scholarly journals Preliminary Evidence-Based Recommendations for Return to Learn: a novel pilot study tracking concussion recovery in college students

Neurology ◽  
2019 ◽  
Vol 93 (14 Supplement 1) ◽  
pp. S33.3-S34
Author(s):  
Zachary Bevilacqua ◽  
Mary Kerby ◽  
David Fletcher ◽  
Zhongxue Chen ◽  
Becca Merritt ◽  
...  
Keyword(s):  
Physical Activity ◽  
Longitudinal Design ◽  
Text Messages ◽  
Return To Play ◽  
Evidence Based ◽  
Full Time ◽  
Symptom Resolution ◽  
Phone Calls ◽  
Return To Learn ◽  
Concussion Recovery

ObjectiveInvestigate the potential factors influencing resolution of chief concussion symptoms in a longitudinal design. Second, assess subjects’ perception of their concussion recovery and what types of activities and accommodations appeared beneficial.BackgroundAthletes re-entering the academic setting after a concussion is commonly referred as return-to-learn (RTL), which has appeared secondary to the abundantly researched return-to-play protocols implemented ubiquitously. Importantly, every concussed collegiate, adolescent, and pediatric athlete is first and foremost a student-athlete, with “student” holding the emphasis. To date, very few studies have examined the RTL aspect of concussion recovery, and the effects premature classroom attendance may cause.Design/MethodsNine concussed, college aged (18-26 years), full-time students were monitored longitudinally throughout their recovery from diagnosis to full symptom-free academic participation. Symptom severity for five prevalent symptoms were recorded 4 times per day, along with a daily phone call to report participant’s diet, duration of screen-time usage and music listened to, physical activity participation, and types of classes attended.ResultsResponse rates to text messages and phone calls yielded a mean 92% and 93% respectively across the nine subjects. Additionally, five variables were significantly associated with symptom resolution (music, sleep, physical activity, water, and time) (p = 0.0004 to p = 0.036). Lastly, subjects reported math and computer-oriented courses as the most difficult (33% and 44% respectively). Additional time on assignments/exams and reducing screen brightness were the most beneficial accommodations (66% and 56% respectively).ConclusionsOur findings introduce a novel and robust approach to monitoring concussed students throughout their recovery. Furthermore, this methodology is the first to produce holistic evidence-based results concerning re-integrating students to the classroom. Lastly, it appears that dietary and social behaviors can indeed influence symptom resolution.

scholarly journals Preliminary evidence-based recommendations for return to learn: a novel pilot study tracking concussed college students

Concussion ◽  
2019 ◽  
Vol 4 (2) ◽  
pp. CNC63 ◽  
Author(s):  
Zachary W Bevilacqua ◽  
Mary E Kerby ◽  
David Fletcher ◽  
Zhongxue Chen ◽  
Becca Merritt ◽  
...  
Keyword(s):  
Recovery Process ◽  
Preliminary Evidence ◽  
Text Messages ◽  
Full Time ◽  
Behavioral Traits ◽  
Phone Calls ◽  
Novel Approach ◽  
Behavioral Variables ◽  
Return To Learn ◽  
Concussion Recovery

Aim: Students re-entering the academic setting after a concussion is commonly referred to as return-to-learn and, to date, very few studies have examined the return-to-learn aspect of concussion recovery. Methodology: Nine college-aged, full-time students who were diagnosed with concussions were monitored throughout their concussion recovery. The severity for five chief symptoms (headache, dizziness, difficulty concentrating, fatigue, anxiety) were recorded six-times per day through text messages, and daily phone calls recorded participant's behavioral traits. Results: We identified five behavioral variables which significantly influenced symptom resolution (music, sleep, physical activity, water and time) (p = 0.0004 to p = 0.036). Additionally, subjects reported math and computer-oriented courses as the most difficult (33 and 44%, respectively). Conclusion: We introduce a novel approach to monitor concussed students throughout their recovery, as well as factors that may influence concussion recovery process.

scholarly journals Adolescents With ADHD Do Not Take Longer to Recover From Concussion

2021 ◽  
Vol 8 ◽  
Author(s):  
Nathan E. Cook ◽  
Grant L. Iverson ◽  
Bruce Maxwell ◽  
Ross Zafonte ◽  
Paul D. Berkner
Keyword(s):  
Recovery Time ◽  
Return To Play ◽  
Return To School ◽  
Prior History ◽  
Return To Sports ◽  
Full Time ◽  
Recovery Times ◽  
Concussion History ◽  
Concussion Recovery ◽  
Medication Status

