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Comparison of Rest to Aerobic Exercise and Placebo-like Treatment of Acute Sport-Related Concussion in Male and Female Adolescents

  • Barry S. Willer
    Correspondence
    Corresponding author Barry S. Willer, PhD, 3435 Main Street, 160 Farber Hall, Buffalo, NY 14214.
    Affiliations
    Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, United States
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  • Mohammad N. Haider
    Affiliations
    UBMD Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, United States

    PhD Program in Biomedical Science, Neuroscience, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, United States
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  • Itai Bezherano
    Affiliations
    Department of Nutrition and Exercise Science, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, United States
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  • Charles G. Wilber
    Affiliations
    UBMD Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, United States
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  • Rebekah Mannix
    Affiliations
    Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States
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  • Katherine Kozlowski
    Affiliations
    Department of Nutrition and Exercise Science, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, United States
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  • John J. Leddy
    Affiliations
    UBMD Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, United States
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Published:August 01, 2019DOI:https://doi.org/10.1016/j.apmr.2019.07.003

      Abstract

      Objective

      To compare a sample of adolescents with sport-related concussion (SRC) who were prescribed rest with 2 arms of a randomized controlled trial comparing aerobic exercise with placebo-like stretching. We also compared sex differences across the 3 approaches to treatment.

      Design

      Quasi-experimental trial.

      Setting

      University concussion management clinics.

      Participants

      Adolescent athletes (aged 13-18 years) presenting within 10 days of SRC (mean, 5 days after injury) received a recommendation for rest (rest group [RG], n=48, 15.4±1y, 25% female). Their outcomes were compared with matched samples of adolescents assigned to aerobic exercise (exercise group [EG], n=52, 15.3±2y, 46% female) or placebo-like stretching (placebo group [PG], n=51, 15.4±2y, 47% female) (N=151).

      Main Outcome Measures

      The primary outcome was median days from injury to recovery. The secondary outcome was proportion classified as normal recovery (<30d) or delayed recovery (≥30d).

      Results

      The RG recovered in 16 days (interquartile range, 9.25-23.25d), which was significantly delayed (P=.020) compared with EG (13d; interquartile range, 10-18.5d). The PG recovered in 17 days (interquartile range, 13-23d). Four percent of the EG, 14% of the PG, and 13% of the RG had delayed recovery (P=.190). There was no difference in recovery time or delayed recovery between male participants and female participants across groups. Female participants prescribed rest experienced an increase in symptoms vs the other groups (P=.013).

      Conclusion

      Relative rest and a placebo-like stretching program were very similar in days to recovery and symptom improvement pattern after SRC. Both conditions were less effective than subsymptom threshold aerobic exercise. Female adolescents appear to be susceptible to symptom increase when prescribed rest.

      Keywords

      List of abbreviations:

      ANOVA (analysis of variance), BCTT (Buffalo Concussion Treadmill Test), BDNF (brain-derived neurotrophic factor), EG (exercise group (adolescents prescribed subthreshold aerobic exercise)), PCSS (Post Concussion Symptom Scale), PG (placebo group (adolescents prescribed stretching exercises)), RCT (randomized controlled trial), RG (rest group (adolescents recommended to rest after diagnosis of concussion)), SRC (sport-related concussion)
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