Dual-Task Exercise for Concussions
Recruiting in Palo Alto (17 mi)
Age: 18 - 65
Sex: Any
Travel: May be covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: University of Nevada, Las Vegas
No Placebo Group
Trial Summary
What is the purpose of this trial?The investigators previously developed a virtual 14-day dual-task walking exercise program and tested its feasibility with individuals with mild traumatic brain injury (mTBI) history. The investigators will test the feasibility and efficacy of a mobile app-version (Uplode) of the same 14-day exercise program (Brain \& Walk Exercise Every Day \[BraW-Day\]), on cognition, sensorimotor, and other functions in a group of voluntary young adults with an mTBI between last three months to two years, including student athletes, Veterans, and ethnic minorities.
Do I have to stop taking my current medications for the trial?
Yes, you must stop taking your current medications to participate in the trial, as being on prescribed medications is part of the exclusion criteria.
What data supports the idea that Dual-Task Exercise for Concussions is an effective treatment?
The available research shows that engaging in physical activity after a concussion can lead to faster recovery. For example, one study found that adolescents who took more steps per day and exercised more frequently returned to play sooner. Specifically, those who took over 10,251 steps per day and exercised more than four times a week recovered faster. Another study highlighted that starting aerobic exercise earlier after a concussion is linked to quicker recovery times. These findings suggest that incorporating physical activity, like Dual-Task Exercise, can be beneficial in concussion recovery.
12345What safety data exists for dual-task exercise treatments for concussions?
The research indicates that supervised exercise challenges, including aerobic and dynamic exercises, are safe and beneficial for concussion recovery. The MOVE protocol, a virtually administered graded exertion test, was found to be safe and feasible for children with subacute concussion, with no adverse events recorded. These findings suggest that structured exercise interventions are safe for managing concussions.
12678Is the treatment Brain & Walk Exercise Every Day (BraW-Day) a promising treatment for concussions?
Yes, the treatment Brain & Walk Exercise Every Day (BraW-Day) is promising for concussions. Research shows that exercise can help people recover from concussions by improving blood flow to the brain and balancing body functions. Studies have found that people who engage in regular physical activity after a concussion tend to recover faster and return to their normal activities sooner. This suggests that BraW-Day, which involves daily exercise, could be an effective way to help people recover from concussions.
29101112Eligibility Criteria
This trial is for adults aged 18-40 who've had a mild traumatic brain injury (mTBI) in the past 3 months to 2 years. It's open to student athletes, Veterans, and ethnic minorities who understand the study and can do all activities. People with other serious medical conditions, psychiatric issues, substance abuse problems, learning disorders or ADHD are not eligible.Inclusion Criteria
I am between 18 and 40 years old.
Participant Groups
The trial tests a mobile app called Uplode that guides users through a virtual dual-task walking exercise program named BraW-Day for two weeks. The goal is to see if it helps improve cognition, sensorimotor functions, and other areas affected by mTBI.
2Treatment groups
Experimental Treatment
Active Control
Group I: InterventionExperimental Treatment1 Intervention
The intervention group will be asked to visit the UNLV study site three times to evaluate baseline (T1), post-intervention (T2), and at 1-month post-intervention (T3) for functional assessments and saliva collection. Each participant will complete the BraW-Day program between baseline (T1) and post-intervention (T2). The program consists of 15-minute-long daily cognitive-walking tasks for 14 consecutive days. The program will be delivered on the Uplode mobile app. Each participant will be asked to perform three different 5-minute-long cognitive tasks (e.g., subtracting numbers or remembering long phrases) and one physical task (tandem walking or 8-shape walking) either indoors or outdoors at the same time for 15 minutes every day, which they will repeat daily for the next 13 days (2 weeks in total).
