American Medical Society for Sports Medicine
For Immediate Release Apr 17, 2015

A Randomized Controlled Trial of Assessment of Exercise Tolerance in Adolescents with Acute Sport-Related Concussion (SRC)

Hollywood, Florida– April 17, 2015– John Leddy, MD, Associate Professor at the University of Buffalo School of Medicine and Biomedical Sciences in Buffalo, NY presented, “A Randomized Controlled Trial of Assessment of Exercise Tolerance in Adolescents with Acute Sport-Related Concussion” today at the 24th Annual Meeting of the American Medical Society for Sports Medicine in Hollywood, FL. 

The 2015 conference, with more than 1,500 sports medicine physicians attending from throughout the United States and around the world, explores current decisions, controversies and best practices related to return-to-play decision making that defines the clinical practice of sports medicine.

Dr. Leddy presented on the topic of assessment of exercise tolerance in the acute phase of concussion and found that exercise testing was safe and could be predictive of short-term concussion outcomes.  Leddy serves as the Medical Director of the University at Buffalo Concussion Clinic which is the first clinic in the United States to use standardized treadmill testing to establish recovery in acute concussion.

Concussions are common in adolescent athletes.   Currently there are no tests available to determine who will have a protracted recovery.  Determining short-term prognosis can be helpful for athletes, schools, parents, and coaches.   Dr. Leddy investigated whether an assessment of exercise tolerance in the acute phase of concussion delays recovery or causes adverse events. A secondary aim of the study was to determine which factors in the acute phase of a concussion are predictive of recovery at 2-3 weeks post injury.

The study randomized 50 adolescents, (17 female, 33 male with a mean age of 15.4), who had sustained a concussion between 1-9 days earlier into two groups.  All participants were assessed for symptoms and underwent a computer concussion test at the initial visit.  All participants also reported daily symptoms on a secure website. Half were randomized to undergo treadmill testing for exercise tolerance at initial assessment and half did not undergo exercise testing.  The participants who were assigned to the exercise testing group were exercised on a treadmill.   Their exercise tolerance level was determined based on whether their symptoms were exacerbated by exercise and at what heart rate and perceived exertion level their symptoms were provoked.   At a follow up appointment 2-3 weeks later all participants had treadmill exercise tolerance testing.  His team then analyzed which factors predicted recovery which was defined as having no symptoms, being tolerant to exercise, and a satisfactory physician evaluation from a physician who was blinded to which group the teen was in.

His study found that no adolescents suffered any adverse events. 19/25 adolescents in the exercise tolerance testing group and 20/25 adolescents in the no tolerance test group had recovered by the follow up visit.   There was no significant difference in the reported daily symptoms between the two groups.   While gender, age, number of prior concussions, symptom severity, and computer test scores at initial assessment were not found to be predictive of short term outcome; heart rate at the threshold where symptoms were provoked at initial evaluation was found to be predictive of recovery at 2-3 weeks.   Based on this small study exercise tolerance assessment appears to be safe and does not delay recovery.  Additionally when utilized in the acute concussion, it can be potentially utilized as a safe way to assess short-term recovery prognosis.  

About the AMSSM Annual Meeting: The conference features lectures and research addressing the most challenging topics in sports medicine today including issues surrounding FIFA & soccer injuries, ACL injury prevention, cardiovascular disease, degenerative joint disease, the power of physical activity in maintaining a healthy population, baseball injuries, Chronic Traumatic Encephalopathy, sports ultrasound, pediatric sports medicine, groin pain/athletic pubalgia and provocative issues dealing with return-to-play decision making.

About the AMSSM: AMSSM is a multi-disciplinary organization of 2,700+ sports medicine physicians dedicated to education, research, advocacy and the care of athletes of all ages. The majority of AMSSM members are primary care physicians with fellowship training and added qualification in sports medicine who then combine their practice of sports medicine with their primary specialty. AMSSM includes members who specialize solely in non-surgical sports medicine and serve as team physicians at the youth level, NCAA, NFL, MLB, NBA, WNBA, MLS and NHL, as well as with Olympic teams. By nature of their training and experience, sports medicine physicians are ideally suited to provide comprehensive medical care for athletes, sports teams or active individuals who are simply looking to maintain a healthy lifestyle. www.amssm.org