Effect of Aerobic Exercise on Symptom Burden and Quality of Life in Adults with Persisting Post-Concussive Symptoms: The ACTBI Randomized Clinical Trial.

Abstract

Objective: To evaluate a 6-week sub-symptom threshold aerobic exercise protocol (AEP) vs a stretching protocol (SP) on symptom burden and quality of life (QoL) in adults with persisting post-concussive symptoms (PPCS).

Design: The Aerobic exercise for treatment of Chronic symptoms following mild Traumatic Brain Injury (ACTBI) Trial was a randomized controlled trial with two groups.

Setting: Outpatient brain injury, pain and physiotherapy clinics.

Participants: A total of 210 participants were screened. A consecutive sample of 52 adults with PPCS and exercise intolerance following mild traumatic brain injury were enrolled. No participants withdrew due to adverse effects of intervention.

Interventions: Participants were randomized to a 6-week AEP (n=27) or 6-week SP (n=25).

Main outcomes and measures: The Rivermead Post Concussion Symptoms Questionnaire (RPQ) was the primary outcome. Secondary outcomes included QoL using the Quality of Life After Brain Injury Questionnaire (QOLIBRI), in addition to measures of mood, anxiety, functional impact of headache, fatigue, dizziness, exercise tolerance and sleep.

Results: Participants were a mean (SD) of 43.0 (10.9) years old (75% female) and 24.7 (14.0) months post-injury. In per protocol analysis, between group difference (AEP vs SP) was not significant for RPQ, but QOLIBRI between group difference was significant (mean change=5.024, 95% Cl [0.057, 9.992], p=0.047) from baseline to 6-weeks. In intention to treat analysis, between group change in primary and secondary outcomes were not significant.

Conclusions: This trial provides preliminary data to support prescription of aerobic exercise for adults with PPCS. Despite presenting with exercise intolerance, participants were able to engage in sub-symptom threshold exercise with QoL benefits.