Haley M Chizuk, Barry S Willer1, Adam Cunningham2, Itai Bezherano2, Eileen Storey3, Christina Master, Rebekah Mannix4, Doug J Wiebe5, Matthew F Grady, William P Meehan, John J Leddy2, Mohammad N Haider2. 1. Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY. 2. UBMD Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY. 3. Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA. 4. Division of Emergency Medicine, Boston Children's Hospital, Boston, MA. 5. Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Abstract
PURPOSE: There is growing evidence that subsymptom threshold aerobic exercise speeds recovery from sport-related concussion (SRC). It is not known whether there is a direct relationship between adherence to a personalized exercise prescription and recovery or if initial symptom burden affects adherence to the prescription. METHODS: This study was a planned secondary analysis of one arm of a randomized controlled trial. Male and female adolescent athletes (age 13-18 yr) presenting within 10 d of SRC were given aerobic exercise prescriptions based on their heart rate threshold at the point of exercise intolerance on a graded treadmill test. Adherence was determined objectively with HR monitors and compared against time to recovery. Participants who completed at least two-thirds of their aerobic exercise prescription were considered to be adherent. RESULTS: Sixty-one percent of adolescents met the adherence criterion. Those who were adherent were more symptomatic and were more exercise intolerant at their initial visit, yet they recovered faster than those who were not adherent (median recovery time, 12 (interquartile range, 9-22) d vs 21.5 (interquartile range, 13-29.8) d; P = 0.016). On linear regression, adherence during week 1 was inversely related to recovery time ( β = -0.002 (-0.003, 0.0), P = 0.046) and to initial exercise tolerance ( β = -0.886 (-1.385, -0.387), P < 0.001), but not to initial symptom severity ( β = 0.545 (-0.232, 1.323), P = 0.146). No adverse events or near misses were reported. CONCLUSIONS: Adherence to individualized subsymptom threshold aerobic exercise within the first week of evaluation is associated with faster recovery from SRC. The data suggest that initial degree of exercise intolerance, but not initial symptom severity, affects adherence to aerobic exercise prescribed to adolescents within 10 d of SRC.
PURPOSE: There is growing evidence that subsymptom threshold aerobic exercise speeds recovery from sport-related concussion (SRC). It is not known whether there is a direct relationship between adherence to a personalized exercise prescription and recovery or if initial symptom burden affects adherence to the prescription. METHODS: This study was a planned secondary analysis of one arm of a randomized controlled trial. Male and female adolescent athletes (age 13-18 yr) presenting within 10 d of SRC were given aerobic exercise prescriptions based on their heart rate threshold at the point of exercise intolerance on a graded treadmill test. Adherence was determined objectively with HR monitors and compared against time to recovery. Participants who completed at least two-thirds of their aerobic exercise prescription were considered to be adherent. RESULTS: Sixty-one percent of adolescents met the adherence criterion. Those who were adherent were more symptomatic and were more exercise intolerant at their initial visit, yet they recovered faster than those who were not adherent (median recovery time, 12 (interquartile range, 9-22) d vs 21.5 (interquartile range, 13-29.8) d; P = 0.016). On linear regression, adherence during week 1 was inversely related to recovery time ( β = -0.002 (-0.003, 0.0), P = 0.046) and to initial exercise tolerance ( β = -0.886 (-1.385, -0.387), P < 0.001), but not to initial symptom severity ( β = 0.545 (-0.232, 1.323), P = 0.146). No adverse events or near misses were reported. CONCLUSIONS: Adherence to individualized subsymptom threshold aerobic exercise within the first week of evaluation is associated with faster recovery from SRC. The data suggest that initial degree of exercise intolerance, but not initial symptom severity, affects adherence to aerobic exercise prescribed to adolescents within 10 d of SRC.
Authors: Paul McCrory; Willem Meeuwisse; Jiří Dvořák; Mark Aubry; Julian Bailes; Steven Broglio; Robert C Cantu; David Cassidy; Ruben J Echemendia; Rudy J Castellani; Gavin A Davis; Richard Ellenbogen; Carolyn Emery; Lars Engebretsen; Nina Feddermann-Demont; Christopher C Giza; Kevin M Guskiewicz; Stanley Herring; Grant L Iverson; Karen M Johnston; James Kissick; Jeffrey Kutcher; John J Leddy; David Maddocks; Michael Makdissi; Geoff T Manley; Michael McCrea; William P Meehan; Shinji Nagahiro; Jon Patricios; Margot Putukian; Kathryn J Schneider; Allen Sills; Charles H Tator; Michael Turner; Pieter E Vos Journal: Br J Sports Med Date: 2017-04-26 Impact factor: 13.800
Authors: John J Leddy; Christina L Master; Rebekah Mannix; Douglas J Wiebe; Matthew F Grady; William P Meehan; Eileen P Storey; Brian T Vernau; Naomi J Brown; Danielle Hunt; Fairuz Mohammed; Andrea Mallon; Kate Rownd; Kristy B Arbogast; Adam Cunningham; Mohammad N Haider; Andrew R Mayer; Barry S Willer Journal: Lancet Child Adolesc Health Date: 2021-10-01
Authors: David R Howell; Danielle L Hunt; Stacey E Aaron; William P Meehan; Can Ozan Tan Journal: Am J Sports Med Date: 2021-04-15 Impact factor: 7.010
Authors: Mohammad N Haider; John J Leddy; Charles G Wilber; Kaitlin B Viera; Itai Bezherano; Kimberly J Wilkins; Jeffrey C Miecznikowski; Barry S Willer Journal: Front Neurol Date: 2019-04-24 Impact factor: 4.003