Related Experiment Video
Updated: May 26, 2025
A Multi-Modal Approach to Assessing Recovery in Youth Athletes Following Concussion
Published on: September 25, 2014
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).
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.
Setting:
Pediatric tertiary referral concussion clinic.
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.
More Related Videos
07:01A Pediatric Concussion Model in Mice: Closed Head Injury with Long-Term Disorders (CHILD)
Published on: February 7, 2025
05:48Autonomic Function Following Concussion in Youth Athletes: An Exploration of Heart Rate Variability Using 24-hour Recording Methodology
Published on: September 21, 2018