Participation in Physical Activity at Time of Presentation to a Specialty Concussion Clinic Is Associated With Shorter Time to Recovery.
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ABSTRACT: Introduction
Novel research suggests that children engaging in physical activity during recovery from concussion may recover more rapidly.Objective
To determine if level of physical activity at presentation to a rehabilitation-based concussion specialty clinic predicted days from injury to recovery.Design
Retrospective cohort.Setting
A concussion sub-specialty clinic at an academic institution.Patients
Retrospective review of medical records between September 2015 and February 2017 identified 178 children ages 6-17 years (mean age = 13.7 years; standard deviation [SD] = 2.7 years) who presented within 60 days of concussion and were ultimately deemed recovered and cleared to progress to full return to high-risk activities.Interventions
Not applicable.Main outcome measures
Physical activity at initial visit was classified as none-to-light (79%) versus moderate-to-heavy (21%). A doubly robust, inverse probability of exposure weighted linear regression model was used to examine the relationship between physical activity level and days to recovery, while adjusting for 10 demographic and clinical variables.Results
Children participating in moderate-to-heavy activity at initial evaluation in concussion clinic averaged recovery 21 days quicker (95% confidence interval [CI] -27.1, -15.5, P < .001) than children who were engaging in none-to-light activity. This finding did not change when removing children who were deemed recovered at the first visit (who may have initiated physical activity after becoming asymptomatic).Conclusions
These data add to growing evidence that progressive physical activity during recovery from concussion does not appear to be harmful. Physical activity represents a modifiable variable in recovery, and physicians can potentially expedite symptomatic recovery by recommending noncontact physical activity as tolerated during concussion recovery.
SUBMITTER: Coslick AM
PROVIDER: S-EPMC8258833 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ObjectiveDemanding psychosocial work characteristics, such as high job demands, can have a detrimental impact on leisure-time physical activity (LTPA), with adverse consequences for employee health and well-being. However, the mechanisms and moderators of this crossover effect are still largely unknown. We therefore aimed to identify and test potential mediating and moderating factors from within and outside the work environment. Based on the previous research, we expected job demands to be negatively related to LTPA through fatigue. In addition, we expected that job control and worktime control would attenuate the relationship between job demands and fatigue. Furthermore, we hypothesized that autonomous exercise motivation and spontaneous action planning would attenuate the relationship between fatigue and LTPA. In addition to these cross-sectional hypotheses, we expected the same effects to predict a change in LTPA in the following year.MethodsTo investigate these assumptions, a preregistered longitudinal survey study was conducted among a large sample of Dutch employees in sedentary jobs. Participants reported on the constructs of interest in 2017 and 2018 (N = 1189 and 665 respectively) and the resulting data were analyzed using path analyses.ResultsOur cross-sectional analyses confirm a weak indirect, negative association between job demands and LTPA, via fatigue. However, this finding was not observed in our longitudinal analyses and none of the other hypotheses were confirmed.ConclusionThis study shows that, among employees with relatively healthy psychosocial work characteristics (i.e., high job control), the evidence for an impact of these work characteristics on participation in LTPA is limited.
| S-EPMC8795020 | biostudies-literature
Project description:BACKGROUND:Timely removal from activity after concussion symptoms remains problematic despite heightened awareness. Previous studies indicated potential adverse effects of continuing to participate in physical activity immediately after sustaining a concussion. Hypothesis/Purpose: The purpose was to determine the effect of timing of removal from play after concussion on clinical outcomes. It was hypothesized that immediate removal from activity after sport-related concussion (SRC) would be associated with less time missed from sport, a shorter symptomatic period, and better outcomes on acute clinical measures. STUDY DESIGN:Cohort study; Level of evidence, 3. METHODS:Data were reported from the National Collegiate Athletic Association and Department of Defense Grand Alliance: Concussion Awareness, Research, and Education (CARE) Consortium. Participants with 506 diagnosed SRCs from 18 sports and 25 institutions and military service academies were analyzed and classified as either immediate removal from activity (I-RFA) or delayed removal from activity (D-RFA). Outcomes of interest included time missed from sport attributed to their SRC, symptom duration, and clinical assessment scores. RESULTS:There were 322 participants (63.6%) characterized as D-RFA. I-RFA status was associated with significantly less time missed from sport ( R2 change = .022-.024, P < .001 to P = .001) and shorter symptom duration ( R2 change = .044-.046, P < .001 [all imputations]) while controlling for other SRC recovery modifiers. These athletes missed approximately 3 fewer days from sport participation. I-RFA athletes had significantly less severe acute SRC symptoms and were at lower risk of recovery taking ?14 days (relative risk = .614, P < .001, small-medium effect size) and ?21 days (relative risk = .534, P = .010, small effect size). CONCLUSION:I-RFA is a protective factor associated with less severe acute symptoms and shorter recovery after SRC. Conveying this message to athletes, coaches, and others involved in the care of athletes may promote timely injury reporting.
