Evaluating Aerobic Exercise to Improve Symptom Burden and Quality of Life in Adults with Persistent Post-Concussive Symptoms
Date
2023-06
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Abstract
Adults who sustain a mild traumatic brain injury (mTBI) and go on to develop persistent post-concussive symptoms (PPCS) struggle to manage their symptoms and return to pre-morbid activity. There are few evidence-based treatments that have shown benefit in improving PPCS. Prescription of sub-symptom threshold aerobic exercise following mTBI has gained attention in recent years; however, the literature has largely focused on adolescents with sport-related mTBI despite the potential role of aerobic exercise in the treatment of adults with PPCS. This thesis begins by characterizing physical activity (PA) and sedentary behavior and their associations with symptom burden and quality of life (QoL) in adults with PPCS. Next, a systematic review describes the evidence for autonomic dysfunction, namely through evaluation of heart rate variability (HRV), following mTBI. Limitations of the literature including confounding variables that may influence interpretation of results are discussed. The next chapter is the protocol of a randomized clinical trial evaluating a sub-symptom threshold aerobic exercise intervention for improvement in symptom burden, QoL, specific symptom outcomes and sleep. In the following chapter, the results of the trial are presented. The thesis goes on to evaluate changes in heart rate, HRV, blood pressure and cardiac baroreceptor sensitivity between adults with PPCS and age/sex-matched controls. In the PPCS group, longitudinal changes in autonomic metrics following an aerobic exercise intervention are also presented. This work builds on our knowledge of PA and sedentary behavior in adults with PPCS and how aerobic exercise may play a role in the treatment of this patient population. Significant improvements in symptom burden, QoL and other specific symptom outcomes were observed following 6-weeks of aerobic exercise. These outcomes did not significantly improve following 6-weeks of stretching. Lower resting HRV in adults with PPCS compared to age/sex-matched controls and blunted response to postural change provides evidence of cardiovascular autonomic dysfunction in this cohort, although improvement in these outcomes was not observed with the exercise intervention. This thesis provides data to suggest adults with PPCS can benefit from sub-symptom threshold exercise and prescription of aerobic exercise should be considered in the chronic phase of injury despite persistence of symptoms.
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Keywords
concussion, mild traumatic brain injury, exercise
Citation
Mercier, L. J. (2023). Evaluating aerobic exercise to improve symptom burden and quality of life in adults with persistent post-concussive symptoms (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.