Early Subthreshold Aerobic Exercise for Sport-Related Concussion A Randomized Clinical Trial
Early Subthreshold Aerobic Exercise for Sport-Related Concussion A Randomized Clinical Trial
复制标题
DOI：
10.1001/jamapediatrics.2018.4397
复制
发表时间：
2019-04-01
期刊：
影响因子：
26.1
通讯作者：
Willer, Barry
中科院分区：
文献类型：
--
作者：
Leddy, John J.;Haider, Mohammad N.;Willer, Barry
重要提示：运动相关脑震荡（SRC）是一个重要的公共卫生问题，没有一个有效的treatment.OBJECTIVE：评估症状下阈值有氧运动与安慰剂样伸展计划规定的青少年在急性期的恢复从SRC.DESIGN，设置，和参与者的有效性：本多中心前瞻性随机临床试验进行了大学脑震荡中心。男女青少年运动员（年龄13-18岁）提出在10天的SRC被随机分配到有氧运动或安慰剂样的拉伸regimeneration.INTERVENTIONS：跑步机运动耐量的系统测定后，第一次访问，参与者被随机分配到一个渐进的亚症状阈值有氧运动或渐进的安慰剂样的拉伸程序（不会大幅提高心率）。这两种形式的运动进行约20分钟，每天，参与者通过website.Main结果和措施，每天的症状和遵守运动prescriptions.Main结果和措施：天从受伤到恢复;恢复被定义为无症状，有恢复确认通过评估由医生不知情的治疗组，并恢复到正常的运动耐力的跑步机测试。结果：共纳入103名参与者（有氧运动：n = 52; 24名女性[46%];拉伸，n = 51; 24名女性[47%]）。有氧运动组的参与者在SRC后平均（SD）为4.9（2.2）天，拉伸组的参与者在SRC后平均（SD）为4.8（2.4）天。在年龄、性别、既往脑震荡、受伤时间、初始症状严重程度评分或初始运动平板试验和体格检查结果方面没有差异。有氧运动参与者在中位数13天（四分位距[IQR]，10-18.5）内恢复，而拉伸参与者在17天（IQR，13-23）内恢复（Mann-Whitney检验P = 0.009）。有氧运动组延迟恢复的发生率无显著性降低（有氧运动组2例[4%] vs安慰剂组7例[14%]; P = 0.08）。结论和相关性：据我们所知，第一个RCT显示，在SRC速度后的第一周内，为有脑震荡症状的青少年规定的个体化亚症状阈值有氧运动治疗恢复，并可能减少延迟恢复的发生率。
IMPORTANCE: Sport-related concussion (SRC) is a significant public health problem without an effective treatment.OBJECTIVE: To assess the effectiveness of subsymptom threshold aerobic exercise vs a placebo-like stretching program prescribed to adolescents in the acute phase of recovery from SRC.DESIGN, SETTING, AND PARTICIPANTS: This multicenter prospective randomized clinical trial was conducted at university concussion centers. Male and female adolescent athletes (age 13-18 years) presenting within 10 days of SRC were randomly assigned to aerobic exercise or a placebo-like stretching regimen.INTERVENTIONS: After systematic determination of treadmill exercise tolerance on the first visit, participants were randomly assigned to a progressive subsymptom threshold aerobic exercise or a progressive placebo-like stretching program (that would not substantially elevate heart rate). Both forms of exercise were performed approximately 20 minutes per day, and participants reported daily symptoms and compliance with exercise prescription via a website.MAIN OUTCOMES AND MEASURES: Days from injury to recovery; recovery was defined as being asymptomatic, having recovery confirmed through an assessment by a physician blinded to treatment group, and returning to normal exercise tolerance on treadmill testing. Participants were also classified as having normal (30 days) recovery.RESULTS: A total of 103 participants were included (aerobic exercise: n = 52; 24 female [46%]; stretching, n = 51; 24 female [47%]). Participants in the aerobic exercise group were seen a mean (SD) of 4.9 (2.2) days after the SRC, and those in the stretching group were seen a mean (SD) of 4.8 (2.4) days after the SRC. There were no differences in age, sex, previous concussions, time from injury, initial symptom severity score, or initial exercise treadmill test and physical examination results. Aerobic exercise participants recovered in a median of 13 (interquartile range [IQR], 10-18.5) days, whereas stretching participants recovered in 17 (IQR, 13-23) days (P = .009 by Mann-Whitney test). There was a nonsignificant lower incidence of delayed recovery in the aerobic exercise group (2 participants [4%] in the aerobic group vs 7 [14%] in the placebo group; P = .08).CONCLUSIONS AND RELEVANCE: This is, to our knowledge, the first RCT to show that individualized subsymptom threshold aerobic exercise treatment prescribed to adolescents with concussion symptoms during the first week after SRC speeds recovery and may reduce the incidence of delayed recovery.