Evaluating a 12-week aerobic exercise intervention in adults with persisting post-concussive symptoms

Leah J Mercier; Samantha J McIntosh; Chloe Boucher; Julie M Joyce; Julia Batycky; Jean-Michel Galarneau; Joel S Burma; Jonathan D Smirl; Michael J Esser; Kathryn J Schneider; Sean P Dukelow; Ashley D Harris; Chantel T Debert

doi:10.3389/fneur.2024.1482266

Evaluating a 12-week aerobic exercise intervention in adults with persisting post-concussive symptoms

Front Neurol. 2024 Dec 24:15:1482266. doi: 10.3389/fneur.2024.1482266. eCollection 2024.

Authors

Leah J Mercier^{1

2}, Samantha J McIntosh^{1

2}, Chloe Boucher^{1

2}, Julie M Joyce^{2

3}, Julia Batycky^{1

2}, Jean-Michel Galarneau⁴, Joel S Burma^{2

4

5

6

7}, Jonathan D Smirl^{2

4

5

6

7}, Michael J Esser^{2

6

8}, Kathryn J Schneider^{2

4

6}, Sean P Dukelow^{1

2}, Ashley D Harris^{2

3

6}, Chantel T Debert^{1

2

6}

Affiliations

¹ Department of Clinical Neurosciences, Division of Physical Medicine and Rehabilitation, University of Calgary, Calgary, AB, Canada.
² Hotchkiss Brain Institute (HBI), University of Calgary, Calgary, AB, Canada.
³ Department of Radiology, University of Calgary, Calgary, AB, Canada.
⁴ Sport Injury Prevention Research Centre (SIPRC), Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.
⁵ Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada.
⁶ Alberta Children's Research Institute (ACHRI), University of Calgary, Calgary, AB, Canada.
⁷ Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.
⁸ Department of Pediatrics, Section of Neurology, University of Calgary, Calgary, AB, Canada.

Abstract

Background: Although guidelines support aerobic exercise in sub-acute mild traumatic brain injury (mTBI), evidence for adults with persisting post-concussive symptoms (PPCS) after mTBI is lacking. The objective was to evaluate the impact of a sub-symptom threshold aerobic exercise intervention on overall symptom burden and quality of life in adults with PPCS.

Methods: This prospective cohort study was nested within the ACTBI Trial (Aerobic Exercise for treatment of Chronic symptoms following mild Traumatic Brain Injury). A total of 50 adults with a diagnosis of mTBI, PPCS and exercise intolerance completed a 12-week sub-symptom threshold aerobic exercise intervention either immediately after enrollment (i-AEP group; n = 27) or following 6-weeks of stretching (d-AEP group; n = 23). Data from all participants (n = 50) were included in the combined AEP (c-AEP) group. The primary outcome was symptom burden on the Rivermead Post Concussion Symptoms Questionnaire (RPQ). Secondary outcomes included measures of quality of life and specific post-concussive symptoms (depressive and anxiety symptoms, functional impact of headache, fatigue, sleep, dizziness and exercise tolerance). Heart rate, blood pressure and heart rate variability were also assessed to understand autonomic function response to intervention.

Results: Participants were a mean (SD) of 42.6 (10.9) years old (74% female) and 25.1 (14.1) months post-mTBI. Following 12-weeks of intervention participants had a significant improvement in symptom burden on the RPQ (i-AEP: mean change = -9.415, p < 0.001; d-AEP: mean change = -3.478, p = 0.034; c-AEP: mean change = -6.446, p < 0.001). Participants also had significant improvement in quality of life (i-AEP: mean change = 9.879, p < 0.001; d-AEP: mean change = 7.994, p < 0.001, c-AEP: mean change = 8.937, p < 0.001), dizziness (i-AEP: mean change = -11.159, p = 0.001; d-AEP: mean change = -6.516, p = 0.019; c-AEP: -8.837, p < 0.001) and exercise tolerance (i-AEP: mean change = 5.987, p < 0.001; d-AEP: mean change = 3.421, p < 0.001; c-AEP: mean change = 4.703, p < 0.001). Headache (mean change = -5.522, p < 0.001) and depressive symptoms (mean change = -3.032, p = 0.001) improved in the i-AEP group. There was no change in measures of autonomic function.

Conclusion: A 12-week aerobic exercise intervention improves overall symptom burden, quality of life and specific symptom domains in adults with PPCS. Clinicians should consider prescription of progressive, individualized, sub-symptom threshold aerobic exercise for adults with PPCS even if presenting with exercise intolerance and months-to-years of symptoms.

Keywords: aerobic exercise; concussion; mild traumatic brain injury; persisting post-concussive symptoms; quality of life.

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This trial was supported by a New Frontiers in Research Fund Exploration Grant, Foundations of Physical Medicine and Rehabilitation Mid-Career Grant and a Hotchkiss Brain Institute PFUND Award. Additional support was provided by the Hotchkiss Brain Institute. L. J. Mercier was supported by a Graduate Studentship in Patient-Oriented Research from the Alberta SPOR Support Unit (jointly funded by Alberta Innovates-Health Solutions and the Canadian Institute of Health Research), a Dr. Matthew Galati Brain Changer Award from Brain Canada, a Graduate Studentship from the Integrated Concussion Research Program and University of Calgary Scholarships. The Dr. Matthew Galati Brain Changer Award has been made possible by the Canada Brain Research Fund (CBRF), an innovative arrangement between the Government of Canada (through Health Canada) and Brain Canada Foundation, and by the Brain Changes Initiative. S. J. McIntosh was supported by an O’Brien Centre Summer Studentship Award and University of Calgary Scholarships. C. Boucher was supported by an Alberta Innovates Summer Research Studentship. A. D. Harris holds a Canada Research Chair in Magnetic Resonance Spectroscopy in Brain Injury.