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Randomized Controlled Trial
. 2024 Feb 5;7(2):e2356458.
doi: 10.1001/jamanetworkopen.2023.56458.

Optimal Volume of Moderate-to-Vigorous Physical Activity Postconcussion in Children and Adolescents

Andrée-Anne Ledoux  1   2 , Veronik Sicard  1 , Vid Bijelic  1 , Nick Barrowman  1 , Michael M Borghese  3 , Nicholas Kuzik  1 , Mark S Tremblay  1   4 , Keith Owen Yeates  5   6 , Adrienne L Davis  7 , Gurinder Sangha  8 , Nick Reed  9 , Roger Leonard Zemek  1   4 ; PERC PedCARE team
Affiliations
Randomized Controlled Trial

Optimal Volume of Moderate-to-Vigorous Physical Activity Postconcussion in Children and Adolescents

Andrée-Anne Ledoux et al. JAMA Netw Open. .

Abstract

Importance: Determining the optimal volume of early moderate-to-vigorous-intensity physical activity (MVPA) after concussion and its association with subsequent symptom burden is important for early postinjury management recommendations.

Objectives: To investigate the association between cumulative MVPA (cMVPA) over 2 weeks and subsequent symptom burden at 1 week, 2 weeks, and 4 weeks postinjury in children and examine the association between cMVPA and odds of persisting symptoms after concussion (PSAC) at 2 weeks and 4 weeks postinjury.

Design, setting, and participants: This multicenter cohort study used data from a randomized clinical trial that was conducted from March 2017 to December 2019 at 3 Canadian pediatric emergency departments in participants aged 10.00 to 17.99 years with acute concussion of less than 48 hours. Data were analyzed from July 2022 to December 2023.

Exposure: cMVPA postinjury was measured with accelerometers worn on the waist for 24 hours per day for 13 days postinjury, with measurements deemed valid if participants had 4 or more days of accelerometer data and 3 or fewer consecutive days of missing data. cMVPA at 1 week and 2 weeks postinjury was defined as cMVPA for 7 days and 13 days postinjury, respectively. Multiple imputations were carried out on missing MVPA days.

Main outcomes and measures: Self-reported postconcussion symptom burden at 1 week, 2 weeks, and 4 weeks postinjury using the Health and Behavior Inventory (HBI). PSAC was defined as reliable change on the HBI. A linear mixed-effect model was used for symptom burden at 1 week, 2 weeks, and 4 weeks postinjury with a time × cMVPA interaction. Logistic regressions assessed the association between cMVPA and PSAC. All models were adjusted for prognostically important variables.

Results: In this study, 267 of 456 children (119 [44.6%] female; median [IQR] age, 12.9 [11.5 to 14.4] years) were included in the analysis. Participants with greater cMVPA had significantly lower HBI scores at 1 week (75th percentile [258.5 minutes] vs 25th percentile [90.0 minutes]; difference, -5.45 [95% CI, -7.67 to -3.24]) and 2 weeks postinjury (75th percentile [565.0 minutes] vs 25th percentile [237.0 minutes]; difference, -2.85 [95% CI, -4.74 to -0.97]) but not at 4 weeks postinjury (75th percentile [565.0 minutes] vs 25th percentile [237.0 minutes]; difference, -1.24 [95% CI, -3.13 to 0.64]) (P = .20). Symptom burden was not lower beyond the 75th percentile for cMVPA at 1 week or 2 weeks postinjury (1 week, 259 minutes; 2 weeks, 565 minutes) of cMVPA. The odds ratio for the association between 75th and 25th percentile of cMVPA and PSAC was 0.48 (95% CI, 0.24 to 0.94) at 2 weeks.

Conclusions and relevance: In children and adolescents with acute concussion, 259 minutes of cMVPA during the first week postinjury and 565 minutes of cMVPA during the second week postinjury were associated with lower symptom burden at 1 week and 2 weeks postinjury. At 2 weeks postinjury, higher cMVPA volume was associated with 48% reduced odds of PSAC compared with lower cMVPA volume.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Ledoux reported receiving grants from Children’s Hospital of Eastern Ontario (CHEO) Foundation, Ontario Brain Institute, University of Ottawa Brain and Mind Research Institute and receiving nonfinancial support from Mobio Interactive outside the submitted work. Dr Sicard reported receiving personal fees from Flammarion Quebec outside the submitted work. Dr Tremblay reported receiving grants from Canadian Institutes of Health Research during the conduct of the study. Dr Yeates reported receiving grants from the Canadian Institutes of Health Research, the National Institutes of Health, Brain Canada Foundation, and the National Football League Scientific Advisory Board and serving on the Data Safety and Monitoring Board of the Concussion Health Improvement Program Trial, funded by the National Institute of Child Health and Human Development, and the National Research Advisory Council of the National Pediatric Rehabilitation Resource Center at Virginia Tech University outside the submitted work. Dr Reed reported having shares in 360 Concussion Care outside the submitted work. Dr Zemek reported receiving grants from Canadian Institutes of Health Research, Ontario Neurotrauma Foundation, Physician Services Incorporated (PSI) Foundation, CHEO Foundation, Ontario Brain Institute, National Football League, Ontario Ministry of Health, Public Health Agency of Canada, Health Canada, Parachute Canada, and Ontario SPOR Support Unit (OSSU); being supported by a Tier 1 Clinical Research Chair in Pediatric Concussion from University of Ottawa; serving on the board of directors for North American Brain Injury Society; and having shares in 360 Concussion Care outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flow Diagram
MD indicates medical doctor.
Figure 2.
Figure 2.. Cumulative Moderate-to-Vigorous-Intensity Physical Activity (cMVPA) and Total Health Behavior Inventory (HBI) Score
Curves are adjusted for randomized treatment group, age, sex, Predicting Persistent Postconcussive Problems in Pediatrics risk score, mental health and learning disability comorbidity, retrospective HBI score, and emergency department HBI score. Circles represent imputed data of the first imputation. Dashed lines represent the 25th and 75th quantiles of cMVPA. Shaded areas represent the 95% CIs.
Figure 3.
Figure 3.. Cumulative Moderate-to-Vigorous-Intensity Physical Activity (cMVPA) and Health Behavior Inventory (HBI) Cognitive Score and Somatic Score
Curves are adjusted for randomized treatment group, age, sex, 5P risk score, mental health and learning disability comorbidity, retrospective HBI score, and emergency department HBI score. Circles represent imputed data of the first imputation. Dashed lines represent the 25th and 75th quantiles of cMVPA. Shaded areas represent the 95% CIs.
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