Concurrent Validity of a Stationary Cycling Test and the Buffalo Concussion Treadmill Test in Adults With Concussion

Robert F Graham; Cody R van Rassel; Joel S Burma; Trevor D Rutschmann; Lauren N Miutz; Bonnie Sutter; Kathryn Schneider

doi:10.4085/1062-6050-0003.21

Concurrent Validity of a Stationary Cycling Test and the Buffalo Concussion Treadmill Test in Adults With Concussion

J Athl Train. 2021 Dec 1;56(12):1292-1299. doi: 10.4085/1062-6050-0003.21.

Authors

Robert F Graham¹, Cody R van Rassel¹, Joel S Burma^{1

2}, Trevor D Rutschmann^{1

3}, Lauren N Miutz¹, Bonnie Sutter⁴, Kathryn Schneider^{1

2

4

5

6}

Affiliations

¹ Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, AB, Canada.
² Hotchkiss Brain Institute, University of Calgary, AB, Canada.
³ Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada.
⁴ University of Calgary Sport Medicine Centre, AB, Canada.
⁵ Alberta Children's Hospital Research Institute, University of Calgary, Canada.
⁶ Evidence Sport and Spinal Therapy, Calgary, AB, Canada.

Abstract

Context: After concussion, a multifaceted assessment is recommended, including tests of physical exertion. The current criterion standard for exercise testing after concussion is the Buffalo Concussion Treadmill Test (BCTT); however, validated tests that use alternative exercise modalities are lacking.

Objective: To evaluate the feasibility and concurrent validity of a universal cycling test of exertion compared with the BCTT in adults who sustained a sport-related concussion.

Design: Crossover study.

Setting: University sports medicine clinic.

Patients or other participants: Twenty adults (age = 18-60 years) diagnosed with a sport-related concussion.

Intervention(s): Participants completed the BCTT and a cycling test of exertion in random order, approximately 48 hours apart.

Main outcome measure(s): The primary outcome of interest was maximum heart rate (HRmax; beats per minute [bpm]). Secondary outcomes of interest were the total number of symptoms endorsed on the Post-Concussion Symptom Scale, whether the participant reached volitional fatigue (yes or no), the symptom responsible for test cessation (Post-Concussion Symptom Scale), maximum rating of perceived exertion, symptom severity on a visual scale (0-10), and the time to test cessation.

Results: Of the 20 participants, 19 (10 males, 9 females) completed both tests. One participant did not return for the second test and was excluded from the analysis. No adverse events were reported. The median HRmax for the BCTT (171 bpm; interquartile range = 139-184 bpm) was not different from the median HRmax for the cycle (173 bpm; interquartile range = 160-182 bpm; z = -0.63; P = .53). For both tests, the 3 most frequently reported symptoms responsible for test cessation were headache, dizziness, and pressure in the head. Of interest, most participants (64%) reported a different symptom responsible for cessation of each test.

Conclusions: On the novel cycling test of exertion, participants achieved similar HRmax and test durations and, therefore, this test may be a suitable alternative to the BCTT. Future research to understand the physiological reason for the heterogeneity in symptoms responsible for test cessation is warranted.

Keywords: exercise intolerance; exercise testing; mild traumatic brain injuries; rehabilitation.

MeSH terms

Adult
Athletic Injuries* / diagnosis
Brain Concussion* / diagnosis
Cross-Over Studies
Exercise Test
Female
Humans
Male
Post-Concussion Syndrome* / diagnosis