Exercise

Activity Trackers

Research Paper:

Effectiveness of wearable activity trackers to increase physical activity and improve health: a systematic review of systematic reviews and meta-analyses

Article Breakdown

This study examined the effectiveness of activity trackers for improving physical activity and other health measures. The shines a positive light on the use of activity trackers and their ability to inspire physical activity and positive health outcomes across some physiological measures. The review noted a meaningful benefit of activity trackers and noted areas for further research on this topic to establish additional insights in relation to other health measures (physiological and psychosocial).

Main Findings

• The meta-analyses suggested activity trackers improved physical activity, body composition (, and fitness, equating to approximately 1800 extra steps per day, 40 min per day more walking, and reductions of approximately 1 kg in bodyweight.
• Effects for other physiological (blood pressure, cholesterol, and glycosylated haemoglobin) and psychosocial (quality of life and pain) outcomes were typically small and often non-significant.

Limitations 

• Although the sample chosen was comprehensive and incorporated elements related to the title, the authors acknowledge the exclusion of systematic reviews related to activity tracker-based interventions in populations with mental illness.

Main Takeaway Message

Activity trackers appear to be effective at increasing physical activity in a variety of age groups and clinical and non-clinical populations. 

Study Reference and Access

Ferguson T, Olds T, Curtis R, Blake H, Crozier AJ, Dankiw K, Dumuid D, Kasai D, O’Connor E, Virgara R, Maher C. Effectiveness of wearable activity trackers to increase physical activity and improve health: a systematic review of systematic reviews and meta-analyses. Lancet Digit Health. 2022 Aug;4(8):e615-e626. doi: 10.1016/S2589-7500(22)00111-X. PMID: 35868813.

Physical Interventions

Research Paper:

Do physical interventions improve outcomes following concussion: a systematic review and meta-analysis?

Article Breakdown

Reid, Farbenblum & McLeod (2022) conducted a systematic review and meta-analysis examining the effect of physical interventions (ie., subthreshold aerobic exercise, cervical, vestibular and/or oculomotor therapies) on days to recovery and symptom scores for concussion management. 

The authors reviewed randomized controlled trials (RCT) for interventions of subthreshold aerobic exercise, cervical, vestibular and/or oculomotor therapies. Twelve RCTs met their inclusion criteria: 7 on subthreshold aerobic exercise, 1 on vestibular therapy, 1 on cervical therapy and 3 on individually tailored multimodal interventions.

Main Findings

• Of the 12 trials reviewed in this study, four of them included participants with acute concussion symptoms and eight included those with persistent symptoms.
• Their analysis found subthreshold aerobic exercise had only a small effect in reducing symptoms, but more importantly it shows that subthreshold aerobic exercise does not make symptoms worse in both acute and persistent concussion, which to date has been somewhat unknown (Reid, Farbenblum & McLeod, 2022, pg. 296).
• Additionally, individually tailored multimodal intervention can help facilitate a faster return to sport while decreasing symptoms with those with persistent symptoms.
• They also found limited evidence for stand-alone cervical, vestibular and oculomotor therapies.
• Although there was limited evidence for stand-alone cervical or vestibular therapy, when it was incorporated into multi-modal collaborative care, including cervical, oculomotor and vestibular rehabilitation tailored to the patient’s presentation, there is evidence of a positive outcome.

Limitations 

• A limitation of the review was the small number of studies for certain interventions and the inclusion of trials with small sample sizes (Reid, Farbenblum & McLeod, 2022, pg. 297). With these limitations, there is a possibility of skewed or biassed data, please interpret the results with caution. 

Main Takeaway Message

This study provides reassurance to the Rhea Active Recovery approach of subthreshold aerobic exercise and its potential benefits in both the acute phase or those with persistent symptoms. The research highlights aerobic exercise in reducing symptoms, as well as no negative implications to using this approach. While this approach does not lead to a faster recovery, other evidence brought forth in this review suggests that a multi-modal approach to recovery can lead to a faster return to sport for those with persistent symptoms.

Study Reference and Access

Reid SA, Farbenblum J, McLeod S. Do physical interventions improve outcomes following concussion: a systematic review and meta-analysis? Br J Sports Med. 2022 Mar;56(5):292-298. doi: 10.1136/bjsports-2020-103470. Epub 2021 Sep 30. PMID: 34593371.

Yoga

Can yoga help with my concussion recovery?

Yoga can be a great source of exercise or mindful movement for people with a concussion. There is something to be said for connecting your mind, body and spirit as you go through the recovery process. And as far as yoga is concerned in the concussion population, Love Your Brain Yoga (LYBY) is a tremendous organization and resource to learn how you can integrate yoga into your recovery regimen today.

Exercise Progression

General Principles

Each stage of exercise should be performed without symptom production either during or after (within an hour or so) exercise.

If a stage of exercise does produce symptoms, then the next session should the patient has to “go back” to the last stage that did not produce symptoms, and subsequently progressed with caution, after a day or two of asymptomatic exercise.

By Whom

Ideally, such an exercise progression should be supervised and monitored by a qualified health professional. However, patients may “supervise” their own progression if needed, so long as they understand both the principles involved and the specifics.

How often to exercise

Sessions in an exercise progression after concussion are typically once daily. In some cases (either severe injuries with prolonged symptoms, or mild injuries with fleeting symptoms) the frequency of these sessions may be reduced (to several sessions per week) or increased (to twice daily) as may be appropriate in the clinical judgement of a supervising health professional.

How quickly to progress

This is not a time-based process; instead, it is based on successfully reaching “milestones”. Each stage is commenced only after the last stage has been completed successfully. There is no “correct” rate of progression so long as the previous stage has been successfully passed.

In the mildest cases with the quickest recovery, an athlete may potentially progress from one stage to another on the same day (if doing two sessions of exercise that day).

In severe or prolonged cases, it is generally prudent to perform exercise successfully (without symptoms or exacerbation) for at least several sessions before progressing to the next stage.

Stages of Exercise Progression

Rest

Goal: Reduction of symptoms/attainment of asymptomatic state

Description: No physical activities that raise HR above resting rate. Should perform non-vigorous isometric stabilization exercises for the neck.

Re-Introduction of Stressors

Goal: Establish capacity for cardio-respiratory exertion without symptom production (or symptom exacerbation if performing progression despite persistent symptoms).

Description: Stationary bicycle (no head movement) with the progression of intensity or duration (not both concurrently in one session).

• 15 minutes @ 120 bpm – increase duration to 30 minutes @ 120 bpm
• 30 minutes @ 140 bpm
• 30 minutes @ 140 bpm – 1-minute maximal sprints every 5 minutes (@ 5, 10, 15, 20, 25 min)

Low-Level Stress

Goal: Establish capacity for at least 30 minutes per day of sport-specific movements that involve progressively greater acceleration of the head without symptom production (or exacerbation)

Description: Sport-specific movement that is most relevant to a patient’s function, with gradual progression of both intensity of exercise and magnitude of head acceleration, individualized as appropriate. At this stage, there should be no “cognitive burden” where drills require them to make decisions or concentrate on a task other than basic movement. No resistance training.

Intermediate Stress

Goal: Establish that at least 30 minutes per day of sport-specific training (stage 3) with additional cognitive and visual tracking burdens and body-weight resistance exercises do not produce or exacerbate symptoms.

Description: Continue with the intensity and duration of sport-specific drills reached in stage 3, but now add an element of thinking or decision-making, such as ball or puck-handling, shooting, passing, positional play, execution of set plays, and so on. Also, add 15 minutes per day of body-weight floor exercises such as planks, push-ups, squats, lunges, sit-ups, box jumps, and so on – progress these from less intense (e.g. planks) to more intense (e.g. box jumps). Do not hold your breath.

Submaximal Stress

Goal: Establish freedom from symptoms in situations that simulate all aspects of normal training, except for the risk of collision.

Description: Sport-specific drills should involve increased complexity in simulating game situations. Increase duration toward normal daily training load for this sport. Resistance training may now use additional weights or machines as would be typical of training programs in your sport. Heavy resistance exercises may involve the Valsalva manoeuvre (breath-holding during very heavy lifting, which increases intracranial pressure).

Full Physical Activity / Sport

Goal: Unrestricted activity without symptom production.

Description: Full participation in sports.