The objective of this study was to determine whether adolescents with attention-deficit/hyperactivity disorder (ADHD) have prolonged return to school and sports following concussion compared to those without ADHD and whether medication status or concussion history is associated with recovery time. We hypothesized that having ADHD would not be associated with longer recovery time. This prospective observational cohort study, conducted between 2014 and 2019, examined concussion recovery among school sponsored athletics throughout Maine, USA. The sample included 623 adolescents, aged 14–19 years (mean = 16.3, standard deviation = 1.3 years), 43.8% girls, and 90 (14.4%) reported having ADHD. Concussions were identified by certified athletic trainers. We computed days to return to school (full time without accommodations) and days to return to sports (completed return to play protocol) following concussion. Adolescents with ADHD [median days = 7, interquartile range (IQR) = 3–13, range = 0–45] did not take longer than those without ADHD (median days = 7, IQR = 3–13, range = 0–231) to return to school (U = 22,642.0, p = 0.81, r = 0.01; log rank: χ12 = 0.059, p = 0.81). Adolescents with ADHD (median days = 14, IQR = 10–20, range = 2–80) did not take longer than those without ADHD (median days = 15, IQR = 10–21, range = 1–210) to return to sports (U = 20,295.0, p = 0.38, r = 0.04; log rank: χ12 = 0.511, p = 0.48). Medication status and concussion history were not associated with longer recovery times. Adolescents with ADHD did not take longer to functionally recover following concussion. Recovery times did not differ based on whether adolescents with ADHD reported taking medication to treat their ADHD or whether they reported a prior history of concussion.

scholarly journals More Physical Activity after Concussion Is Associated with Faster Return to Play among Adolescents

2021 ◽  
Vol 18 (14) ◽  
pp. 7373
Author(s):  
Corrine N. Seehusen ◽  
Julie C. Wilson ◽  
Gregory A. Walker ◽  
Sarah E. Reinking ◽  
David R. Howell
Keyword(s):  
Physical Activity ◽  
Return To Play ◽  
Post Injury ◽  
Exercise Frequency ◽  
Early Introduction ◽  
Youth Athletes ◽  
Concussion Management ◽  
Concussion History ◽  
Concussion Recovery ◽  
Optimal Quantity

Concussion management has evolved to de-emphasize rest in favor of early introduction of post-injury physical activity. However, the optimal quantity, frequency and intensity of physical activity are unclear. Our objective was to examine the association between objective physical activity metrics and clinical recovery after concussion. We prospectively enrolled a cohort of 32 youth athletes with concussion, evaluated within 14 days of injury and after return-to-play (RTP) clearance. For two weeks after enrollment, we quantified steps/day and exercise frequency, duration, and intensity via wrist-worn actigraphy. We grouped participants by RTP clearance timing (<28 days vs. ≥28 days). Seventeen (53%) participants required ≥28 days post-concussion for RTP clearance. Groups were similar in age (14.9 ± 1.9 vs. 15.4 ± 1.5 years; p = 0.38), proportion of females (47% vs. 40%; p = 0.69), and concussion history (59% vs. 47%; p = 0.49). During the study period, the RTP ≥ 28 days group took fewer steps/day (8158 ± 651 vs. 11,147 ± 4013; p = 0.02), exercised fewer days/week (2.9 ± 2.4 vs. 5.0 ± 1.9 days/week; p = 0.01), and exercised fewer total minutes/week (117 ± 122 vs. 261 ± 219 min/week; p = 0.03). Furthermore, we observed ≥10,251 average steps/day, ≥4 exercise sessions/week, and exercising ≥134 total minutes/week were optimal cutpoints to distinguish between groups. These findings support the benefit of physical activity during concussion recovery.

scholarly journals Rationale and Methods for the Hombres Saludables trial: Increasing Physical Activity in Latino Men through Tailoring (Preprint)

2020 ◽  
Author(s):  
Kim Gans ◽  
Akilah Dulin ◽  
Vanessa Palomo ◽  
Tanya Benitez ◽  
Shira Dunsiger ◽  
...  
Keyword(s):  
Physical Activity ◽  
Primary Outcome ◽  
Text Message ◽  
Text Messages ◽  
Processes Of Change ◽  
Latino Men ◽  
Phone Calls ◽  
Internet Control ◽  
Randomized Control ◽  
Physical Activity Recall

