Improving Symptom Burden in Individuals With Persistent Post Concussive Symptoms: A Step-wise Aerobic Exercise Trial
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 52
- 试验地点
- 1
- 主要终点
- Change in symptom burden
研究概览
简要总结
The objective of this study is to investigate an aerobic exercise program as a treatment for adults with persistent post-concussive symptoms (PPCS) following mild traumatic brain injury. In this delayed-start trial participants will be initially randomized into either a 6-week low-impact stretching protocol or 12-week aerobic exercise protocol. Following the completion of the stretching protocol participants will continue on to complete the aerobic exercise protocol in full. 56 participants aged 18-65 yrs will be recruited from the Calgary Brain Injury Program (CBIP), including the Early Concussion Education Program at Foothills Medical Centre, Calgary Pain Program, University of Calgary Sports Medicine Centre acute concussion clinic and a physiotherapy clinic (Tower Physio) all of which are located in Calgary, Alberta, Canada. Participants will complete an online follow up (symptom questionnaires and questions regarding exercise behaviour) 3 and 9 weeks post intervention.
详细描述
Demographic information will be collected prior to study participation and include age, sex, education, family medical history, past medical history, concussion history, litigious status and medication use. The PAR-Q+ questionnaire will be completed to determine readiness for exercise by a physician. Baseline questionnaires will be completed, such as the Fatigue Severity Scale (FSS), Generalized Anxiety Disorder Scale (GAD-7), Headache Intensity Scale-6 (HIT-6), Patient Health Questionnaire(PHQ-9), Epworth Sleepiness Scale(ESS) and Quality of Life After Brain Injury(QOLIBRI), Rivermead Post Concussion Symptoms Questionnaire (RPQ), Modified Godin Leisure-Time Exercise Questionnaire(GLTQ), Rapid Assessment Disuse Index (RADI) and Postconcusion Syndrome Checklist (PCSC). Pre- and post-intervention blood samples will be collected from all participants. Participants will be asked to perform a tactile assessment pre- and post-intervention. Sleep will be monitored using wrist-based actigraphy and a sleep diary for 3-6 days/nights prior to the intervention start and for five days following completion of the exercise protocol. Pre and post magnetic resonance spectroscopy (MRS) will also be completed. Participants will be randomized to a structured aerobic exercise protocol (AEP) or stretching protocol, followed by aerobic exercise protocol(SP+AEP) with a random number generator. Both groups will undergo exercise testing using the Buffalo Concussion Treadmill Test to determine exercise prescription. Upon completion of SP, participants will continue on to the AEP and complete it in full. Following the exercise protocols, all questionnaires will be completed post-intervention. At 3 and 9 weeks following protocol completion, online follow surveys will be completed to assess symptom burden (RPQ, QOLIBRI, HIT-6, ESS, FSS) along with questions regarding current exercise.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Crossover
- 主要目的
- Treatment
- 盲法
- Single (Investigator)
盲法说明
Allocation will be concealed through the use of sequentially numbered, opaque envelopes.
入排标准
- 年龄范围
- 18 Years 至 65 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Diagnosis of mild traumatic brain injury (mTBI) based on the American Congress of Rehabilitation Medicine (ACRM) criteria.
- •mTBI occurrence from 3 months to 5 years from study start date
- •Diagnosis of persistent post-concussion symptoms based on the ICD-10 criteria.
- •Cleared for physical activity based on The Physical Activity Readiness Questionnaire for Everyone (PAR-Q+) by treating physician
- •exercise intolerance (inability to exercise at pre-injury intensity/duration due to acute presentation of symptoms)
排除标准
- •past medical history of neurological disorders (i.e., Parkinson's disease, neuromuscular disorders)
- •contraindications to MRI
- •cardiopulmonary disorder
- •chronic musculoskeletal condition
- •psychiatric disorder other than depression and/or anxiety (i.e., schizophrenia, bipolar disorder)
- •pregnancy
研究组 & 干预措施
Aerobic Exercise Protocol (AEP)
Symptom threshold will be determined at baseline and repeated every 3 weeks using the Buffalo Concussion Treadmill Test. Briefly, there will be an initial 4min warm up at 1.7mph. The protocol will start with treadmill speed se to 3.3 mph and 0.0% incline. Each subsequent minute, the incline will increase by 1.0% to a max of 15%. At 15% grade, if the participant is still able to continue, treadmill speed will increase by 0.4mph each minute. Heart rate (HR) and rating of perceived excretion (RPE Borg scale) will be measured every minute. The test will be terminated upon symptom exacerbation at which time HR and RPE will be recorded. Every 3 weeks the symptom threshold test will be repeated for all participants and exercise prescription will be adjusted accordingly.
干预措施: Aerobic Exercise Protocol (Behavioral)
Stretching Protocol (SP)
The exercise testing for the stretching protocol to determine exercise prescription will be the same as described above.
干预措施: Aerobic Exercise Protocol (Behavioral)
Stretching Protocol (SP)
The exercise testing for the stretching protocol to determine exercise prescription will be the same as described above.
干预措施: Stretching Protocol (Behavioral)
结局指标
主要结局
Change in symptom burden
时间窗: Repeated measure: Pre-intervention, after 6-weeks of SP/AEP, after 12-weeks of AEP, 3-weeks post-AEP, 9-weeks post-AEP
Rivermead Post-concussion Symptoms Questionnaire (RPQ): an instrument developed to assess the frequency and severity of 16 common post-concussion symptoms. On this paper and pencil tool, patients rate the extent to which their symptoms (compared to their pre-injury levels) have become more problematic over the past 24 hours using a rating scale from 0-4 (0=not experienced, 1=no more of a problem, 2=mild problem, 3=moderate problem, 4=severe problem). A total symptom score is calculated out of 64.
次要结局
- Change in sleep duration(Repeated measure: Pre-intervention, after 6-weeks of SP/AEP, after 12-weeks of AEP)
- Change in function related to headaches(Repeated measure: Pre-intervention, after 6-weeks of SP/AEP, after 12-weeks of AEP, 3-weeks post-AEP, 9-weeks post-AEP)
- Change in fatigue(Repeated measure: Pre-intervention, after 6-weeks of SP/AEP, after 12-weeks of AEP, 3-weeks post-AEP, 9-weeks post-AEP)
- MRS quantification of GABA/Glutathione(Repeated measure: Pre-intervention, after 6-weeks of SP/AEP, after 12-week of AEP)
- Change in daytime sleepiness(Repeated measure: Pre-intervention, after 6-weeks of SP/AEP, after 12-weeks of AEP, 3-weeks post-AEP, 9-weeks post-AEP)
- Change in blood derived neurotrophic factor (BDNF)(Repeated measure: Pre-intervention, after 6-weeks of SP/AEP, after 12-weeks of AEP)
- Change in cytokine profile(Repeated measure: Pre-intervention, after 6-weeks of SP/AEP, after 12-weeks of AEP)
- Change in telomere length (TL)(Repeated measure: Pre-intervention, after 6-weeks of SP/AEP, after 12-weeks of AEP)
- Change in anxiety(Repeated measure: Pre-intervention, after 6-weeks of SP/AEP, after 12-weeks of AEP)
- Change in depression(Repeated measure: Pre-intervention, after 6-weeks of SP/AEP, after 12-weeks of AEP)