Exercise-Induced Symptom Exacerbation and Adverse Events in Moderate-to-Severe Traumatic Brain Injury, 2025, Gallow et al

forestglip

Moderator
Staff member
Exercise-Induced Symptom Exacerbation and Adverse Events in Moderate-to-Severe Traumatic Brain Injury

Gallow, Sara BPhysio; McGinley, Jennifer PhD; Olver, John MD, FAFRM; McKenzie, Dean PhD; Williams, Gavin PhD

Objective
To determine the incidence of exercise-induced symptom exacerbation and adverse events from cardiorespiratory fitness (CRF) and high-level mobility (HLM) exertional testing in the early subacute phase (≤3 months post-injury) following moderate-to-severe traumatic brain injury (TBI).

Setting
Inpatient TBI subacute rehabilitation unit.

Participants
One hundred fifty adults and adolescents ≥15 years with moderate-to-severe TBI completed a total of 205 exertional tests (83 participants completed CRF only, 12 HLM only, and 55 both CRF and HLM).

Design
Prospective observational cohort study. Consecutive admissions were screened for recruitment between August 2017 and August 2021. Symptom ratings were recorded pre- and post-CRF and HLM exertional testing on the Sports Concussion Assessment Tool symptom scale. A summed symptom severity score (SCAT-SS) was calculated with a ≥10-point increase classified as symptom exacerbation and a ≥10-point reduction classified as symptom improvement.

Main measures
SCAT symptom scale.

Results
One participant experienced a ≥10-point increase in SCAT-SS (ie, symptom exacerbation) post-CRF testing (1/138 = 0.7%, 95% confidence interval [CI] = 0.01%-4.0%) and 1 post-HLM testing (1/67 = 1.5%, 95% CI = 0.04%-8.0%). Sixteen of 138 (11.6%, 95% CI = 6.8%-18.1%) CRF tests resulted in a ≥10-point decrease in SCAT-SS (ie, symptom improvement). Nine of 67 (13.4%, 95% CI = 6.3%-24.0%) HLM tests resulted in a ≥10-point decrease in SCAT-SS. Participants were more likely to experience symptom improvement than symptom exacerbation for both CRF and HLM exertion (P ≤ .05). One adverse event, a fall, occurred during an HLM testing session.

Conclusions
CRF and HLM exertional testing in the early subacute phase of recovery following moderate-to-severe TBI appears to be safe, with low rates of symptom exacerbation and adverse events identified.

Web | Journal of Head Trauma Rehabilitation | Paywall
 
Even if it’s safe (I have no idea about the methodology), it doesn’t look like it’s very effective either with few patients experiencing what I assume they’ve defined as meaningful symptomatic improvement.
 
Even if it’s safe (I have no idea about the methodology), it doesn’t look like it’s very effective either with few patients experiencing what I assume they’ve defined as meaningful symptomatic improvement.
Exercise seems to be one of the few “interventions” modern medicine treats, as “helpful until proven otherwise”
 
Even if it’s safe (I have no idea about the methodology), it doesn’t look like it’s very effective either with few patients experiencing what I assume they’ve defined as meaningful symptomatic improvement.
It looks like they're just making sure it's safe, since they refer to it as a "test", not a "treatment", at least in the abstract.

I'm just concerned that:
1. Their symptom scale may not be well-suited enough to capture symptom exacerbation.
2. It may be the case that for most people with TBI, exercise testing is safe, but the authors then assume that TBI is largely similar in everyone and that exercise can be prescribed for anyone with TBI. Like the authors did here with GWI:

Exercise does not cause post-exertional malaise Gulf War Illness: A randomized, controlled, dose–response, crossover study, 2024, Boruch et al.

If some patients with TBI are saying they have post-exercise symptom exacerbation, which I assume was the rationale for this study, I'd err on the side of believing them.
 
Also I’m not sure I like the logic of, “the average patient doesn’t react badly to [X] so [X] is safe”
That’s also a good point. It puts into question how much you value the health of the ones the experience adverse events.
It looks like they're just making sure it's safe, since they refer to it as a "test", not a "treatment", at least in the abstract.

I'm just concerned that:
1. Their symptom scale may not be well-suited enough to capture symptom exacerbation.
2. It may be the case that for most people with TBI, exercise testing is safe, but the authors then assume that TBI is largely similar in everyone and that exercise can be prescribed for anyone with TBI. Like the authors did here with GWI:

Exercise does not cause post-exertional malaise Gulf War Illness: A randomized, controlled, dose–response, crossover study, 2024, Boruch et al.

If some patients with TBI are saying they have post-exercise symptom exacerbation, which I assume was the rationale for this study, I'd err on the side of believing them.
I’ve just started to assume that adverse events are far more common than reported, for various reasons including suboptimal measurements, bias, underreporting, conflict of interests, etc.
 
Back
Top Bottom