焦虑在脑震荡后运动不耐受和自主神经系统功能障碍中的作用。
Role of anxiety in exercise intolerance and autonomic nervous system dysfunction post-concussion.
作者信息
Zynda Aaron J, Trbovich Alicia M, Kehinde Faith, Burley Christopher, Collins Michael W, Okonkwo David O, Mucha Anne, Ostop Sarah, Holland Cyndi, Perry Courtney, Womble Melissa N, Jennings Sabrina, Fedor Sheri, Dollar Christina, Durfee Kori J, Elbin R J, Kontos Anthony P
机构信息
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Neurological Surgery, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA, USA.
出版信息
Neurol Sci. 2025 Apr 28. doi: 10.1007/s10072-025-08204-9.
OBJECTIVE
To compare autonomic nervous system (ANS) response using the Buffalo Concussion Bike Test (BCBT) between adult post-concussion patients with and without pre-existing and post-injury anxiety.
DESIGN
Cross-sectional cohort study of participants from the Targeted, Multidomain (T-MD) Treatment for Concussion Randomized Controlled Trial.
SETTING
Two concussion specialty clinics.
PARTICIPANTS
Ages 18-49 years, 8 days to 6 months from injury, without a history of cardiovascular/neurological/vestibular disorders. 256 participants were eligible, 120 declined, 136 enrolled, and 30 were excluded.
EXPOSURES
Participants completed the BCBT at a baseline study visit following initial clinical evaluation.
MAIN OUTCOMES AND MEASURES
Number of BCBT stages completed and Visual Analogue Scale (VAS), heart rate (HR), blood pressure (BP), and Ratings of Perceived Exertion (RPE) pre- and post-BCBT.
RESULTS
106 participants (age = 25.5 [12.5], 66 [62.3%] female) were included, 44 (41.5%) with pre-existing anxiety, 61 (57.6%) without pre-existing anxiety, 33 (31.1%) with post-injury anxiety, and 73 (68.9%) without post-injury anxiety. Eighteen (17.0%) were in both anxiety groups. Results supported a significant group x time interaction in participants with pre-existing anxiety for increased diastolic BP (F[1,97] = 5.03, p = 0.03) and VAS (F[1,99] = 5.05, p = 0.03) while controlling for covariates. Participants with pre-existing anxiety (median = 8[4]) and post-injury anxiety (median = 8[5]) completed fewer BCBT stages than those without pre-existing (median = 11[6], p < 0.01) and post-injury (median = 10[6], p = 0.03) anxiety.
CONCLUSIONS
Adults with pre-existing and post-injury anxiety experienced altered physiological responses to exercise post-concussion and completed fewer stages of the BCBT. Anxiety should be considered by clinicians when interpreting findings from exercise intolerance tests such as the BCBT.
TRIAL REGISTRATION
www.
CLINICALTRIALS
gov ; identifier: NCT04549532; https://clinicaltrials.gov/study/NCT04549532.
目的
使用布法罗脑震荡自行车测试（BCBT）比较有和没有伤前及伤后焦虑症的成年脑震荡后患者的自主神经系统（ANS）反应。
设计
对来自脑震荡针对性多领域（T-MD）治疗随机对照试验的参与者进行横断面队列研究。
设置
两家脑震荡专科诊所。
参与者
年龄在18 - 49岁之间，受伤8天至6个月，无心血管/神经/前庭疾病史。256名参与者符合条件，120名拒绝，136名登记，30名被排除。
暴露因素
参与者在初始临床评估后的基线研究访视时完成BCBT。
主要结局和测量指标
完成的BCBT阶段数以及BCBT前后的视觉模拟量表（VAS）、心率（HR）、血压（BP）和自觉用力程度评分（RPE）。
结果
纳入106名参与者（年龄 = 25.5[12.5]，66名[62.3%]为女性），44名（41.5%）有伤前焦虑症，61名（57.6%）无伤前焦虑症，33名（31.1%）有伤后焦虑症，73名（68.9%）无伤后焦虑症。18名（17.0%）同时属于两个焦虑症组。结果支持在控制协变量时，有伤前焦虑症的参与者存在显著的组×时间交互作用，表现为舒张压升高（F[1,97]=5.03，p = 0.03）和VAS升高（F[1,99]=5.05，p = 0.03）。有伤前焦虑症（中位数 = 8[4]）和伤后焦虑症（中位数 = 8[5]）的参与者完成的BCBT阶段数少于无伤前（中位数 = 11[6]，p < 0.01）和伤后（中位数 = 10[6]，p = 0.03）焦虑症的参与者。
结论
有伤前和伤后焦虑症的成年人在脑震荡后对运动的生理反应发生改变，且完成的BCBT阶段数较少。临床医生在解释运动不耐受测试（如BCBT）的结果时应考虑焦虑症因素。
试验注册
www.
临床试验
gov；标识符：NCT04549532；https://clinicaltrials.gov/study/NCT04549532。
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