Quantifying Physical Activity After Concussion: The Relationship Between Sleep Quality, Symptoms, And Steps.

Abstract

BACKGROUND: Concussion management guidelines have evolved over recent years to include earlier introduction of physical activity. Determining optimal post-concussion physical activity levels with objective methods will further aid clinicians in counseling patients on the role of physical activity in concussion recovery. PURPOSE: Our aim was to investigate the relationship of physical activity, as measured by daily step count, with post-injury sleep quality, symptom rating, and dual-task gait measures among youth athletes with concussion. METHODS: We conducted a longitudinal investigation of youth athletes who sustained a concussion and were evaluated at 2 time points: within 2 weeks of injury and at clearance for return-to-play. Following the initial visit, athletes wore an activity tracking device (Fitbit Charge 3). Dual-task gait, Post-Concussion Symptom Inventory, and Pittsburgh Sleep Quality Index values were collected at both visits. We compared outcomes between those who recorded an average of ≥10,000 steps/day (high physical activity) and <10,000 steps day (low physical activity) between initial and return-to-play clearance visits. RESULTS: Six concussed athletes were classified as having high physical activity (33% female; 14.9±2.0 years of age; 13,900±3,390 steps/day), and five were classified as having low physical activity (40% female; 15.8±1.7 years of age; 8,415±1,775 steps/day). There were no significant differences found at initial visit for total symptom severity (44.3±30.8 vs. 58.2±28.4; p=0.46), sleep quality (6.8±4.4 vs. 8.8±2.0; p=0.38), or dual-task gait cost (-22.4±7.9% vs. -20.1±13.5%; p=0.73) between the high and low physical activity groups. At the time of return-to-play clearance, however, the high physical activity group reported significantly better sleep quality (1.3 ±1.9 vs. 6.7±1.5; p=0.009) and lower symptom severity (0.3±0.8 vs. 3.0±2.0; p=0.02) than the low physical activity group. CONCLUSIONS: Adolescents with a concussion who participated in more physical activity after their initial clinical visit reported better sleep quality and lower symptom severity at return-to-play clearance than the low physical activity group. These preliminary results further support the utility of physical activity in concussion management.