UMEM Educational Pearls

Sport related concussion has been estimated to affect almost 2 million children and adolescents in the United states annually

Patients who take longer than four weeks to recover are considered to have persistent post concussive symptoms

This diagnosis is associated with poor educational, social and developmental outcomes in pediatric patients

Following sport related concussion, patients are recommended to have an individualized aerobic exercise program

Prior studies have found that sub symptom threshold aerobic exercise safely and significantly speeds recovery from sport related concussion.

Purpose: This study attempted to answer whether there is a direct relationship between adherence to a personalized exercise prescription and recovery or if initial symptom burden effects adherence to the prescription.

Design: Male and female adolescents aged 13 to 18 years old presenting within 10 days of injury and diagnosed with sport related concussion.

Almost all participants (94%) sustained concussion during interscholastic games or practices.

As it is known that physician encouragement can influence patient adherence to medical interventions, treating physicians in the study were blinded to study arm assignment.

Patients were given aerobic exercise prescriptions based on their heart rate threshold at the point of exercise intolerance on a graded treadmill test

Adherence to prescription was determined objectively with heart rate monitors. No participants exercised above their prescribed heart rate intensity.

Patients who completed at least 2/3 of their aerobic exercise prescription were considered to be adherent

Results: 61% of adolescents met the adherence criterion

Adherent patients were more symptomatic and were more exercise intolerant (worse initial exercise tolerance) at their initial visit.

These patients were also more adherent than those with fewer symptoms and with better exercise tolerance. This likely indicates a stronger motivation for those more symptomatic patients to engage in a potentially effective intervention.

Adherent patients recovered faster than those who were not adherent (median recovery time 12 days versus 21.5 days (P = 0.016)

Adherence during week one was inversely related to recovery time and to initial exercise tolerance but not to initial symptom severity

Conclusion: Adherence to individualized sub symptom threshold aerobic exercise within the first week of sport related concussion is associated with faster recovery. The initial degree of exercise intolerance (but not initial symptom severity) affects adherence to aerobic exercise prescription in an adolescent population with sport related concussion

 

 

 

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