PTOTCohortJournal of rehabilitation medicine2025

Exploring exercise intolerance in adult patients with persistent post-concussion symptoms after mild traumatic brain injury.

Lars-Johan V Valaas, Helene L Soberg, Mari S Rasmussen and 2 others

PMID 41194579

WHAT IT FOUND

In adults with persistent concussion symptoms, 81% had exercise intolerance confirmed by treadmill testing.

Higher overall symptom burden predicted this intolerance. Within those intolerant, higher resting heart rate allowed more exercise, while higher anxiety lowered the threshold for symptoms.

Key findings

0181% of patients with persistent post-concussion symptoms and self-reported exercise exacerbation were classified as exercise intolerant by the Buffalo Concussion Treadmill Test.

02A higher Rivermead Post Concussion Symptoms Questionnaire score was associated with increased odds of testing positive for exercise intolerance.

03In patients with exercise intolerance, a higher resting heart rate before the test was associated with a higher symptom threshold, while higher anxiety scores were associated with a lower symptom threshold.

STILL TO COME

How it was doneWhat they foundWhat it means for PTsWhat it means for OTs

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What it does not show

The study recruited patients from a specialized outpatient clinic who were motivated to participate in an exercise trial, representing a more severe and selected population than the general mild traumatic brain injury population. The cross-sectional design cannot establish causality between factors like anxiety or resting heart rate and exercise intolerance. Patients aged under 18 or over 60 were excluded. The regression model explained only 21% of the variance in symptom threshold, indicating other unmeasured factors influence exercise intolerance.

Declared interests

The study was approved by the Regional Committee for Medical and Health Research Ethics South-East Norway. Funding sources and conflicts of interest are not explicitly detailed in the provided text, though it notes the study is baseline data for an ongoing RCT.

The easy way to misread this

Do not assume that fatigue or low physical activity levels are the primary drivers of exercise intolerance in these patients, as neither differed between exercise-intolerant and tolerant groups nor predicted symptom thresholds in this study.

Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →