed to identify factors associated with prolonged recovery. RESULTS Among a cohort of 3105 youth with concussion, those with a history of mental health diagnoses, in a dose-response fashion, had greater postinjury emotional symptom burden (7 emotional symptoms vs 4; P < 0.01), visio-vestibular dysfunction (65% abnormal vs 56% abnormal; P < 0.01), later return to symptom-limited exercise (23 vs 21 days; P < 0.01), and overall longer concussion recovery (38 days, interquartile range [IQR] 18, 80) versus 25 days (IQR 13, 54; P < 0.01). Boys with prolonged recovery after concussion had greater emotional symptom burden than girls (5 emotional symptoms vs 3; P < 0.01). CONCLUSION Pre-existing mental health diagnoses are associated with greater postinjury emotional symptom burden and longer concussion recovery in a dose-response fashion. Visiovestibular deficits and delayed return to exercise are also associated with pre-existing mental health diagnoses and prolonged recovery. Boys with prolonged recovery from concussion experience greater emotional symptom burden than girls. CLINICAL RELEVANCE Addressing pre-existing mental health diagnoses is essential to concussion management. Boys with prolonged recovery from concussion may particularly benefit from interventions to address their higher emotional symptom burden. Interventions, including a home visio-vestibular exercise program and symptom-limited exercise, may contribute to improving time to concussion recovery.
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Affiliation(s)
- Christina L Master
- Sports Medicine and Performance Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Daniel J Corwin
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Daniele Fedonni
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Steven B Ampah
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kaitlyn C Housel
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Catherine McDonald
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Kristy B Arbogast
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Matthew F Grady
- Sports Medicine and Performance Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Howell DR, Wingerson MJ, Smulligan KL, Magliato S, Simon S, Wilson JC. Exercising More Than 150 min/wk After Concussion Is Associated With Sleep Quality Improvements. J Head Trauma Rehabil 2023:00001199-990000000-00124. [PMID: 38032838 PMCID: PMC11070449 DOI: 10.1097/htr.0000000000000918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
OBJECTIVE To examine whether a high volume of aerobic exercise after concussion (>150 min/wk) is associated with improved sleep quality over a 1-month period. We hypothesized that more than 150 min/wk of exercise would be associated with improved sleep quality across concussion recovery. DESIGN Prospective cohort observational study. SETTING Sports medicine clinic. PARTICIPANTS Adolescents initially tested 8.4 ± 3.5 (range, 2-18) days postconcussion who returned for a follow-up assessment 34.3 ± 7.7 (range: 20-49) days postconcussion. MAIN OUTCOME MEASURES Participants completed the Pittsburgh Sleep Quality Index and the Post-Concussion Symptom Inventory. No specific exercise or sleep recommendations were given beyond what their treating physician provided. Between study visits, participants recorded exercise performed via wrist-worn actigraphy. We calculated average exercise minutes per week and grouped participants as those who exercised more than 150 min/wk versus those who exercised 150 min/wk or less. RESULTS Thirty-six adolescents participated. Fifteen (42%) recorded more than 150 min/wk of aerobic exercise (age = 14.0 ± 1.7 years; 47% female; mean = 5.6 ± 1.2 d/wk of exercise; mean = 49.2 ± 17.5 min/session), and 21 recorded 150 min/wk or less of aerobic exercise (age = 15.0 ± 1.9 years; 76% female; mean = 2.7 ± 1.6 d/wk of exercise; mean = 30.2 ± 7.8 min/session). There were no significant group differences in the proportion of those who self-reported beginning physical activity prior to enrollment (47% vs 33%; P = .42) or for initial sleep quality rating (8.0 ± 3.7 vs 8.6 ± 4.1; P = .67) or initial concussion symptom severity rating (34.9 ± 28.0 vs 42.6 ± 25.9; P = .40). The group that exercised more than 150 min/wk between visits demonstrated significantly greater median PSQI rating improvements than those who exercised 150 min/wk or less, with a large effect size noted (median change [interquartile range] = 5 [3, 7] vs 1 [0, 4]; P = .008; Cohen d = 0.96). CONCLUSION Current recommendations suggest that subsymptom aerobic exercise can be beneficial after concussion. Our findings indicate that an exercise volume of more than 150 min/wk led to greater sleep quality improvements than those who exercised below this level.