Group II: Wait-list ControlActive Control1 Intervention
The wait-list control group will be will be asked to visit the UNLV study site four times to evaluate pre-baseline (T0), baseline (T1), post-intervention (T2), and at 1-month post-intervention (T3) for functional assessments and saliva collection. Each participant will complete the BraW-Day program between baseline (T1) and post-intervention (T2). The program consists of 15-minute-long daily cognitive-walking tasks for 14 consecutive days. The program will be delivered on the Uplode mobile app. Each participant will be asked to perform three different 5-minute-long cognitive tasks (e.g., subtracting numbers or remembering long phrases) and one physical task (tandem walking or 8-shape walking) either indoors or outdoors at the same time for 15 minutes every day, which they will repeat daily for the next 13 days (2 weeks in total).
Find A Clinic Near You
Research locations nearbySelect from list below to view details:
University of Nevada, Las VegasLas Vegas, NV
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Who is running the clinical trial?
University of Nevada, Las VegasLead Sponsor
References
Randomized controlled trial of early aerobic exercise following sport-related concussion: Progressive percentage of age-predicted maximal heart rate versus usual care. [2023]To examine the effect of a readily accessible, structured aerobic exercise intervention on days to asymptomatic status and days to medical clearance compared to usual care exercise prescription in a cohort of adolescents and young adults following sport-related concussion (SRC).
More Physical Activity after Concussion Is Associated with Faster Return to Play among Adolescents. [2021]Concussion management has evolved to de-emphasize rest in favor of early introduction of post-injury physical activity. However, the optimal quantity, frequency and intensity of physical activity are unclear. Our objective was to examine the association between objective physical activity metrics and clinical recovery after concussion. We prospectively enrolled a cohort of 32 youth athletes with concussion, evaluated within 14 days of injury and after return-to-play (RTP) clearance. For two weeks after enrollment, we quantified steps/day and exercise frequency, duration, and intensity via wrist-worn actigraphy. We grouped participants by RTP clearance timing (<28 days vs. ≥28 days). Seventeen (53%) participants required ≥28 days post-concussion for RTP clearance. Groups were similar in age (14.9 ± 1.9 vs. 15.4 ± 1.5 years; p = 0.38), proportion of females (47% vs. 40%; p = 0.69), and concussion history (59% vs. 47%; p = 0.49). During the study period, the RTP ≥ 28 days group took fewer steps/day (8158 ± 651 vs. 11,147 ± 4013; p = 0.02), exercised fewer days/week (2.9 ± 2.4 vs. 5.0 ± 1.9 days/week; p = 0.01), and exercised fewer total minutes/week (117 ± 122 vs. 261 ± 219 min/week; p = 0.03). Furthermore, we observed ≥10,251 average steps/day, ≥4 exercise sessions/week, and exercising ≥134 total minutes/week were optimal cutpoints to distinguish between groups. These findings support the benefit of physical activity during concussion recovery.
The Role of Aerobic Exercise in Reducing Persistent Sport-related Concussion Symptoms. [2020]Aerobic exercise has received increasing attention in the scientific literature as a component of management for individuals who sustain a concussion. Because exercise training has been reported to reduce symptoms and improve function for those experiencing persistent postconcussion symptoms, it represents a potentially useful and clinically pragmatic rehabilitation technique. However, the specific exercise parameters that best facilitate recovery from concussion remain poorly defined and unclear. This review will provide a summary of the current understanding of the role of subsymptom exercise to improve outcomes after a concussion and will describe the exercise parameters that appear to be important. The latter will take into account the three pillars of exercise dose-frequency, duration, and intensity-to examine what is currently known. In addition, we identify important gaps in our knowledge of exercise as a treatment for those who develop persistent symptoms of concussion.
Earlier time to aerobic exercise is associated with faster recovery following acute sport concussion. [2019]To 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.
Early Exercise is Associated with Faster Concussion Recovery Among Collegiate Athletes: Findings from the NCAA-DoD CARE Consortium. [2023]Growing evidence indicates early exercise may improve symptoms and reduce clinical recovery time after concussion, but research examining collegiate student-athletes is scarce.
