Exertion Test Research Articles

Test-Retest, Interrater Reliability, and Minimal Detectable Change of the Dynamic Exertion Test (EXiT) for Concussion.

The Dynamic Exertion Test (EXiT) was developed to inform return-to-play (RTP) decision-making following clinical recovery from sport-related concussion (SRC). The purpose of the current study was to document intrarater and test-retest reliability and minimal detectable change (MDC) scores for physiological [heart rate (HR) and blood pressure], performance (change-of-direction task completion time and errors), and clinical outcomes (endorsed symptoms, perceived exertion) of EXiT, and interrater reliability of performance outcomes. Healthy athletes would exhibit stable physiological responses to the EXiT across visits, demonstrate consistent change-of-direction task completion time between consecutive trials at each visit, and the fastest time (of 2 trials) across visits, and endorse equivocal symptoms and effort across visits. Cross-sectional, test-retest. Level 3. Seventy-nine (female: 34 [43%], 19.6 ± 5.0 years) athletes completed the EXiT at 2 study visits (8.7 ± 4.7 days between visits). Two-way, mixed, intraclass correlation coefficients (ICCs) were used to evaluate intrarater and test-retest reliability. Cronbach's alpha was used to document the internal consistency of symptoms at each visit, and MDC scores were calculated on the physiological, performance, and clinical outcomes. Measured and percentage of age-estimated maximum HR were reliable following EXiT (ICC = 0.579-0.618). Change-of-direction task completion time (MDC range = 0.75-8.70 s) had good-to-excellent test-retest (ICC = 0.703-0.948) and interrater (ICC = 0.932-0.965) reliability. Symptoms had a high internal consistency at visits 1 (α = 0.894) and 2 (α = 0.805) and were reliable across visits (ICC = 0.588). The current investigation established test-retest reliability in addition to MDC scores of an objective dynamic exercise assessment among healthy adolescent and adult athletes. The EXiT may be an objective approach to inform RTP decision-making following SRC recovery. The EXiT is a clinically feasible exertion-based assessment that can be readily administered in a variety of outpatient clinical settings.

The Dynamic Exertion Test for Sport-Related Concussion: A Comparison of Athletes at Return-to-Play and Healthy Controls.

To describe the Dynamic Exertion Test (EXiT) by comparing physiological, performance, and clinical outcomes between athletes medically cleared following sport-related concussion (SRC) and healthy controls. One hundred four (female = 41, 39.4%) participants (14-21y of age) including 52 medically cleared for return to play at 21.48 (15.40)days following SRC and 52 healthy athletes completed the EXiT involving (1) 12-minute aerobic component and (2) 18-minute dynamic component including 2 functional movement and 5 change-of-direction(COD) tasks. Physiological (heart rate and blood pressure), clinical (endorsed symptoms and rating of perceived exertion), and performance (COD-task completion time and errors) outcomes were collected throughout EXiT. Participants also completed the Postconcussion Symptom Scale and vestibular/ocular motor screening before EXiT. Independent-samples t tests were used to compare groups on resting heart rate and blood pressure, COD-task completion time, and Mann-Whitney U tests on Postconcussion Symptom Scale, vestibular/ocular motor screening, and EXiT symptoms, rating of perceived exertion, and errors. COD-task completion time and resting systolic blood pressure and heart rate were similar between groups (P > .05). SRC reported greater rating of perceived exertion during the aerobic component (P < .05) and lower total dizziness (P = .003) and total symptoms (P = .021) during EXiT and had lower near point of convergence distance (P < .001) and total symptoms (P = .007) for vestibular/ocular motor screening than healthy athletes. Physiological, performance, and clinical EXiT outcomes were equivocal between athletes at medical clearance following SRC and healthy controls. The multidomain EXiT may help to inform safe return-to-play decision making post-SRC.

The Role of Age, Sex, Body Mass Index, and Sport Type on the Dynamic Exertion Test in Healthy Athletes: A Cross-Sectional Study.

The dynamic exertion test (EXiT) was developed to help inform return to play after sport-related concussion, but some factors may threaten the internal validity of EXiT and affect clinical interpretation. To compare age, sex, BMI, and sport types across EXiT physiological [pre-EXiT and post-EXiT percentage of maximum heart rate (HR %max) and blood pressure (BP)], performance (change-of-direction task completion time and committed errors), and clinical [symptoms and rating of perceived exertion (RPE)] outcomes among healthy adolescents and adults. Cross-sectional. Eighty-seven participants ( F = 55, 37.4%) reported symptoms and RPE during the EXiT, which consists of a 12-minute treadmill running protocol, and the dynamic circuit, ball toss, box shuffle (SHUF) and carioca (CAR), zig zag (ZZ), proagility (PA), and arrow agility (AA) tasks. Independent samples t tests were conducted for pre-EXiT and post-EXiT HR %max and BP and change-of-direction task completion time and Mann-Whitney U tests for errors, symptoms, and RPE. A series of 1-way analysis of variance (ANOVAs) and Kruskal-Wallis H tests were conducted to compare collision, contact, and noncontact sport types. Adolescents had lower completion time across AA ( P = 0.01) and male athletes lower than female athletes on CAR, ZZ, PA, and AA ( P < 0.04). Male athletes reported greater RPE after the SHUF, CAR, and AA ( P < 0.03). HR %max , errors, and symptoms were equivocal across all subgroups ( P > 0.05). Age and sex should be considered in the interpretation of performance and clinical, but not physiological, EXiT outcomes. The EXiT is a standardized exercise assessment and generalizable to healthy athletes.

