Exercise intolerance among active-duty service members with persistent symptoms related to mild traumatic brain injury

Abstract: Objectives: Exercise intolerance (EI) after a mild traumatic brain injury (mTBI) has been explored in the acute phase of injury, but little is known about this disorder in the chronic phase of injury. To describe EI in a sample of military service members (SMs) who are reporting persistent post concussive symptoms. Design: Cross-sectional study. Setting: Intrepid Spirit Center at Naval Hospital Camp Pendleton. Participants: Participants (N=28) were recruited primarily from the Intrepid Spirit Center at Naval Hospital Camp Pendleton and included SMs with a history of mTBI and persistent postconcussive symptoms. Interventions: Not applicable. Main Outcome Measures: As part of a larger randomized controlled trial, participants completed a Buffalo Concussion Treadmill Test to determine EI. The Buffalo Concussion Treadmill Test is a validated test of EI, which is diagnosed if concussion-specific symptoms are exacerbated with increased physical activity. This test identifies a heart rate threshold that is used to establish a safe level of exercise for the treatment of concussion. Participants’ postconcussive symptoms were measured with the Neurobehavioral Symptom Inventory, a nonexertional resting-state symptom inventory. Results: Of the total sample, 29% (n=8) participants had EI. Of those with EI, headache was the most frequent complaint (75%; n=6), followed by dizziness (25%; n=2). There was no statistical difference in self-reported symptom burden between EI and non-EI participants based on Neurobehavioral Symptom Inventory total scores and 4 subscale scores (all P>.05). Conclusions: Recognition and management of EI are critical for both warfighter health and military readiness. Our findings suggest approximately one-third of SMs with mTBI and persistent-related symptoms may be intolerant to exercise, which nonexertional symptom testing may fail to detect.

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