An At-Home, Virtually Administered Graded Exertion Protocol for Use in Concussion Management: Preliminary Evaluation of Safety and Feasibility for Determining Clearance to Return to High-Intensity Exercise in Healthy Youth and Children With Subacute Concussion. [2023]Graded exertion testing (GXT) is an important tool for concussion management, as it is used to personalize post-concussion exercise prescription and return athletes to sport. However, most GXT requires expensive equipment and in-person supervision. Our objective was to assess the safety and feasibility of the Montreal Virtual Exertion (MOVE) protocol, a no-equipment, virtually compatible GXT, in healthy children and children with subacute concussion. The MOVE protocol consists of seven stages of bodyweight and plyometric exercises performed for 60 sec each. Twenty healthy (i.e., non-concussed) children completed the MOVE protocol virtually over Zoom Enterprise. Next, 30 children with subacute concussion (median: 31.5 days post-injury) were randomized to the MOVE protocol or Buffalo Concussion Treadmill Test (BCTT), which increases the incline or speed of the treadmill every minute until maximum exertion. Out of an abundance of caution, all concussed participants completed the MOVE protocol in an in-person clinical space. However, the test evaluator was stationed in a different room within the clinic and administered the MOVE protocol using Zoom Enterprise software to mimic telehealth conditions. Safety and feasibility outcomes were recorded throughout GXT, including heart rate, rate of perceived exertion (RPE), and symptom outcomes. No adverse events were recorded, and all feasibility criteria were successfully met in healthy youth and youth with concussion. Among concussed youth, increases in heart rate (MOVE: 82.4 ± 17.9 bpm, BCTT: 72.1 ± 23.0 bpm; t(28) = 1.36, p = 0.18), RPE (MOVE: 5.87 ± 1.92, BCTT: 5.07 ± 2.34, t(28) = 1.02, p = 0.32), and overall symptom presentation were similar between the MOVE and BCTT protocols. The MOVE protocol is a safe and feasible GXT in healthy youth and youth with subacute concussion. Future studies should assess the fully virtual administration of the MOVE in children with concussion, MOVE protocol tolerability in children with acute concussion, and whether the MOVE protocol can be used to guide individualized exercise prescription.
Adolescents With More Oculomotor and Vestibular Signs of Sport-Related Concussion Benefit from Aerobic Exercise: An Exploratory Analysis. [2023]Abstract Early targeted heart rate (HR) aerobic exercise has been shown to reduce the duration of recovery from sport-related concussion (SRC) as well as the incidence of persistent post-concussive symptoms (PPCS). It is not known, however, if more severe oculomotor and vestibular presentations of SRC benefit from a prescription of aerobic exercise. The current study is an exploratory analysis of two published randomized controlled trials that compared aerobic exercise within 10 days of injury with a placebo-like stretching intervention. Combining the two studies yielded a larger sample size to stratify severity of concussion based on the number of abnormal physical examination signs present at the initial office evaluation, which were confirmed with self-reported symptoms and recovery outcomes. The most discriminant cut-off was between those who had ≤3 oculomotor and vestibular signs and those who had >3 signs. Aerobic exercise (hazard ratio = 0.621 [0.412, 0.936], p = 0.023) reduced recovery times even when controlling for site (hazard ratio = 0.461 [0.303, 0.701], p < 0.001), severity (hazard ratio = 0.528 [0.325, 0.858], p = 0.010) and the interaction term of intervention and severity (hazard ratio = 0.972 [0.495, 1.909], p = 0.935). Adolescents who presented with >3 signs and were assigned to the placebo-like stretching group had a PPCS incidence of 38%, which was the highest of all subgroups (aerobic exercise and ≤3 findings: 8%; stretching and ≤3 findings: 11%; aerobic exercise and >3 findings: 21%). This exploratory study provides pilot evidence that prescribed sub-symptom threshold aerobic exercise treatment early after SRC may be effective for adolescents with more oculomotor and vestibular physical examination signs and should be validated in future adequately powered trials.