UNSTRUCTURED Introduction: Latino men in the U.S. report low physical activity (PA) levels and related health conditions (e.g., diabetes, obesity). Engaging in regular PA can reduce the risk of chronic diseases and yield many health benefits; yet, there is a paucity of interventions developed exclusively for Latino men. To address the need for culturally relevant PA interventions, we developed Hombres Saludables, a 6-month Spanish-language, theory-based, tailored web and text message PA intervention for Latino men. This paper describes the study design, intervention, and evaluation methods for Hombres Saludables. Methods: Latino men ages 18-65 are randomized to either the individually-tailored PA internet intervention arm or the nutrition and wellness internet control arm. The PA intervention includes: 2 check-in phone calls, automated SMS text messages, a pedometer, a 6-month gym membership, access to a private Facebook group, and an interactive website with PA tracking, goal setting, and individually-tailored PA content. Outcomes: The primary outcome is minutes/week of moderate-to-vigorous PA (MVPA) assessed via ActiGraph GT3X+ accelerometer and 7-Day Physical Activity Recall at baseline and 6-months. Secondary outcomes will examine potential moderators (e.g., demographics, acculturation, and environmental variables) and mediators (e.g., self-efficacy, cognitive and behavioral processes of change) of treatment effects at 6-months post-randomization. Conclusions: Hombres Saludables uses an innovative, interactive web and text message-based intervention for improving PA among Latino men, an underserved population at risk of low PA and related chronic disease. If the intervention demonstrates feasibility, acceptability, and preliminary efficacy, we will refine and evaluate it in a larger randomized control trial.

scholarly journals Relationship Between Sedentary Behavior and Physical Activity at Work and Cognition and Mood

2020 ◽  
Vol 17 (11) ◽  
pp. 1140-1152
Author(s):  
Sophie E. Carter ◽  
Richard Draijer ◽  
Andrew Thompson ◽  
Dick H.J. Thijssen ◽  
Nicola D. Hopkins
Keyword(s):  
Physical Activity ◽  
Working Memory ◽  
Sedentary Behavior ◽  
Leisure Time ◽  
Work Hours ◽  
Evidence Based ◽  
Cognitive Tests ◽  
Full Time ◽  
Regression Analyses ◽  
Increase Productivity

Background: Sedentary behavior is negatively associated with cognition and mood. Adults often engage in high levels of sedentary behavior at work through sitting, which may impact productivity. Consequently, replacing sitting with standing and physical activity (PA) is recommended. However, the associations between sitting, standing, and PA at work and cognition and mood are unknown; this study, therefore, aimed to explore these relationships. Methods: A total of 75 healthy full-time workers (33 male, mean [SD]; 33.6 [10.4] y, 38 [7] work hr/wk) wore sedentary behavior (activPAL) and PA (SenseWear Pro) monitors for 7 days and recorded their work hours. The day after this monitoring period, participants completed cognitive tests (executive function, attention, and working memory) and mood questionnaires (affect, alert, content, and calm). Multiple linear regression analyses examined the associations between cognition and mood and the time spent sitting, standing, and in each PA intensity during work hours, weekday leisure time, and weekends. Results: Workplace sitting, standing, or PA were not significantly associated with cognition or mood (P > .05). No significant associations were observed between these variables during weekday leisure time or weekends (P > .05). Conclusions: In a cohort of healthy workers, workplace sitting, standing, and PA are not associated with cognition or mood. Further research in this population is needed, examining the influence of workplace behaviors on cognition and mood, because this will contribute to evidence-based workplace guidelines to increase productivity.

Self-monitoring and reminder texts to increase physical activity after colorectal cancer (Smart Pace): A pilot trial.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 166-166 ◽  
Author(s):  
Erin Van Blarigan ◽  
Katherine Van Loon ◽  
Stacey A. Kenfield ◽  
June M Chan ◽  
Yoshimi Fukuoka ◽  
...  
Keyword(s):  
Physical Activity ◽  
Colorectal Cancer ◽  
Physical Activity Intervention ◽  
Pilot Trial ◽  
Text Messages ◽  
Stage I ◽  
Comprehensive Cancer Center ◽  
Moderate Physical Activity ◽  
Full Time ◽  
English Speaking