| S-EPMC6988451 | biostudies-literature
Project description:IntroductionTo examine the association between participation frequency per week in physical education (PE) classes and physical activity (PA) and sitting time levels in adolescents according to the economic development level of the region of residence.MethodsA cross-sectional study with a sample representative of Brazil was carried out with 12,220 students aged 11-19 years. Participation frequency per week in PE classes, moderate-to-vigorous PA (MVPA), PA during PE classes, active commuting, PA outside of school hours, total accumulated PA, time sitting in front of the TV and total sitting time were assessed by using a self-administered questionnaire.ResultsAdolescents who reported having PE classes were more likely to meet MVPA recommendations (1-2 PE class/week-OR: 1.3, 95%CI: 1.1-1.5; ≥3 PE class/week-OR: 2.0, 95%CI: 1.7-2.5), spent more time in PA outside of school hours (1-2 PE class/week-OR: 1.6, 95%CI: 1.4-1.9; ≥3 PE class/week-OR: 2.0, 95%CI: 1.5-2.6), and accumulated more PA (1-2 PE class/week-OR: 1.9, 95%CI: 1.6-2.2; ≥3 PE class/week-OR: 6.0, 95%CI: 4.0-8.9) than students who reported not taking PE classes. Boys from regions with higher Human Development Index (HDI) who took ≥3 PE classes/week were more likely to have higher levels of active commuting (OR: 1.4, 95%CI: 1.1-1.9) and less likely of getting in front of TV (OR: 0.7, 95%CI: 0.5-0.9). Adolescents from regions with higher HDI were more likely to have more time spent in PA during PE classes (Male-OR: 2.7, 95%CI: 2.4-3.1; Female-OR = 3.2, 95%CI: 2.8-3.7).ConclusionsHaving PE classes is associated with a higher level of PA in both sexes and in both regions and lower level of sitting time in boys from regions with higher HDI.
| S-EPMC6415839 | biostudies-literature
Project description:ImportancePediatric mild traumatic brain injury (TBI) and concussion are a public health challenge with up to 30% of patients experiencing prolonged recovery. Pediatric patients presenting to concussion clinics often have ongoing impairments and may be at increased risk for persistent symptoms. Understanding this population is critical for improved prognostic estimates and optimal treatment.ObjectiveTo describe pediatric patients presenting to concussion clinics and characterize factors associated with their recovery.Design, setting, and participantsThis prospective cohort study included patients enrolled at multicenter concussion specialty clinics from the Four Corners Youth Consortium from December 2017 to July 2019, with up to 12-month follow-up. Patients were eligible if they were aged 5 to 18.99 years with a diagnosis of mild TBI or concussion presenting to participating clinics within 8 weeks of injury. Patients were excluded if the patient or their parents were unable to read or sign the consent document, or if the patient had a Glasgow Coma Scale score less than 13 or a penetrating injury. Data were analyzed from February 2019 to April 2020.ExposuresDiagnosis of mild TBI or concussion.Main outcomes and measuresThis study used National Institute of Neurological Disorders and Stroke common data elements, including data on demographic characteristics, injury details, history, neurological and neuropsychological assessments, and treatment.ResultsA total of 600 patients were consecutively enrolled, among whom 324 (54.0%) were female and 435 (72.5%) were adolescents (ie, aged 13-18 years). A higher proportion of girls and women (248 patients [76.5%]) were adolescents compared with boys and men (187 patients [67.8%]) (P = .02), and girls and women reported significantly more preexisting anxiety compared with boys and men (80 patients [26.7%] vs 46 patients [18.7%]; P = .03). Significantly more adolescents reported preexisting migraines compared with preadolescents (82 patients [20.9%] vs 15 patients [10.9%]; P = .01). Girls and women recovered more slowly than boys and men (persistent symptoms after injury: week 4, 217 patients [81.6%] vs 156 patients [71.2%]; week 8, 146 patients [58.9%] vs 89 patients [44.3%]; week 12, 103 patients [42.6%] vs 58 patients [30.2%]; P = .01). Patients with history of migraine or anxiety or depression recovered more slowly than those without, regardless of sex.Conclusions and relevanceThese findings suggest that identification of subgroups of pediatric patients with mild TBI or concussion at risk for prolonged recovery could aid in better prognostic estimates and more targeted treatment interventions.
