Research Reports - Aerobic exercise for adolescents with prolonged symptoms after mild traumatic brain injury

Brad G. Kurowski, M.D., M.S.,1 Jason Hugentobler, P.T.,2 Catherine Quatman-Yates, D.P.T., Ph.D.,2 Jennifer Taylor, B.A.,1 Paul J. Gubanich, M.D., M.P.H.,2 Mekibib Altaye, Ph.D.,3 and Shari L. Wade, Ph.D.1

J Head Trauma Rehabil. 2017 Mar-Apr; 32(2): 79–89.

Objective
To describe the methodology and report primary outcomes of an exploratory randomized clinical trial (RCT) of aerobic training for management of prolonged symptoms after mild traumatic brain injury (mTBI) in adolescents.

Setting
Outpatient research setting

Participants
Thirty adolescents between the ages of 12 and 17 years who sustained a mTBI and had between four and 16 weeks of persistent symptoms.

Design
Partially blinded, pilot RCT of sub-symptom exacerbation aerobic training compared to a full-body stretching program.

Main Measures
The primary outcome was post injury symptom improvement assessed by the adolescent’s self-reported Post Concussion Symptom Inventory (PCSI) repeated for at least six weeks of the intervention. Parent-reported PCSI and adherence are also described.

Results
Twenty-two percent of eligible participants enrolled in the trial. Repeated measures Analysis of Variance via mixed model analysis demonstrated a significant group by time interaction with self-reported PCSI ratings, indicating a greater rate of improvement in the sub-symptom exacerbation aerobic training compared to the full-body stretching group (F-value = 4.11, p-value = .044). Adherence to the home exercise programs was lower in the sub-symptom exacerbation aerobic training compared to the full-body stretching group (mean (SD) times per week = 4.42 (1.95) versus 5.85 (1.37), p < .0001) over the duration of the study.

Conclusion
Findings from this exploratory randomized clinical trial suggest sub-symptom exacerbation aerobic training is potentially beneficial for adolescents with persistent symptoms after mTBI. These findings and other recent research support the potential benefit of active rehabilitation programs for adolescents with persistent symptoms after mTBI. Larger replication studies are needed to verify findings and improve generalizability. Future work should focus on determining the optimal type, timing, and intensity of active rehabilitation programs and characteristics of individuals most likely to benefit.

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