Evaluating a 12-week aerobic exercise intervention in adults with persisting post-concussive symptoms, 2024, Leah J. Mercier et al

[Mij]

Background: Although guidelines support aerobic exercise in sub-acute mild traumatic brain injury (mTBI), evidence for adults with persisting post-concussive symptoms (PPCS) after mTBI is lacking. The objective was to evaluate the impact of a sub-symptom threshold aerobic exercise intervention on overall symptom burden and quality of life in adults with PPCS.
Methods: This prospective cohort study was nested within the ACTBI Trial (Aerobic Exercise for treatment of Chronic symptoms following mild Traumatic Brain Injury). A total of 50 adults with a diagnosis of mTBI, PPCS and exercise intolerance completed a 12-week sub-symptom threshold aerobic exercise intervention either immediately after enrollment (i-AEP group; n = 27) or following 6-weeks of stretching (d-AEP group; n = 23). Data from all participants (n = 50) were included in the combined AEP (c-AEP) group. The primary outcome was symptom burden on the Rivermead Post Concussion Symptoms Questionnaire (RPQ). Secondary outcomes included measures of quality of life and specific post-concussive symptoms (depressive and anxiety symptoms, functional impact of headache, fatigue, sleep, dizziness and exercise tolerance). Heart rate, blood pressure and heart rate variability were also assessed to understand autonomic function response to intervention.

Results: Participants were a mean (SD) of 42.6 (10.9) years old (74% female) and 25.1 (14.1) months post-mTBI. Following 12-weeks of intervention participants had a significant improvement in symptom burden on the RPQ (i-AEP: mean change = −9.415, p < 0.001; d-AEP: mean change = −3.478, p = 0.034; c-AEP: mean change = −6.446, p < 0.001). Participants also had significant improvement in quality of life (i-AEP: mean change = 9.879, p < 0.001; d-AEP: mean change = 7.994, p < 0.001, c-AEP: mean change = 8.937, p < 0.001), dizziness (i-AEP: mean change = −11.159, p = 0.001; d-AEP: mean change = −6.516, p = 0.019; c-AEP: −8.837, p < 0.001) and exercise tolerance (i-AEP: mean change = 5.987, p < 0.001; d-AEP: mean change = 3.421, p < 0.001; c-AEP: mean change = 4.703, p < 0.001). Headache (mean change = −5.522, p < 0.001) and depressive symptoms (mean change = −3.032, p = 0.001) improved in the i-AEP group. There was no change in measures of autonomic function.

Conclusion: A 12-week aerobic exercise intervention improves overall symptom burden, quality of life and specific symptom domains in adults with PPCS. Clinicians should consider prescription of progressive, individualized, sub-symptom threshold aerobic exercise for adults with PPCS even if presenting with exercise intolerance and months-to-years of symptoms.
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[rvallee]

Trying to think of all the weird stuff people could come up with in other disciplines if they could get away with random nonsense like this and I got nothing because it's too weird and obsessive.

Basically if you ignore the problem and do some random stuff and base your evaluation on that random stuff you could show that this random stuff is good at what this random stuff does. Now you still have your original problem but it's been obscured by distraction. The Aristocrats!

 

[Sean]

No controls?

All gains on subjective self-report measures.

No gains on objective measures.

Enough said.

 

[SNT Gatchaman]

Trying to think of all the weird stuff people could come up with in other disciplines if they could get away with random nonsense like this and I got nothing because it's too weird and obsessive.

A few days ago an excellent (very long) article was posted on the delayed and disputed report into the 2016 Egypt Air crash. Egypt was running the investigation and ultimately produced a report that was in contradiction with the French report and counterfactual. It has parallels to what we experience with BPS research. The difference is that this was a one-off, rather than systemic.

Taken in total, then, what does this leave us with? The traces of TNT on the remains are unreliable, the structural analysis is farcical, there was no sound of an explosion, and the plane didn’t depressurize. It doesn’t look like a duck, talk like a duck, or walk like a duck, and yet the EAAID proclaims, “Duck.” Never before have I seen an accident report that so plainly lost the plot. One of the experts I spoke to said it was the worst report they had ever read. The BEA seemed to agree, writing in its comments that, “The factual accuracy of the report is questionable, and the reasoning for the scenarios appears to distort the facts. … This leads to an unrealistic scenario incompatible with the sequence of warnings, failures and crew announcements”.

because the Triple Committee concluded that a bomb in the galley was the cause of the crash, the EAAID bent itself into a pretzel trying to make the evidence fit that theory.

Unfortunately, we don’t know why the Triple Committee and the EAAID chose to die on this hill. Egypt’s government is not transparent and lacks accountability, creating a vacuum of trust. Various speculative motives for attempting to cover up the cause of the crash have been put forward, which I won’t enumerate here. However, intentional or not, this is the first time I have ever come away from an aircraft accident report believing that a coverup might have taken place.

I would like to believe that the EAAID is made up of professionals who understand the principles of air crash investigation and wrote their own shambolic report under duress. But I wouldn’t stake my life on it. One can never completely rule out the possibility that they just didn’t know what they were doing.