A new study will evaluate whether persistent symptoms following concussion, also known as post-concussion syndrome, can be treated using a personalized, progressive aerobic exercise program. Data from this ongoing study by researchers at the University of Calgary will be presented this week at the Association of Academic Physiatrists Annual Meeting in Orlando.

Up to 30% of adults who experience a concussion will continue to experience persistent post-concussive symptoms (PPCS) months to years following their injury. In concussed adolescents, sub-symptom threshold aerobic exercise interventions have been shown to speed recovery and decrease the burden of concussive symptoms. Researchers are evaluating a 6-week aerobic exercise program compared to a stretching program in adults with persistent symptoms following concussion, and are halfway through this new study, says Leah Mercier, MSc, a graduate student at the University of Calgary in Alberta, Canada, and one of the study’s co-authors.

“While aerobic exercise trials in teens with sports-related concussion have shown promise, a similar program in adults has not yet been studied. The individuals in the current study are experiencing chronic symptoms following injury, often affecting their ability to return to work, exercise and perform other daily activities,” says Mercier. “Unfortunately, for this patient population there are few personalized, non-pharmacological interventions with the potential to treat multiple symptoms.”

This ongoing aerobic exercise clinical trial has the potential to decrease overall symptom burden in adults following concussion as measured using the Rivermead Post-concussion Symptom Questionnaire (RPQ), says Mercier. Measures of specific symptoms including fatigue, mood, anxiety, dizziness, headache and sleep will be evaluated. The researchers also will analyze blood biomarkers and magnetic resonance imaging (MRI) data to better understand the mechanisms of recovery following the intervention.

Fifty-six adults aged 18 to 65 presenting with persistent symptoms of more than 3 months to 5 years will be enrolled in the study. Study participants will be randomized to complete either a 6-week aerobic exercise program or a 6-week stretching program. Aerobic and stretching prescriptions will be for 5 days per week for 30 minutes each. Participants will be prescribed a heart rate target for exercise based on their individual symptom threshold. They will log their activity in a daily online diary.

The researchers are using the Buffalo Concussion Treadmill Test (BCTT) to assess participants’ exercise intolerance. The prescribed target heart rate for the aerobic exercise protocol is 80% of the maximum heart rate achieved on this standard test. Exercise prescriptions are updated every 3 weeks.

Recruitment for the study will continue until the end of 2020, when the researchers will evaluate the efficacy of aerobic exercise to treat adults with PPCS, says Mercier.

“Individuals with PPCS frequently continue to struggle with headaches, dizziness, fatigue, cognitive impairments, low mood, anxiety and exercise intolerance for months to years following concussion,” she says. “A progressive aerobic exercise intervention has the potential to not only decrease exercise intolerance, but also treat multiple post-concussive symptoms.”