Maree Cassimatis, Rhonda Orr, Andrew Fyffe, Gary Browne
{"title":"Exercise Tolerance in Pediatric Concussion: An 8-Year Longitudinal Study.","authors":"Maree Cassimatis, Rhonda Orr, Andrew Fyffe, Gary Browne","doi":"10.1097/HTR.0000000000001039","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>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.</p><p><strong>Setting: </strong>Pediatric tertiary referral concussion clinic.</p><p><strong>Participants: </strong>Children and adolescents (aged 6-18 years) presenting to the concussion clinic between January 2015 and December 2022.</p><p><strong>Design: </strong>Retrospective longitudinal study.</p><p><strong>Main measures: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>GXT is a clinically relevant measure to identify children and adolescents at risk of a prolonged concussion recovery.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.4000,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Head Trauma Rehabilitation","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/HTR.0000000000001039","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
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.
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.
期刊介绍：
The Journal of Head Trauma Rehabilitation is a leading, peer-reviewed resource that provides up-to-date information on the clinical management and rehabilitation of persons with traumatic brain injuries. Six issues each year aspire to the vision of “knowledge informing care” and include a wide range of articles, topical issues, commentaries and special features. It is the official journal of the Brain Injury Association of America (BIAA).
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