Sports Medicine Research: In the Lab & In the Field: Medical Professionals Could Measure the Athlete’s Change of Heart Following A Concussion (Sports Med Res)
Wednesday, June 7, 2017

Medical Professionals Could Measure the Athlete’s Change of Heart Following A Concussion

Heart rate variability of athletes across concussion recovery milestones: A preliminary study

Senthinathan A, Mainwaring L, Hutchison M. Clin J Sport Med. 2017; 27(3):288-295

Take Home Message: Athletes that sustained a concussion displayed altered heart rate variability measures compared with controls, and those with a history of concussion had more disturbances in heat rate variability measures.

Concussions can affect numerous physiological processes including those in the cardiovascular system (via the autonomic nervous system). Medical professionals can measure heart rate variability as a noninvasive, objective measure to assess the influence of concussions on the heart and to assist with return-to-play decisions. However, heart rate variability, which has been explored for severe brain injury, has been understudied with respect to sport concussion. Therefore, the authors evaluated heart rate variability among 11 athletes that sustained a concussion and 11 healthy sex- and sport-matched controls. They tested the athletes at 3 phases during an athlete’s concussion recovery: (1) within 1-week after injury (the symptomatic phase), (2) after resolution of symptoms (progressing to exercise in return-to-play progression), and (3) 1-week after medical clearance to return to play. During each session, participants completed the Rivermead Post-Concussion Symptoms Questionnaire and physicians measured the participant’s heart rate variability with heart rate monitors during three 5-minute intervals: twice when the participant was sitting and once when standing, which provided a measurement during a change in state and effort. The authors found no relationship between heart rate variability measures and concussion symptoms nor days taken to return to play. However, the authors found a relationship between concussion history and physiological function of the heart where those with a greater number of previous concussions had greater physiologic disturbances and increased sympathetic and decreased parasympathetic activation while sitting. The authors also detected that several measures of heart rate variability were different between groups over time. Typically, the two groups were different during the symptomatic phase (2-7 days post injury). However, the controls didn’t change much over time but the athletes with a concussion had heart rate variability changes that made their variability more like the control athletes by one week after return to play.

The authors found that an athlete with a concussion is likely to have altered heart rate variability when compared with a control athlete. The authors also suggested that heart rate variability was related to increased frequency of previous concussions.  It is interesting to note that such most of the heart rate variability findings were noted in the sitting position, and not in the standing position. However, further investigation is necessary to determine if this is still true after controlling for concussion history, which was found to be associated with heart rate variability. On the other hand, the authors also found a small change in heart rate variability measures in the control group, which could be attributed to other physiological and psychological stressors (exams, relationships, work). Future studies should incorporate baseline heart rate variability testing, while also assessing and accounting for other physiological and psychological stresses that could be going on during a baseline testing session. At this time, medical professionals should be aware of the impact of concussion and concussion history on the heart, and continue to educate athletes on the risks concussions pose on themselves if they do not report a possible concussion injury (e.g., heart rate variability, greater risk of lower extremity injury).

Question for Discussion: Do you monitor heart rate variability following injuries? Could you implement heart rate monitors during preseason baseline testing? Would you consider adding this to your concussion assessment and return to play protocol?

Written by: Jane McDevitt, PhD
Reviewed by: Jeff Driban

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Senthinathan A, Mainwaring LM, & Hutchison M (2017). Heart Rate Variability of Athletes Across Concussion Recovery Milestones: A Preliminary Study. Clinical Journal of Sport Medicine, 27 (3), 288-295 PMID: 27379659

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