| S-EPMC7670312 | biostudies-literature
Project description:Whether and how moderate exercise might allow for accelerated limb recovery in chronic critical limb ischemia (CLI) remains to be determined. Chronic CLI was surgically induced in mice, and the effect of moderate exercise (training five times per week over a 3-week period) was investigated. Tissue damages and functional scores were assessed on the 4th, 6th, 10th, 20th, and 30th day after surgery. Mice were sacrificed 48 h after the last exercise session in order to assess muscle structure, mitochondrial respiration, calcium retention capacity, oxidative stress and transcript levels of genes encoding proteins controlling mitochondrial functions (PGC1α, PGC1β, NRF1) and anti-oxidant defenses markers (SOD1, SOD2, catalase). CLI resulted in tissue damages and impaired functional scores. Mitochondrial respiration and calcium retention capacity were decreased in the ischemic limb of the non-exercised group (Vmax = 7.11 ± 1.14 vs. 9.86 ± 0.86 mmol 02/min/g dw, p < 0.001; CRC = 7.01 ± 0.97 vs. 11.96 ± 0.92 microM/mg dw, p < 0.001, respectively). Moderate exercise reduced tissue damages, improved functional scores, and restored mitochondrial respiration and calcium retention capacity in the ischemic limb (Vmax = 9.75 ± 1.00 vs. 9.82 ± 0.68 mmol 02/min/g dw; CRC = 11.36 ± 1.33 vs. 12.01 ± 1.24 microM/mg dw, respectively). Exercise also enhanced the transcript levels of PGC1α, PGC1β, NRF1, as well as SOD1, SOD2, and catalase. Moderate exercise restores mitochondrial respiration and calcium retention capacity, and it has beneficial functional effects in chronic CLI, likely by stimulating reactive oxygen species-induced biogenesis and anti-oxidant defenses. These data support further development of exercise therapy even in advanced peripheral arterial disease.
| S-EPMC5524729 | biostudies-other
Project description:ImportanceThe Four Corners Youth Consortium was created to fill the gap in our understanding of youth concussion. This study is the first analysis of posttraumatic headache (PTH) phenotype and prognosis in this cohort of concussed youth.ObjectiveTo describe the characteristics of youth with PTH and determine whether the PTH phenotype is associated with outcome.Design, setting, and participantsThis cohort study examined outcomes from patients in a multi-institutional registry of traumatic brain injury (TBI) clinics from December 2017 to June 2019. Inclusion criteria included being between ages 5 and 18 years at enrollment and presentation within 8 weeks of a mild TBI. Data were analyzed between February 2019 and January 2021.ExposureMild TBI with standard care.Main outcomes and measuresTime to recovery and headache 3 months after injury; measurement device is the Postconcussion Symptom Inventory (PCSI). PTH with migraine phenotype was defined as moderate-severe headache that is new or significantly worse compared with baseline and associated with nausea and/or photophobia and phonophobia.ResultsA total of 612 patients with 625 concussions were enrolled, of whom 387 patients with 395 concussions consented to participate in this study. One hundred nine concussions were excluded (concussions, rather than patients, were the unit of analysis), leaving 281 participants with 286 concussions (168 [58.7%] girls; 195 [75.6%] White; 238 [83.2%] aged 13-18 years). At the initial visit, 133 concussions (46.5%) were from patients experiencing PTH with a migraine phenotype, 57 (20%) were from patients experiencing PTH with a nonmigraine phenotype, and 96 (34%) were from patients with no PTH. Patients with any PTH after concussion were more likely to have prolonged recovery than those without PTH (median [interquartile range], 89 [48-165] days vs 44 [26-96] days; log-rank P < .001). Patients with PTH and a migraine phenotype took significantly longer to recover than those with nonmigraine phenotype (median [interquartile range], 95 [54-195] days vs 70 [46-119] days; log-rank P = .01). Within each phenotype, there was no significant difference between sexes in recovery or PTH at 3 months.Conclusions and relevancePTH with a migraine phenotype is associated with persistent symptoms following concussion compared with nonmigraine PTH or no PTH. Given that female sex is associated with higher rates of migraine and migraine PTH, our finding may be one explanation for findings in prior studies that girls are at higher risk for persistent postconcussion symptoms than boys.
