The association between sleep and physical activity with persisting postconcussion symptoms among adolescent athletes

Exercising More Than 150 min/wk After Concussion Is Associated With Sleep Quality Improvements

OBJECTIVE

To examine whether a high volume of aerobic exercise after concussion (>150 min/wk) is associated with improved sleep quality over a 1-month period. We hypothesized that more than 150 min/wk of exercise would be associated with improved sleep quality across concussion recovery.

DESIGN

Prospective cohort observational study.

SETTING

Sports medicine clinic.

PARTICIPANTS

Adolescents initially tested 8.4 ± 3.5 (range, 2-18) days postconcussion who returned for a follow-up assessment 34.3 ± 7.7 (range: 20-49) days postconcussion.

MAIN OUTCOME MEASURES

Participants completed the Pittsburgh Sleep Quality Index and the Post-Concussion Symptom Inventory. No specific exercise or sleep recommendations were given beyond what their treating physician provided. Between study visits, participants recorded exercise performed via wrist-worn actigraphy. We calculated average exercise minutes per week and grouped participants as those who exercised more than 150 min/wk versus those who exercised 150 min/wk or less.

RESULTS

Thirty-six adolescents participated. Fifteen (42%) recorded more than 150 min/wk of aerobic exercise (age = 14.0 ± 1.7 years; 47% female; mean = 5.6 ± 1.2 d/wk of exercise; mean = 49.2 ± 17.5 min/session), and 21 recorded 150 min/wk or less of aerobic exercise (age = 15.0 ± 1.9 years; 76% female; mean = 2.7 ± 1.6 d/wk of exercise; mean = 30.2 ± 7.8 min/session). There were no significant group differences in the proportion of those who self-reported beginning physical activity prior to enrollment (47% vs 33%; P = .42) or for initial sleep quality rating (8.0 ± 3.7 vs 8.6 ± 4.1; P = .67) or initial concussion symptom severity rating (34.9 ± 28.0 vs 42.6 ± 25.9; P = .40). The group that exercised more than 150 min/wk between visits demonstrated significantly greater median PSQI rating improvements than those who exercised 150 min/wk or less, with a large effect size noted (median change [interquartile range] = 5 [3, 7] vs 1 [0, 4]; P = .008; Cohen d = 0.96).

CONCLUSION

Current recommendations suggest that subsymptom aerobic exercise can be beneficial after concussion. Our findings indicate that an exercise volume of more than 150 min/wk led to greater sleep quality improvements than those who exercised below this level.

Concussion symptom presentation and clinical recovery among pediatric athletes: comparing concussions sustained during school and summer months

OBJECTIVE

We examined post-concussion symptom presentation, exercise, and sleep among pediatric athletes who sustained concussion during the school year vs. summer months.

METHODS

We evaluated athletes 6-18 years old within 21-days of concussion. They reported symptoms (Health and Behavior Inventory), with cognitive/somatic domain sub-scores calculated, and indicated if they had exercised or experienced sleep problems since injury. We grouped patients by injury season: summer months (June-August) vs. school year (September-May).

RESULTS

350 patients (14.4 ± 2.4 years old; 37% female; initial visit 8.8 ± 5.3 days post-concussion) were seen for care: 24% sustained a concussion during summer months, 76% during the school year. Lower cognitive (median = 7 [IQR = 1, 15] vs. 9.5 [4, 17]; p = 0.01), but not somatic (7 [2.5, 11] vs. 8 [4, 13]; p = 0.06), HBI scores were observed for patients injured during the summer. Groups were similar in proportion exercising (16% vs 17%) and endorsing sleep problems (29% vs 31%). After adjustments, sustaining a concussion during the summer predicted total (β=-3.43; 95%CI = -6.50, -0.36; p = 0.029) and cognitive (β = -2.29; 95%CI = -4.22, -0.36; p = 0.02), but not somatic (β=-1.46; 95%CI = -2.84, -0.08; p = 0.04), symptom severity.

CONCLUSION

Pediatric patients with concussion may present with greater cognitive symptoms during the school year, compared to summer months.

The Fundamentals and Applications of Wearable Sensor Devices in Sports Medicine: A Scoping Review

PURPOSE

To (1) characterize the various forms of wearable sensor devices (WSDs) and (2) review the peer-reviewed literature of applied wearable technology within sports medicine.

METHODS

A systematic search of PubMed and EMBASE databases, from inception through 2023, was conducted to identify eligible studies using WSDs within sports medicine. Data extraction was performed of study demographics and sensor specifications. Included studies were categorized by application: athletic training, rehabilitation, and research.

RESULTS

In total, 43 studies met criteria for inclusion in this review. Forms of WSDs include pedometers, accelerometers, encoders (consisting of magnetometers and gyroscopes), force sensors, global positioning system trackers, and inertial measurement units. Outcome metrics include step counts; gait, limb motion, and angular positioning; foot and skin pressure; change of direction and inclination, including analysis of both body parts and athletes on a field; displacement and velocity of body segments and joints; heart rate; plethysmography; sport-specific kinematics; range of motion, symmetry, and alignment; head impact; sleep; throwing biomechanics; and kinetic and spatiotemporal running metrics. WSDs are used in athletic training to assess sport-specific biomechanics and workload with a goal of injury prevention and training optimization, as well as for rehabilitation monitoring and research such as for risk predicting and aiding diagnosis.

CONCLUSIONS

WSDs enable real-time monitoring of human performance across a variety of implementations and settings, allowing collection of metrics otherwise not achievable. WSDs are powerful tools with multiple applications within athletic training, patient rehabilitation, and orthopaedic and sports medicine research.

CLINICAL RELEVANCE

Wearable technology may represent the missing link to quantitatively addressing return to play and previous performance. WSDs are commercially available and portable adjuncts that allow clinicians, trainers, and individual athletes to monitor biomechanical parameters, workload, and recovery status to better contextualize personalized training, injury risk, and rehabilitation.