An Australian research group led by Dr. Gary Browne of Sydney Children’s Hospital Network has published a study “Exercise Tolerance in Pediatric Concussion: An 8-Year Longitudinal Study” published in the Journal of Head Trauma Rehabilitation. Dr. Browne’s group looked at exercise tolerance in 313 pediatric concussion patients aged 6-18 years old who entered a concussion clinic over an 8-year period between January 2015 and December 2022.
The 313 patients were given an exercise test on a treadmill called the “Bruce Protocol”. Developed by cardiologist Dr. Robert A. Bruce, the test has the patient walk on an uphill treadmill in a graded exercise test with electrodes on the chest to monitor. Every 3 minutes, the speed and incline of the treadmill are increased, for a total of 7 times.
Based on how patients performed on the test they were divided into 2 groups: (1) an “exercise tolerant” group if they could last 9 or more minutes; or (2) an “exercise intolerant” group if they could last less than 9 minutes. The groups were compared for number and severity of symptoms related to concussion (called “symptom burden”), cognitive function, and recovery duration. The exercise test was performed at multiple visits for the same patient.
Key Findings:
- Delayed presentation of the initial injury and high initial “symptom burden” were significant predictors of prolonged concussion recovery
- Graded exercise tolerance is also a good predictor of prolonged concussion recovery
- Exercise-intolerant participants reported 2 times greater initial symptom severity and performed poorly in visual memory and reaction time
We’ve blogged previously about the importance of active therapy after concussion. This study highlights the importance of personalized, activity-based rehabilitation approaches in pediatric concussion management. By identifying exercise intolerance early, healthcare providers can tailor rehabilitation strategies to each child’s specific needs, potentially shortening recovery durations and improving overall well-being. You can access the abstract of the study here: The Journal of Head Trauma Rehabilitation