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Affiliation(s)
- David R. Howell
- Sports Medicine Center, Children’s Hospital Colorado, Aurora, CO, USA
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Mathew J. Wingerson
- Sports Medicine Center, Children’s Hospital Colorado, Aurora, CO, USA
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Samantha Magliato
- Sports Medicine Center, Children’s Hospital Colorado, Aurora, CO, USA
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Stacey Simon
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
- Pediatric Sleep Center, Children’s Hospital of Colorado, Aurora, CO, USA
| | - Julie C. Wilson
- Sports Medicine Center, Children’s Hospital Colorado, Aurora, CO, USA
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
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Rademacher JG, Wingerson MJ, Smulligan KL, Little CC, Wilson JC, Howell DR. Early Moderate to Vigorous Physical Activity After Concussion Is Associated With Faster Symptom Resolution Time. J Sport Rehabil 2023; 32:790-796. [PMID: 37295788 DOI: 10.1123/jsr.2023-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 06/12/2023]
Abstract
CONTEXT Early physical activity (PA) after concussion may promote symptom resolution. Prior studies have investigated exercise frequency/duration, yet precise PA intensity or volume required for optimal recovery requires further investigation. moderate to vigorous physical activity (MVPA) is beneficial for physical health. We investigated whether sedentary time, light activity time, MVPA time, or activity frequency in the weeks following concussion are associated with time to symptom resolution among adolescents. DESIGN Prospective cohort study. METHODS Adolescents 10-18 years of age were tested ≤14 days of concussion and followed until symptom resolution. At the initial visit, participants rated symptom severity and were provided wrist-worn activity trackers to monitor PA for the following week. PA behavior was categorized each day based on heart rate: sedentary (resting), light PA (50%-69% age-predicted max heart rate), and MVPA (70%-100% age-predicted max heart rate). Symptom resolution was defined as the date when participants reported cessation of concussion-like symptoms. Patients were not given specific PA instructions, though some may have received instructions from their physician. RESULTS Fifty-four participants were included in the study (54% female; mean age = 15.0 [1.8] y; initially assessed 7.5 [3.2] d after concussion). Female athletes recorded more sedentary time (900 [46] vs 738 [185] min/d; P = .01; Cohen d = 0.72), and less time in light PA (194.7 [64.5] vs 224 [55] min/d; P = .08; Cohen d = 0.48) and MVPA (23 [17] vs 38 [31] min/d; P = .04; Cohen d = 0.58) than male athletes. After adjusting for sedentary time, hours per day with >250 steps, sex, and initial symptom severity, more MVPA time was associated with faster symptom resolution time (hazard ratio = 1.016; 95% confidence interval, 1.001-1.032; P = .04). CONCLUSION Our findings offer preliminary insight into how varying PA intensities affect concussion recovery, as MVPA may be a higher intensity than what is typically prescribed in concussion care.
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Affiliation(s)
| | - Mathew J Wingerson
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO,USA
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO,USA
| | - Katherine L Smulligan
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO,USA
| | - Casey C Little
- University of Virginia School of Medicine, Charlottesville, VA,USA
| | - Julie C Wilson
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO,USA
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO,USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO,USA
| | - David R Howell
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO,USA
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO,USA
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Howell DR, Wingerson MJ, Kirkwood MW, Grubenhoff JA, Wilson JC. Early aerobic exercise among adolescents at moderate/high risk for persistent post-concussion symptoms: A pilot randomized clinical trial. Phys Ther Sport 2022; 55:196-204. [DOI: 10.1016/j.ptsp.2022.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 12/22/2022]
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