Role Of Age, Gender, And Bmi In Test-retest Performance On Dynamic Exertion Testing For Concussion

Aerobic and dynamic exertion testing is used to inform return to play decisions following sport-related concussion (SRC). However, there are limited data on the repeatability of these tests and we know little about the role of demographic and health status factors on outcomes. PURPOSE: To evaluate test-retest reliability of a new dynamic exertion test (EXiT) protocol including age-estimated heart rate (HR) and rating of perceived exertion (RPE) following aerobic (AERO) and dynamic (DYN) movement components, agility task completion time, and total symptoms; in relation to age, gender, and body mass index (BMI). METHODS: A total of 79 (34-F [43%], 19.63 ± 5.01 yrs) healthy athletes completed the following EXiT components across 2 visits (8.72 ± 4.65 days): 12 min treadmill run (AERO) and DYN; dynamic circuit (CIRC), ball toss (BT), box-drill shuffle (SHUF) and carioca (CAR), zig-zag (ZZ), pro agility (PA), and arrow agility (AA) tasks. Participants were categorized into 14-19yo (YOUTH) or 20-31yo (ADULT); male (M) or F; and low or high (50th%) BMI. Two-way, mixed, intra-class correlation coefficients (ICC) were used to evaluate test-retest reliability. Paired samples t-tests were used for HR and test completion time, with Wilcoxon tests used for symptoms and RPE. RESULTS: Results supported a reduction in HR following the CIRC (p < .05), and moderate to high agreement following AERO (ICC = .579-.910, p < .01) and DYN (ICC = .503-.618, p < .05). A reduction in completion time was reported for YOUTH on SHUF (p = .004) and ADULT on SHUF, CAR, and ZZ (p < .05). Both M and F experienced a reduction in SHUF, CAR, and ZZ (p < .05); and a reduction among high BMI for SHUF, CAR, ZZ, and AA tasks (p < .05). Results supported moderate to high agreement for completion time on SHUF (ICC = .607-.935), CAR (ICC = .564-.950), ZZ (ICC = .750-.949), PA (ICC = .546-.940), and AA (ICC = .793-.820); as well as RPE (ICC = .707-847) and symptoms(ICC = .517-.919) (p < .05). CONCLUSIONS: The findings indicate that the EXiT outcomes are consistent across repeated administrations in healthy athletes, regardless of age, gender or BMI. As such, changes in performance across time are more likely to reflect effects of concussion and the recovery process than performance inconsistency and these potential confounding factors.

Dynamic Exertion Testing (EXIT): A New Approach To Inform Return To Play Following Sport-related Concussion

A multifaceted assessment to inform clinicians of an athletes’ readiness to return to play (RTP) following sport-related concussion (SRC) includes symptoms, and neurocognitive, vestibular, and ocular function. Athletes must also complete a progressive exertion protocol that systematically increases exercise intensity and sport-specificity. However, ambiguous exercise parameters and reliance on subjective symptom reports limit the current approach and there is a need for a brief, clinical assessment to better inform RTP decisions. A novel dynamic exertion test (EXiT) that incorporates ACSM exercise prescription recommendations to replicate physiological demands from a variety of sport types and provides objective criteria can address these limitations. A comparison of EXiT outcomes between athletes recently cleared to RTP (RTP-A) and matched healthy controls (CON) is warranted to determine the clinical feasibility and interpretation of EXiT. PURPOSE: Compare heart rate (HR), endorsed symptoms, rating of perceived exertion (RPE), and performance outcomes during the completion of a 1) aerobic treadmill protocol, and 2) 5 hand-timed agility tasks between RTP-A and CON groups completing EXiT. METHODS: Twenty-eight (F=9, 32.1%;) athletes (ht.: 172.3±10.5 cm; wt.: 68.7± 14.5 kg) completed the EXiT test at RTP evaluation and were age-, gender-, and sport-matched to healthy controls (ht.: 171.1±9.0 cm, wt.: 64.1±17.5 kg). Participants wore an Equivital Lifemonitor physiological monitoring system, reported symptoms and RPE, and were timed by independent raters during completion of Box drills, Zigzag, Pro-agility, and Arrow agility EXIT tasks. Independent samples t-tests were conducted to compare HR, symptoms, RPE, and EXIT agility task completion time between RTP-A and CON groups. RESULTS: RTP-A and CON groups had similar post-EXIT HR (176.7±22.5 vs. 184.7±12.4), symptoms (0.93±3.56 vs. 2.00±5.92), RPE (15.7±2.8 vs. 15.0±2.9), and agility task completion time across EXIT outcomes. (p>.05). CONCLUSIONS: EXiT clinical outcomes were similar to athletes recently cleared to RTP following SRC and matched healthy controls. The new EXiT provides a multidomain, ACSM exercise criteria-based evaluation to inform RTP clinical decision making.