A Fully Virtual Graded Exertion Test Is Safe and Feasible in Symptomatic and Asymptomatic Children With Concussion

Current graded exertion tests (GXTs) for concussion management require specialized equipment and in-person supervision. The Montreal Virtual Exertion (MOVE) protocol is a telehealth-compatible GXT but has been tested only in pseudo-virtual conditions.

To determine the safety and feasibility of the MOVE protocol when administered remotely to children with concussion.

Cohort study.

Virtual visit.

Asymptomatic (9 girls, 6 boys; age = 12.9 ± 2.7 years, time postconcussion = 40.8 ± 19.2 days) and symptomatic (9 girls, 6 boys; age = 12.9 ± 2.5 years, time postconcussion = 28.7 ± 23.0 days) children with concussion were recruited from the Montreal Children's Hospital Concussion Clinic between November 2023 and June 2024.

Participants completed the MOVE protocol and a follow-up visit 24 hours later over Zoom. The MOVE protocol consists of 7 plyometric exercises performed for 60 seconds with 60 seconds of rest between stages. Safety (adverse events) and feasibility measures (protocol, outcomes, intensity, and technology categories) were collected. Linear mixed models were used to evaluate exercise intensity outcomes with all other outcomes analyzed using chi-square tests.

One participant in each group experienced a minor adverse event (symptom increase of ≥10 points on the Post-Concussion Symptom Inventory at the 24-hour visit); however, no major adverse events were reported. Mean heart rate (78.7 ± 33.6 beats/min; P < .001) and rate of perceived exertion (4.87 ± 1.50; P < .001) change scores increased throughout the MOVE protocol, but no main effect of group or interaction effect was observed. Feasibility outcomes were less likely to be captured during the rest period for asymptomatic children (outcomes not collected on time on 33 [31.4%] of 105 occasions) than symptomatic children (11 [11.7%] of 94 occasions; ${\text{χ}}_1^2$ = 10.1, P < .001). Otherwise, all outcomes met the a priori definition of feasibility.

The MOVE protocol can be safely and feasibly administered virtually. A no-equipment, virtual GXT can remove barriers to exercise testing and broaden access to best-practice concussion-management strategies.