The Role of Subsymptom Threshold Aerobic Exercise for Persistent Concussion Symptoms in Patients With Postconcussion Syndrome: A Systematic Review.
Journal
American journal of physical medicine & rehabilitation
ISSN: 1537-7385
Titre abrégé: Am J Phys Med Rehabil
Pays: United States
ID NLM: 8803677
Informations de publication
Date de publication:
03 2020
03 2020
Historique:
entrez:
22
2
2020
pubmed:
23
2
2020
medline:
6
5
2020
Statut:
ppublish
Résumé
In recent years, there has been a shift away from rest until total symptom resolution after concussion, due to the potential adverse consequences of inactivity. Aerobic exercise has been increasingly investigated for the treatment of postconcussion syndrome, whereby symptoms persist beyond 4 wks. The aim of this review was to systematically review the literature on subsymptom threshold aerobic exercise as a treatment for postconcussion syndrome. We conducted systematic literature searches in databases: MEDLINE (Ovid), CINAHL, PubMed, and Embase. After thorough review, 12 articles met the eligibility criteria and were included in the systematic review. The quality of selected studies was low to moderate. Subsymptom threshold aerobic exercise was associated with improvement in symptoms in patients with postconcussion syndrome for all included studies. The most commonly used protocols incorporated 20 mins of exercise at 80% of the heart rate that provoked symptoms, 5-6 days per week, with no adverse events documented. However, there was considerable variation in exercise protocols, and many studies incorporated subsymptom threshold aerobic exercise as part of a broader rehabilitation plan. Evidence supports subsymptom threshold aerobic exercise as a promising treatment for postconcussion syndrome. Further studies are required to delineate the optimal intensity, duration, and frequency of exercise for postconcussion syndrome in a variety of populations.
Identifiants
pubmed: 32079897
doi: 10.1097/PHM.0000000000001340
pii: 00002060-202003000-00011
doi:
Types de publication
Journal Article
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
257-264Références
Menon DK, Schwab K, Wright DW, et al.: Position statement: definition of traumatic brain injury. Arch Phys Med Rehabil 2010;91:1637–40
Hon KL, Leung AK, Torres AR: Concussion: a global perspective. In Seminars in Pediatric Neurology. Philadelphia, PA, WB Saunders; 2019;30:117–27
Powell JM, Ferraro JV, Dikmen SS, et al.: Accuracy of mild traumatic brain injury diagnosis. Arch Phys Med Rehabil 2008;89:1550–5
Ropper AH, Gorson KC: Concussion. New Engl J Med 2007;356:166–72
Rao DP, McFaull S, Thompson W, et al.: Trends in self-reported traumatic brain injury among Canadians, 2005-2014: a repeated cross-sectional analysis. CMAJ Open 2017;5:E301
May KH, Marshall DL, Burns TG, et al.: Pediatric sports specific return to play guidelines following concussion. Int J Sports Phys Ther 2014;9:242–55
Silverberg ND, Iverson GL: Etiology of the post-concussion syndrome: physiogenesis and psychogenesis revisited. NeuroRehabilitation 2011;29:317–29
Dobney DM, Grilli L, Kocilowicz H, et al.: Is there an optimal time to initiate an active rehabilitation protocol for concussion management in children? A case series. J Head Trauma Rehabil 2018;33:E11–7
Frost RB, Farrer TJ, Primosch M, et al.: Prevalence of traumatic brain injury in the general adult population: a meta-analysis. Neuroepidemiology 2013;40:154–9
Lal A, Kolakowsky-Hayner S, Ghajar J, et al.: A systematic review and meta-analysis on the role of exercise or rest in patients with concussion and mild traumatic brain injury. Br J Sports Med 2017;51:A83
Katz DI, Zafonte RD, Zasler ND: Brain Injury Medicine: Principles and Practice. New York, NY, Demos Medical Publishing; 2006
Schneider KJ, Iverson GL, Emery CA, et al.: The effects of rest and treatment following sport-related concussion: a systematic review of the literature. Br J Sports Med 2013;47:304–7
Downs SH, Black N: The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Commun Health 1998;52:377–84
Chan C, Iverson GL, Purtzki J, et al.: Safety of active rehabilitation for persistent symptoms after pediatric sport-related concussion: a randomized controlled trial. Arch Phys Med Rehabil 2018;99:242–9
Kurowski BG, Hugentobler J, Quatman-Yates C, et al.: Aerobic exercise for adolescents with prolonged symptoms after mild traumatic brain injury: an exploratory randomized clinical trial. J Head Trauma Rehabil 2017;32:79–89