| S-EPMC7941198 | biostudies-literature
Project description:ObjectivesDetermine the impact of classroom-based physically active lessons on time-on-task. Secondarily, determine the relationship of time-on-task with academic achievement controlling for key demographic variables.MethodsSeventeen elementary schools were cluster randomized to receive classroom physical activity (A+PAAC, N=9) or control (i.e., no physical activity, N=8) for a 3-year trial. Teachers were trained to deliver physically active lessons with moderate-to-vigorous intensity targeting 100 minutes per week. Outcome measures included academic achievement (Weschler Individual Achievement Test-III), administered at baseline and repeated each spring for 3 years, time spent in moderate-to-vigorous physical activity (MVPA), and time spent on task (TOT) pre- and post-physical activity. Multilevel modeling was utilized to estimate the impacts of percent time spent in MVPA and percent TOT post-lesson on academic achievement and the change in these impacts over 3 years, accounting for dependency among observations and covariates including age, gender, race, free or reduced lunch, BMI, and fitness.ResultsA greater percentage of time performing MVPA were each significantly associated with higher math scores (p=.034) and spelling scores (p<.001), but not reading scores. Academic achievement was not associated with TOT.ConclusionFindings suggest that a greater percentage of time spent participating in MVPA results in higher math scores and spelling scores, but not reading scores, independent of TOT. Future studies should continue to evaluate the influence of physically active classroom lessons on time spent on task and its impact on academic achievement. Furthermore, strategies are needed to maximize impact and to determine the sustainability of physical activity's effect on classroom behavior and academic achievement.
| S-EPMC6771264 | biostudies-literature
Project description:ImportanceThere are limited data to guide screen time recommendations after concussion.ObjectiveTo determine whether screen time in the first 48 hours after concussion has an effect on the duration of concussive symptoms.Design, setting, and participantsThis randomized clinical trial was conducted in the pediatric and adult emergency departments of a tertiary medical center between June 2018 and February 2020. Participants included a convenience sample of patients aged 12 to 25 years presenting to the emergency department within 24 hours of sustaining a concussion. A total of 162 patients were approached, 22 patients met exclusion criteria, and 15 patients declined participation; 125 participants were enrolled and randomized.InterventionsPatients were either permitted to engage in screen time (screen time permitted group) or asked to abstain from screen time (screen time abstinent group) for 48 hours after injury.Main outcomes and measuresThe primary outcome was days to resolution of symptoms, defined as a total Post-Concussive Symptom Scale (PCSS) score of 3 points or lower. Patients completed the PCSS, a 22-symptom scale that grades each symptom from 0 (not present) to 6 (severe), each day for 10 days. Kaplan-Meier curves and Cox regression modeling were used to compare the 2 groups. A Wilcoxon rank sum test was also performed among participants who completed the PCSS each day through recovery or conclusion of the study period.ResultsAmong 125 patients with concussion, the mean (SD) age was 17.0 (3.4) years; 64 participants (51.2%) were male. A total of 66 patients were randomized to the screen time permitted group, and 59 patients were randomized to the screen time abstinent group. The Cox regression model including the intervention group and the patient's self-identified sex demonstrated a significant effect of screen time (hazard ratio [HR], 0.51; 95% CI, 0.29-0.90), indicating that participants who engaged in screen time were less likely to recover during the study period. In total, 91 patients were included in the Wilcoxon rank sum test (47 patients from the screen time permitted group, and 44 patients from the screen time abstinent group). The screen time permitted group had a significantly longer median recovery time of 8.0 days (interquartile range [IQR], 3.0 to >10.0 days) compared with 3.5 days (IQR, 2.0 to >10.0 days; P = .03) in the screen time abstinent group. The screen time permitted group reported a median screen time of 630 minutes (IQR, 415-995 minutes) during the intervention period compared with 130 minutes (IQR, 61-275 minutes) in the screen time abstinent group.Conclusions and relevanceThe findings of this study indicated that avoiding screen time during acute concussion recovery may shorten the duration of symptoms. A multicenter study would help to further assess the effect of screen time exposure.Trial registrationClinicalTrials.gov Identifier: NCT03564210.
