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Exercise Tolerance in Pediatric Concussion: An 8-Year Longitudinal Study.

Maree Cassimatis1, Rhonda Orr, Andrew Fyffe

  • 1Author Affiliations: Discipline of Exercise and Sports Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia (Ms Cassimatis, Prof Orr, Mr Fyffe); Sydney Children's Hospital Network, Children's Hospital Institute of Sports Medicine, Children's Hospital Westmead, Sydney, NSW, Australia (Orr and Dr Browne); and The Children's Hospital at Westmead Clinical School, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia (Dr Browne).

The Journal of Head Trauma Rehabilitation
|February 25, 2025
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Summary

Exercise intolerance in children with concussion is linked to more severe symptoms, cognitive issues, and longer recovery times. Graded exercise testing (GXT) can identify those at risk for prolonged recovery.

Keywords:
graded exercise testingmild traumatic brain injuryrecoveryrisk stratificationsport-related concussion

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Area of Science:

  • Pediatric neurology
  • Sports medicine
  • Rehabilitation science

Background:

  • Concussion recovery in children is complex and can be influenced by various factors.
  • Exercise tolerance is increasingly recognized as a potential biomarker in concussion management.
  • Understanding the relationship between exercise capacity and recovery outcomes is crucial for effective clinical intervention.

Purpose of the Study:

  • To determine the relationship between exercise tolerance and post-concussion symptom severity, cognitive function, and recovery duration.
  • To examine the longitudinal effect of exercise tolerance on symptom burden during pediatric concussion recovery.
  • To assess if exercise intolerance is a significant predictor of prolonged recovery in pediatric concussion.

Main Methods:

  • Retrospective longitudinal study of 313 children and adolescents (aged 6-18) treated at a pediatric concussion clinic.
  • Exercise tolerance measured using graded exercise testing (GXT) via the Bruce Protocol, dichotomizing participants into exercise-tolerant (≥9 minutes) and exercise-intolerant (<9 minutes) groups.
  • Comparison of symptom burden, cognitive function (visual memory, reaction time), and recovery duration between groups, with subgroup analysis for longitudinal changes.

Main Results:

  • Exercise-intolerant participants exhibited 2 times greater initial symptom severity and poorer performance in visual memory and reaction time compared to exercise-tolerant peers.
  • Recovery duration was significantly longer for exercise-intolerant children (94 days) versus exercise-tolerant children (69 days).
  • Delayed presentation, high initial symptom burden, and exercise intolerance were significant predictors of prolonged concussion recovery.

Conclusions:

  • Graded exercise testing (GXT) is a clinically relevant tool for identifying pediatric concussion patients at risk of prolonged recovery.
  • Exercise intolerance is a significant determinant of recovery duration and symptom burden in pediatric concussion.
  • Early identification of exercise intolerance can guide targeted interventions to improve concussion outcomes.