Leddy JJ, Cox JL, Baker JG, et al.: Exercise treatment for postconcussion syndrome: a pilot study of changes in functional magnetic resonance imaging activation, physiology, and symptoms. J Head Trauma Rehabil 2013;28:241–9
Wells G: The Newcastle-Ottawa Scale (NOS) for assessing the quality of non randomised studies in meta-analyses. Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed August 20, 2019
Peterson J, Welch V, Losos M, et al.: The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa, Ottawa Hospital Research Institute; 2011
National Heart L, Institute B: Study Quality Assessment Tools: Quality Assessment Tool for Case Series Studies. Washington, DC, NHLBI; 2014
Chrisman SPD, Whitlock KB, Somers E, et al.: Pilot study of the sub-symptom threshold exercise program (SSTEP) for persistent concussion symptoms in youth. NeuroRehabilitation 2017;40:493–9
Dobney DM, Grilli L, Kocilowicz H, et al.: Evaluation of an active rehabilitation program for concussion management in children and adolescents. Brain Inj 2017;31:1753–9
Gagnon I, Galli C, Friedman D, et al.: Active rehabilitation for children who are slow to recover following sport-related concussion. Brain Inj 2009;23:956–64
Gagnon I, Grilli L, Friedman D, et al.: A pilot study of active rehabilitation for adolescents who are slow to recover from sport-related concussion. Scand J Med Sci Sports 2016;26:299–306
Grabowski P, Wilson J, Walker A, et al.: Multimodal impairment-based physical therapy for the treatment of patients with post-concussion syndrome: a retrospective analysis on safety and feasibility. Phys Ther Sport 2017;23:22–30
Imhoff S, Fait P, Carrier-Toutant F, et al.: Efficiency of an active rehabilitation intervention in a slow-to-recover paediatric population following mild traumatic brain injury: a pilot study. J Sports Med (Hindawi Publ Corp) 2016;2016:5127374
Leddy JJ, Kozlowski K, Donnelly JP, et al.: A preliminary study of subsymptom threshold exercise training for refractory post-concussion syndrome. Clin J Sport Med 2010;20:21–7
Leddy JJ, Willer B: Use of graded exercise testing in concussion and return-to-activity management. Curr Sports Med Rep 2013;12:370–6
McGeown JP, Zerpa C, Lees S, et al.: Implementing a structured exercise program for persistent concussion symptoms: a pilot study on the effects on salivary brain-derived neurotrophic factor, cognition, static balance, and symptom scores. Brain Inj 2018;32:1556–65
Moore BM, Adams JT, Barakatt E: Outcomes following a vestibular rehabilitation and aerobic training program to address persistent post-concussion symptoms. J Allied Health 2016;45:e59–68
Rytter HM, Westenbaek K, Henriksen H, et al.: Specialized interdisciplinary rehabilitation reduces persistent post-concussive symptoms: a randomized clinical trial. Brain Inj 2019;33:266–81
McCrory P, Meeuwisse W, Dvořák J, et al.: Consensus statement on concussion in sport-the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med 2017;51:838–47
McCrory P, Johnston K, Meeuwisse WH, et al.: Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague 2004. Br J Sports Med 2005;39:196–204
Lovell M, Collins M, Bradley J: Return to play following sports-related concussion. Clin Sports Med 2004;23:421–41, ix
Master CL, Gioia GA, Leddy JJ, et al.: Importance of ‘return-to-learn’ in pediatric and adolescent concussion. Pediatr Ann 2012;41:1–6
McGrath N: Supporting the student-athlete’s return to the classroom after a sport-related concussion. J Athl Train 2010;45:492–8
Sady MD, Vaughan CG, Gioia GA: School and the concussed youth: recommendations for concussion education and management. Phys Med Rehabil Clin N Am 2011;22:701–19, ix
Kirkwood MW, Yeates KO, Wilson PE: Pediatric sport-related concussion: a review of the clinical management of an oft-neglected population. Pediatrics 2006;117:1359–71
Gubanich PJ, Hugentobler J, Quatman-Yates C, et al.: Aerobic exercise for adolescents with prolonged symptoms after mTBI: a randomized clinical pilot study 1910 board# 62 June 2, 200 PM-330 PM. Med Sci Sports Exerc 2016;48(5S):526
Hugentobler JA, Vegh M, Janiszewski B, et al.: Physical therapy intervention strategies for patients with prolonged mild traumatic brain injury symptoms: a case series. Int J Sports Phys Ther 2015;10:676–89