| S-EPMC8424526 | biostudies-literature
Project description:ObjectiveTo determine whether earlier time to initiation of aerobic exercise following acute concussion is associated with time to full return to (1) sport and (2) school or work.MethodsA retrospective stratified propensity score survival analysis of acute (≤14 days) concussion was used to determine whether time (days) to initiation of aerobic exercise post-concussion was associated with, both, time (days) to full return to (1) sport and (2) school or work.ResultsA total of 253 acute concussions [median (IQR) age, 17.0 (15.0-20.0) years; 148 (58.5%) males] were included in this study. Multivariate Cox regression models identified that earlier time to aerobic exercise was associated with faster return to sport and school/work adjusting for other covariates, including quintile propensity strata. For each successive day in delay to initiation of aerobic exercise, individuals had a less favourable recovery trajectory. Initiating aerobic exercise at 3 and 7 days following injury was associated with a respective 36.5% (HR, 0.63; 95% CI, 0.53-0.76) and 73.2% (HR, 0.27; 95% CI, 0.16-0.45) reduced probability of faster full return to sport compared to within 1 day; and a respective 45.9% (HR, 0.54; 95% CI, 0.44-0.66) and 83.1% (HR, 0.17; 95% CI, 0.10-0.30) reduced probability of faster full return to school/work. Additionally, concussion history, symptom severity, LOC deleteriously influenced concussion recovery.ConclusionEarlier initiation of aerobic exercise was associated with faster full return to sport and school or work. This study provides greater insight into the benefits and safety of aerobic exercise within the first week of the injury.
| S-EPMC5905975 | biostudies-literature
Project description:AimAs sport and physical activity are vital to support extended health spans, this study aimed to analyse the current trends in sports participation and physical activity rates among individuals aged 65 years and older in Scotland. Data were compared with the Chief Medical Officer (CMO) guidelines and analysed the influence of key factors on participation rates.MethodsThe study used data from the Scottish Health Survey and the Scottish Household Survey (2019) to investigate self-reported participation in physical activity and sports across different age groups. Descriptive statistics and cross-tabulations were used to analyse the relationships between participation rates and influencing factors. Participation data for Parkrun events in Scotland were also analysed for the years 2008-2018.ResultsThe study found a clear decline in sports participation with age, with a steep decline after the age of 65, particularly in women. The majority of participation among individuals aged 65+ was in walking, with a sport participation rate of only 31.2% when walking was excluded. Physical activity and sport participation was lower in women across all age ranges but particularly so in the 75+ age group. The most popular sporting activities in the older age group were keep fit/aerobics, swimming and golf. Additionally, the study found that social deprivation had a major impact on sports participation rates, with the most deprived households exhibiting the lowest participation levels irrespective of age. The prevalence of loneliness was lower among individuals who participated in sports or adhered to the CMO guidelines for moderate/vigorous physical activity and strength-building exercises.DiscussionThe findings of this study have implications for promoting physical activity and sports participation among older adults, particularly in deprived communities. This study highlights the importance of balance exercises within sport and the need for more targeted efforts to increase participation rates among older adults. The study also emphasizes the positive impact of sports participation on reducing loneliness among older adults. Overall, the findings suggest the need for ongoing efforts to promote physical activity and sports participation among older adults to improve their overall health and well-being.
| S-EPMC10562595 | biostudies-literature