Use of physical exertion to enhance objective testing following mild traumatic brain injury: a systematic review

Background Assessment of recovery from mild traumatic brain injury (mTBI) is complex and challenging. Post-exertion testing, where individuals undergo objective testing following physical exercise, has shown promise in identifying mTBI-related impairments that may not be evident at rest, but could h...

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Main Authors: Duncan Reid, Katherine Forch, Sharon Olsen, Mangor Pedersen, Nicola CM Towersey
Format: Article
Language:English
Published: BMJ Publishing Group 2025-04-01
Series:BMJ Open Sport & Exercise Medicine
Online Access:https://bmjopensem.bmj.com/content/11/2/e002385.full
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author Duncan Reid
Katherine Forch
Sharon Olsen
Mangor Pedersen
Nicola CM Towersey
author_facet Duncan Reid
Katherine Forch
Sharon Olsen
Mangor Pedersen
Nicola CM Towersey
author_sort Duncan Reid
collection DOAJ
description Background Assessment of recovery from mild traumatic brain injury (mTBI) is complex and challenging. Post-exertion testing, where individuals undergo objective testing following physical exercise, has shown promise in identifying mTBI-related impairments that may not be evident at rest, but could hinder a safe return to sport.Objectives To conduct a systematic review to determine if physical exertion affects objective physiological or sensorimotor tests differently in individuals with mTBI compared with healthy controls.Methods A systematic search of 11 databases and five trial registries on 30 May 2024 identified reports that: (i) compared individuals aged 12–65 years within 12 months of mTBI against healthy control participants, (ii) investigated the effects of a single session of physical exertion and (iii) collected before, during or after exertion, objective measures of physiological or sensorimotor function. Risk of bias was assessed with the Risk Of Bias In Non-randomized Studies of Interventions tool. Results were analysed descriptively.Results The review included 22 studies with 536 participants wih mTBI. Risk of bias was deemed high. At rest, 8/22 (36%) studies detected differences in physiological responses between participants wih mTBI and healthy control participants. During or after exertion, 21/22 (96%) studies detected differences in physiological responses, including cardiovascular, respiratory and cerebral autoregulation.Conclusion The findings indicate that objective testing during or after physical exertion can enhance the ability to detect mTBI-related impairments in various physiological parameters, and this concept could be considered when monitoring recovery and return to sport. Further studies are needed.PROSPERO registration number CRD42023411681.
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spelling doaj-art-7c4575fe41d9476dbeb6ebfb8d98babe2025-08-20T02:57:13ZengBMJ Publishing GroupBMJ Open Sport & Exercise Medicine2055-76472025-04-0111210.1136/bmjsem-2024-002385Use of physical exertion to enhance objective testing following mild traumatic brain injury: a systematic reviewDuncan Reid0Katherine Forch1Sharon Olsen2Mangor Pedersen3Nicola CM Towersey4School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New ZealandAxis Sports Medicine, Auckland, New ZealandHealth and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New ZealandAuckland University of Technology, Auckland, New ZealandAuckland University of Technology, Auckland, New ZealandBackground Assessment of recovery from mild traumatic brain injury (mTBI) is complex and challenging. Post-exertion testing, where individuals undergo objective testing following physical exercise, has shown promise in identifying mTBI-related impairments that may not be evident at rest, but could hinder a safe return to sport.Objectives To conduct a systematic review to determine if physical exertion affects objective physiological or sensorimotor tests differently in individuals with mTBI compared with healthy controls.Methods A systematic search of 11 databases and five trial registries on 30 May 2024 identified reports that: (i) compared individuals aged 12–65 years within 12 months of mTBI against healthy control participants, (ii) investigated the effects of a single session of physical exertion and (iii) collected before, during or after exertion, objective measures of physiological or sensorimotor function. Risk of bias was assessed with the Risk Of Bias In Non-randomized Studies of Interventions tool. Results were analysed descriptively.Results The review included 22 studies with 536 participants wih mTBI. Risk of bias was deemed high. At rest, 8/22 (36%) studies detected differences in physiological responses between participants wih mTBI and healthy control participants. During or after exertion, 21/22 (96%) studies detected differences in physiological responses, including cardiovascular, respiratory and cerebral autoregulation.Conclusion The findings indicate that objective testing during or after physical exertion can enhance the ability to detect mTBI-related impairments in various physiological parameters, and this concept could be considered when monitoring recovery and return to sport. Further studies are needed.PROSPERO registration number CRD42023411681.https://bmjopensem.bmj.com/content/11/2/e002385.full
spellingShingle Duncan Reid
Katherine Forch
Sharon Olsen
Mangor Pedersen
Nicola CM Towersey
Use of physical exertion to enhance objective testing following mild traumatic brain injury: a systematic review
BMJ Open Sport & Exercise Medicine
title Use of physical exertion to enhance objective testing following mild traumatic brain injury: a systematic review
title_full Use of physical exertion to enhance objective testing following mild traumatic brain injury: a systematic review
title_fullStr Use of physical exertion to enhance objective testing following mild traumatic brain injury: a systematic review
title_full_unstemmed Use of physical exertion to enhance objective testing following mild traumatic brain injury: a systematic review
title_short Use of physical exertion to enhance objective testing following mild traumatic brain injury: a systematic review
title_sort use of physical exertion to enhance objective testing following mild traumatic brain injury a systematic review
url https://bmjopensem.bmj.com/content/11/2/e002385.full
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