Mercier Leah J, McIntosh Samantha J, Boucher Chloe, Joyce Julie M, Batycky Julia, Galarneau Jean-Michel, Burma Joel S, Smirl Jonathan D, Esser Michael J, Schneider Kathryn J, Dukelow Sean P, Harris Ashley D, Debert Chantel T
Department of Clinical Neurosciences, Division of Physical Medicine and Rehabilitation, University of Calgary, Calgary, AB, Canada.
Hotchkiss Brain Institute (HBI), University of Calgary, Calgary, AB, Canada.
Front Neurol. 2024 Dec 24;15:1482266. doi: 10.3389/fneur.2024.1482266. eCollection 2024.
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.
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; = 27) or following 6-weeks of stretching (d-AEP group; = 23). Data from all participants ( = 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.
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, < 0.001; d-AEP: mean change = -3.478, = 0.034; c-AEP: mean change = -6.446, < 0.001). Participants also had significant improvement in quality of life (i-AEP: mean change = 9.879, < 0.001; d-AEP: mean change = 7.994, < 0.001, c-AEP: mean change = 8.937, < 0.001), dizziness (i-AEP: mean change = -11.159, = 0.001; d-AEP: mean change = -6.516, = 0.019; c-AEP: -8.837, < 0.001) and exercise tolerance (i-AEP: mean change = 5.987, < 0.001; d-AEP: mean change = 3.421, < 0.001; c-AEP: mean change = 4.703, < 0.001). Headache (mean change = -5.522, < 0.001) and depressive symptoms (mean change = -3.032, = 0.001) improved in the i-AEP group. There was no change in measures of autonomic function.
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.
尽管指南支持在亚急性轻度创伤性脑损伤（mTBI）中进行有氧运动，但缺乏关于mTBI后有持续脑震荡后症状（PPCS）的成年人的证据。目的是评估亚症状阈值有氧运动干预对患有PPCS的成年人的总体症状负担和生活质量的影响。
这项前瞻性队列研究嵌套在ACTBI试验（轻度创伤性脑损伤后慢性症状的有氧运动治疗）中。共有50名诊断为mTBI、PPCS和运动不耐受的成年人在入组后立即（i-AEP组；n = 27）或经过6周的拉伸后（d-AEP组；n = 23）完成了为期12周的亚症状阈值有氧运动干预。所有参与者（n = 50）的数据被纳入联合AEP（c-AEP）组。主要结局是Rivermead脑震荡后症状问卷（RPQ）上的症状负担。次要结局包括生活质量和特定脑震荡后症状（抑郁和焦虑症状、头痛的功能影响、疲劳、睡眠、头晕和运动耐量）的测量。还评估了心率、血压和心率变异性，以了解自主神经功能对干预的反应。
参与者的平均（标准差）年龄为42.6（10.9）岁（74%为女性），mTBI后25.1（14.1）个月。经过为期12周的干预，参与者在RPQ上的症状负担有显著改善（i-AEP组：平均变化 = -9.415，p < 0.001；d-AEP组：平均变化 = -3.478，p = 0.034；c-AEP组：平均变化 = -6.446，p < 0.001）。参与者的生活质量（i-AEP组：平均变化 = 9.879，p < 0.001；d-AEP组：平均变化 = 7.994，p < 0.001，c-AEP组：平均变化 = 8.937，p < 0.