Symptom Provocation During Aerobic and Dynamic Supervised Exercise Challenges in Adolescents With Sport-Related Concussion. [2022]Supervised exercise challenges (SECs) have been shown to be safe and beneficial in the early symptomatic period after concussion. Thus far, most in-clinic SECs studied have included a form of basic aerobic exercise only. An SEC that also includes dynamic forms of exercise mimics all steps of a standard return-to-play progression and may enhance the detection of concussion symptoms to guide in-clinic management decisions.
Randomized Controlled Trial Evaluating Aerobic Training and Common Sport-Related Concussion Outcomes in Healthy Participants. [2020]Aerobic exercise interventions are increasingly being prescribed for concussion rehabilitation, but whether aerobic training protocols influence clinical concussion diagnosis and management assessments is unknown.
Lower extremity kinematics during walking and elliptical training in individuals with and without traumatic brain injury. [2013]Elliptical training may be an option for practicing walking-like activity for individuals with traumatic brain injuries (TBI). Understanding similarities and differences between participants with TBI and neurologically healthy individuals during elliptical trainer use and walking may help guide clinical applications incorporating elliptical trainers.
Dual-Task Assessment Protocols in Concussion Assessment: A Systematic Literature Review. [2019]Study Design Systematic review. Background When assessed in isolation, balance and neurocognitive testing may not be sufficiently responsive to capture changes that occur with concussion. Normal daily activities require simultaneous cognitive and physical demands. Therefore, a dual-task assessment paradigm should be considered to identify performance deficits. Objectives To evaluate the literature and to identify dual-task testing protocols associated with changes in gait after concussion. Methods A systematic review of articles of individuals with concussion who underwent dual-task testing with a combination of motor and cognitive tasks was conducted. The AMED, CINAHL, Embase, PsycINFO, PubMed, Scopus, SPORTDiscus, and Web of Science databases and gray literature were searched from inception to January 29, 2017. Title and abstract, full-text, and quality review and data abstraction were performed by 2 independent reviewers. Results Twenty-four articles met the inclusion criteria. Eleven articles reported decreased gait velocity and increased medial-lateral displacement for individuals with concussion during dual-task conditions. Overall, included articles were of poor to moderate methodological quality. Fifteen articles used the same participants and data sets, creating a threat to validity and limiting the ability to make conclusions. Conclusion A deterioration in gait performance during dual-task testing is present among people with concussion. Specific recommendations for the use of a dual-task protocol to assess individuals with suspected concussion injury in a clinical setting have yet to be determined. J Orthop Sports Phys Ther 2018;48(2):87-103. Epub 7 Nov 2017. doi:10.2519/jospt.2018.7432.
Return to full functioning after graded exercise assessment and progressive exercise treatment of postconcussion syndrome. [2022]Exercise assessment and aerobic exercise training for postconcussion syndrome (PCS) may reduce concussion-related physiological dysfunction and symptoms by restoring autonomic balance and improving cerebral blood flow autoregulation. In a descriptive pilot study of 91 patients referred to a university clinic for treatment of PCS, a subset of 63 patients were contacted by telephone for assessment of symptoms and return to full daily functioning. Those who experienced symptoms during a graded exercise treadmill test (physiologic PCS, n = 40) were compared to those who could exercise to capacity (PCS, n = 23). Both groups had been offered progressive exercise rehabilitation. Overall 41 of 57 (72%) who participated in the exercise rehabilitation program returned to full daily functioning. This included 27 of 35 (77%) from the physiologic PCS group, and 14 of 22 (64%) from the PCS group. Only 1 of the 6 patients who declined exercise rehabilitation returned to full functioning. Interpretation of these results is limited by the descriptive nature of the study, the small sample size, and the relatively few patients who declined exercise treatment. Nonetheless, exercise assessment indicates that approximately one third of those examined did not have physiologic PCS.