A Preliminary Study of Subsymptom Threshold Exercise Training for Refractory Post-Concussion Syndrome

@article{Leddy2010APS,
  title={A Preliminary Study of Subsymptom Threshold Exercise Training for Refractory Post-Concussion Syndrome},
  author={John J Leddy and Karl F. Kozlowski and James P. Donnelly and David Robert Pendergast and Leonard H. Epstein and Barry S Willer},
  journal={Clinical Journal of Sport Medicine},
  year={2010},
  volume={20},
  pages={21-27}
}
Objective:To evaluate the safety and effectiveness of subsymptom threshold exercise training for the treatment of post-concussion syndrome (PCS). Design:Prospective case series. Setting:University Sports Medicine Concussion Clinic. Participants:Twelve refractory patients with PCS (6 athletes and 6 nonathletes). Intervention:Treadmill test to symptom exacerbation threshold (ST) before and after 2 to 3 weeks of baseline. Subjects then exercised 5 to 6 days per week at 80% ST heart rate (HR) until… 

Early Subthreshold Aerobic Exercise for Sport-Related Concussion: A Randomized Clinical Trial

TLDR
This is the first RCT to show that individualized subsymptom threshold aerobic exercise treatment prescribed to adolescents with concussion symptoms during the first week after SRC speeds recovery and may reduce the incidence of delayed recovery.

Safety and Prognostic Utility of Provocative Exercise Testing in Acutely Concussed Adolescents: A Randomized Trial

TLDR
Systematic evaluation of exercise tolerance using the BCTT within 1 week after sport-related concussion did not affect recovery, and the degree of early exercise intolerance after SRC was important for prognosis.

Exercise intolerance in individuals with postconcussion syndrome.

TLDR
Patients with PCS had a symptom-limited response to exercise, and the treadmill test was a potentially useful tool to monitor the recovery from PCS, and rating of perceived exertion was the only physiologic measure to show an overall difference between groups.

Exercise for Sport-Related Concussion and Persistent Postconcussive Symptoms

TLDR
A majority of studies show that spontaneous physical activity is safe after SRC and that subsymptom threshold aerobic exercise safely speeds up recovery after S RC and reduces symptoms in those with PPCS.

Active recovery from concussion

TLDR
Evidence supports the safety, tolerability, and efficacy of controlled sub-symptom threshold aerobic exercise treatment for PCS patients.

Reliability of a Graded Exercise Test for Assessing Recovery From Concussion

TLDR
The Balke exercise treadmill protocol has very good IRR and sufficient RTR for identifying patients with symptom exacerbation from concussion and a sensitivity of 99% and specificity of 89% for ruling out concussion symptoms.

A Preliminary Formula to Predict Timing of Symptom Resolution for Collegiate Athletes Diagnosed With Sport Concussion.

TLDR
The results suggest that self-reported duration of 4 symptoms during the initial 24 hours after injury along with total symptom severity as measured by ImPACT accounted for a considerable amount of variance associated with days symptomatic after SC in collegiate athletes.

Graded Exercise Testing Predicts Recovery Trajectory of Concussion in Children and Adolescents.

TLDR
Exercise testing during the subacute phase after a concussion can predict longer recovery, and can identify a unique window where patients can be safely transitioned to activity, enabling clinicians to better inform patients and families, allocate resources and streamline care.

Autonomic cardiovascular response during and after a graded exercise test in concussed athletes and healthy controls

TLDR
Heart rate measurements in athletes with symptoms of sport-related concussion should be continued duringCool-down after the graded exercise test, as dysfunction of the autonomic cardiovascular system might manifest also during cool-down.

Subsymptomatic Aerobic Exercise for Patients With Postconcussion Syndrome: A Critically Appraised Topic.

TLDR
There is moderate evidence to support subsymptomatic aerobic exercise as a treatment of PCS; therefore, it should be considered as a clinical option for reducing PCS and prolonged concussion symptoms.
...

References

SHOWING 1-10 OF 29 REFERENCES

Concussion in sports: postconcussive activity levels, symptoms, and neurocognitive performance.

TLDR
Activity level after concussion affected symptoms and neurocognitive recovery, and athletes engaging in high levels of activity after concussion demonstrated worse neuroc cognitive performance.

Exercise following a sport induced concussion

TLDR
Findings indicate that exercise capacity is unaffected in concussed athletes who are asymptomatic at rest, however, their heart rate response to submaximal exercise is increased.

Acute effects and recovery time following concussion in collegiate football players: the NCAA Concussion Study.

CONTEXT Lack of empirical data on recovery time following sport-related concussion hampers clinical decision making about return to play after injury. OBJECTIVE To prospectively measure immediate

Regulatory and autoregulatory physiological dysfunction as a primary characteristic of post concussion syndrome: implications for treatment.

TLDR
It is proposed that PCS results from ongoing central and systemic physiologic regulatory dysfunction after traumatic brain injury (TBI) and it is suggested that this physiologic dysfunction may be reduced or alleviated by individualized controlled sub-symptom threshold aerobic exercise rehabilitation.

Heart rate variability of recently concussed athletes at rest and exercise.

TLDR
Low-moderate steady-state exercise elicits a neuroautonomic cardiovascular dysfunction in concussed athletes that is not present in a rested state, which alludes to an exercise induced uncoupling between the autonomic and cardiovascular systems.

Management of concussion and post-concussion syndrome

TLDR
A clinical model is presented to suggest that concussion evolves to become mTBI after PCS has developed, representing a more severe form of brain injury.

Diagnostic criteria for postconcussional syndrome after mild to moderate traumatic brain injury.

TLDR
Prevalence of postconcussional syndrome was higher using ICD-10 than DSM-IV criteria and specificity to TBI was limited because PCS criteria were often fulfilled by patients with extracranial trauma.

Heart-rate variability in chronic traumatic brain injury.

TLDR
Alarming abnormalities in both time and frequency domains of HRV are present in patients with traumatic brain injury (TBI) during the post-acute recovery phase.

Neurobehavioral outcome following minor head injury: a three-center study.

TLDR
The data suggest that a single uncomplicated minor head injury produces no permanent disabling neurobehavioral impairment in the great majority of patients who are free of preexisting neuropsychiatric disorder and substance abuse.