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Aerobic Exercise for Adolescents With Prolonged Symptoms After Mild Traumatic Brain Injury: An Exploratory Randomized Clinical Trial

Kurowski, Brad G. MD, MS; Hugentobler, Jason PT; Quatman-Yates, Catherine DPT, PhD; Taylor, Jennifer BA; Gubanich, Paul J. MD, MPH; Altaye, Mekibib PhD; Wade, Shari L. PhD

Journal of Head Trauma Rehabilitation: March/April 2017 - Volume 32 - Issue 2 - p 79–89
doi: 10.1097/HTR.0000000000000238
Original Articles

Objective: To describe the methodology and report primary outcomes of an exploratory randomized clinical trial (RCT) of aerobic training for management of prolonged symptoms after a mild traumatic brain injury (mTBI) in adolescents.

Setting: Outpatient research setting.

Participants: Thirty adolescents between the ages of 12 and 17 years who sustained a mTBI and had between 4 and 16 weeks of persistent symptoms.

Design: Partially blinded, pilot RCT of subsymptom exacerbation aerobic training compared with a full-body stretching program.

Main Measures: The primary outcome was postinjury symptom improvement assessed by the adolescent's self-reported Post-Concussion Symptom Inventory (PCSI) repeated for at least 6 weeks of the intervention. Parent-reported PCSI and adherence are also described.

Results: Twenty-two percent of eligible participants enrolled in the trial. Repeated-measures analysis of variance via mixed-models analysis demonstrated a significant group × time interaction with self-reported PCSI ratings, indicating a greater rate of improvement in the subsymptom exacerbation aerobic training group than in the full-body stretching group (F = 4.11, P = .044). Adherence to the home exercise programs was lower in the subsymptom exacerbation aerobic training group compared with the full-body stretching group (mean [SD] times per week = 4.42 [1.95] vs 5.85 [1.37], P < .0001) over the duration of the study.

Conclusion: Findings from this exploratory RCT suggest subsymptom exacerbation aerobic training is potentially beneficial for adolescents with persistent symptoms after an mTBI. These findings and other recent research support the potential benefit of active rehabilitation programs for adolescents with persistent symptoms after an mTBI. Larger replication studies are needed to verify findings and improve generalizability. Future work should focus on determining the optimal type, timing, and intensity of active rehabilitation programs and characteristics of individuals most likely to benefit.

Divisions of Physical Medicine and Rehabilitation (Drs Kurowski and Wade and Ms Taylor), Sports Medicine (Mr Hugentobler and Drs Quatman-Yates and Gubanich); and Epidemiology and Biostatistics (Dr Altaye), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

Corresponding Author: Brad G. Kurowski, MD, MS, Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 4009, Cincinnati, OH 45229 (

Funding for this study was supported in part by the Cincinnati Children's Research Foundation Trustees Grant program, Ohio Department of Public Safety, National Institute for Child Health and Human Development K23HD074683-01A1, and grant 8 UL1 TR000077 from the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or other supporting agencies.

The authors declare no conflicts of interest.

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