Sports Medicine Research: In the Lab & In the Field: Fitness Level and Baseline Concussion Symptoms (Sports Med Res)
Friday, May 17, 2013

Fitness Level and Baseline Concussion Symptoms

Does an Individual’s Fitness Level Affect Baseline Concussion Symptoms?

Mrazik, M; Naidu, D; Lebrun, C; Game, A; Matthews-White, J. Journal of Athletic Training In-Press. doi: 10.4085/1062-6050-48.3.19

Take Home Message: Fitness level may influence baseline concussion symptom reporting with fitter individuals reporting fewer concussion symptoms.  Athletes also appear to report more concussion symptoms when reporting after exercise.

Baseline testing in concussion management, including graded symptom assessment, has become commonplace in multiple sports on almost every level of competition.  Different assessment tools (e.g., Sideline Concussion Assessment Tool [SCAT3], Immediate Post-Concussion Assessment and Cognitive Testing [ImPACT]) establish a baseline for many nonspecific symptoms so that post-injury symptoms may be compared to baseline results.   Previous research has shown that multiple factors, including physical-activity level, can result in reports of more neurological symptoms. Therefore, Mrazik, et al sought to evaluate if an individual’s fitness level correlated with report of concussion symptoms at baseline. They hypothesized that after exertion, athletes with higher fitness levels would report fewer symptoms at baseline.  During scheduled preseason fitness evaluations, 95 collegiate athletes and 30 recreational athletes completed the SCAT2 symptom report before, 10 minutes after, and one day after the Leger 20-m shuttle-run test (a.k.a. beep test).  Based on the Leger shuttle run, the authors estimated an athlete’s peak aerobic power, which they used to determine fitness level. Athletes were then grouped for analysis based on participation in contact versus non-contact sports and subdivided based on level of fitness (per American College of Sports Medicine guidelines).  Results showed that athletes in better physical condition had lower baseline SCAT2 symptom scores before, immediately after, and 1 day after exertional activity.  All athletes reported more symptoms immediately after exertional activity when compared to pre-exertion reporting, but the number of symptoms went back down after 24 hours.

The results of this study are noteworthy because they highlight the importance of individual athlete variables that may potentially influence subjective self-reporting.  The timing of self-reporting also appears to be influenced by physical exertion which is important to consider given that many athletes complete pre-season concussion baseline testing with other pre-season testing that may involve physical activity, such as strength and conditioning assessments.  While there are currently no guidelines to suggest specifically when pre-season SCAT assessments should be conducted, these results suggest that self-reporting assessments should not be conducted in conjunction with exertional activity.  

Do you have any experience with athletes participating in baseline testing after exertional activity? Do you think guidelines should exist as to when pre-season baseline testing should be conducted?

Written by: Stephen Stache, MD
Reviewed by: Marc Harwood, MD and Jeffrey Driban

Related Posts:
Mrazik, M., Naidu, D., Lebrun, C., Game, A., & Matthews-White, J. (2013). Does an Individual's Fitness Level Affect Baseline Concussion Symptoms? Journal of Athletic Training DOI: 10.4085/1062-6050-48.3.19

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