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4) Rest & Exercise
4.2 Graded exercise testing provides insight into the associated symptom burden of children and adolescents with concussion
  1. Maree Cassimatis1,
  2. Gary Browne1,3,
  3. Andrew Fyffe1,2,
  4. Rhonda Orr2,4
  1. 1Sydney Children’s Hospital Network, Children’s Hospital Institute of Sports Medicine, The Royal Alexandra Hospital for Children, Children’s Hospital Westmead, Sydney, Australia
  2. 2Discipline of Exercise and Sports Science, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
  3. 3Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, Australia
  4. 4The Children’s Hospital at Westmead Clinical School, Sydney Medical School, The University of Sydney, Sydney, Australia

Abstract

Objective Graded exercise testing is fast emerging as an innovative approach to assess individuals with concussion and predict recovery outcomes. The aim of this study is to determine the correlation between graded exercise testing and symptom severity in children and adolescents diagnosed with a concussion.

Design Prospective cohort study.

Setting Sydney paediatric hospital.

Participants Two hundred and fifty-eight children and adolescents with a concussion, aged 7–18 years.

Interventions (or Assessment of Risk Factors) A graded exercise test (GXT) was conducted on a treadmill, following the Bruce protocol. Participants were supervised and monitored at each stage of the GXT utilising a heart rate monitor, the Wong-Baker FACES Pain Rating Scale and Rating of Perceived Exertion (RPE) 1–10 scale.

Outcome Measures GXT time was measured in minutes. The Post-Concussion Symptom Scale (PCSS) was used to assess symptom severity.

Main Results Of the 258 participants recruited (mean age: 13.34 ± 2.25, 73% male), 438 GXT times and concurrent PCSS data entries were analysed. The mean GXT time was 10.65 (95% CI: 10.38–10.93) minutes and mean PCSS score was 20.25 (95% CI: 18.28–22.22). Pearson’s correlation revealed a moderate negative association between GXT time and symptom severity (r = -0.410, p<0.001). No adverse events during testing were reported.

Conclusions Graded exercise testing is a safe and valuable tool in assessing children and adolescents with concussion, providing insight into their associated symptom burden. Implementing a GXT as part of standard concussion assessments will be useful for clinicians when devising an individualised graded return to play program.

https://doi.org/10.1136/bjsports-2023-concussion.64

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