166 Background: Colorectal cancer (CRC) survivors can improve their quality-of-life (QOL), and potentially survival, by engaging in physical activity. The aim of this pilot randomized controlled trial (RCT) is to determine the feasibility of a technology-based physical activity intervention for CRC survivors. Methods: 40 CRC survivors will be randomized (1:1) to a 12-week physical activity intervention (Fitbit Flex, daily text messages) or usual care. Eligible individuals must: 1) have stage I-III colon or rectal adenocarcinoma; 2) have completed therapy; 3) be considered cancer-free; 4) be English speaking; 5) have no contraindications to moderate physical activity; 6) engage in < 150 min/week of moderate physical activity; and 7) have Internet and a phone that can receive text messages. Our primary outcomes are adherence (e.g., Fitbit wear time, text response rate) and acceptability assessed via survey. Secondary outcomes include change in physical activity via 7-days of ActiGraph GT3X+ accelerometers and QOL. Results: We have screened 350 individuals with stage I-III CRC at the University of California, San Francisco (UCSF) for eligibility. Of these, 181 (52%) were not eligible [non-English speaking (46%), ≥ 150 min/week of physical activity (22%), contraindications to physical activity (22%), not cancer-free (7%), did not own a mobile phone (2%)]. We invited the remaining 169 eligible CRC survivors to participate by mail, e-mail, phone, or in clinic; 76 (45%) actively declined and 59 (35%) did not respond after up to 3 contact efforts. As of October 2016, 34 CRC survivors have been randomized to intervention (n = 16) or control (n = 18). These individuals are: 55% female; 64% Non-Hispanic White; 73% have a 4-y college degree; and 64% work full-time. The median (IQR) age and BMI are: 56 (50, 65) y and 26.4 (23.2, 32.4) kg/m2, respectively. Conclusions: The results of this pilot study will inform a definitive RCT to determine whether a technology-based physical activity intervention improves QOL and survival after CRC diagnosis. Funding: This research was supported by the NIH (K07CA197077, KL2TR000143), Mt. Zion Health Fund and UCSF Helen Diller Family Comprehensive Cancer Center.

scholarly journals STEP UP! LESS PHYSICAL ACTIVITY AFTER CONCUSSION IS ASSOCIATED WITH PROLONGED CLINICAL RECOVERY AMONG ADOLESCENTS

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0003
Author(s):  
Corrine N. Seehusen ◽  
Julie C. Wilson ◽  
Gregory A. Walker ◽  
Sarah E. Reinking ◽  
David R. Howell
Keyword(s):  
Physical Activity ◽  
Classification Accuracy ◽  
Activity Level ◽  
Return To Play ◽  
Initial Visit ◽  
Adolescent Athletes ◽  
Post Injury ◽  
Concussion Management ◽  
Clinical Recovery ◽  
Concussion Recovery

Background: While many adolescent athletes recover from concussion within one month, some will not recover within this timeframe. Concussion management guidelines have evolved to de-emphasize rest and promote early re-introduction of sub-symptomatic physical activity. However, the optimal levels of physical activity during concussion recovery have yet to be determined. Hypothesis/Purpose: To investigate the association between quantity, frequency and intensity of physical activity after concussion with clinical recovery, defined as return-to-play (RTP) clearance from their physician. Methods: We conducted an observational, prospective cohort study of 26 youth athletes who sustained a concussion and were evaluated at two time points: initial visit (<14 days post-injury) and RTP clearance visit. Participants reported concussion symptoms using the Post-Concussion Symptom Inventory (PCSI). Participants wore an activity tracking device for the first two weeks after initial visit. This allowed us to quantify average steps/day, exercise frequency (average workouts/week), exercise duration (average time/workout), and exercise intensity (average/maximum HR during workouts). We grouped participants by clinical recovery timing (RTP <28 days vs. ≥28 days post-injury) and compared physical activity measures using independent samples t-tests. We then identified the sensitivity, specificity, and classification accuracy of cutpoints for each exercise variable using a Receiver Operating Characteristic (ROC) and Area under the Curve (AUC) analysis. Results: Half (n=13) of the participants required ≥28 days to receive RTP clearance. The two groups were similar in age, proportion of females, and past concussion history (Table 1). Those who required ≥28 days for RTP clearance reported significantly greater symptom severity at the initial examination than the RTP <28 days group, despite similar initial visit timing (Table 1). During the two weeks after the initial visit, the RTP ≥28 days group took fewer steps/day, exercised fewer days/week, and exercised fewer total minutes/week (Table 2). Among the activity/exercise variables examined, the highest classification accuracy between groups consisted of ≥9,100 average steps/day, ≥4 sessions/week, and spending ≥135 total minutes/week exercising (Table 3). Conclusion: Higher daily step counts and more frequent/longer exercise sessions were associated with clearance for RTP within 28 days from concussion in adolescent athletes. These preliminary results further support the benefit of physical activity during concussion recovery. However, our study cannot assess the causal effect of these findings, given that those who felt better earlier may have been willing to participate in more physical activity. Further research is needed to develop duration-, frequency- and intensity-specific physical activity level guidelines to aid clinicians in concussion management. [Table: see text][Table: see text][Table: see text]

A Pilot Study Evaluating the Timing of Vestibular Therapy After Sport-Related Concussion: Is Earlier Better?

2021 ◽  
pp. 194173812199868
Author(s):  
Ranbir Ahluwalia ◽  
Scott Miller ◽  
Fakhry M. Dawoud ◽  
Jose O. Malave ◽  
Heidi Tyson ◽  
...  
Keyword(s):  
Pilot Study ◽  
Therapy Group ◽  
Vestibular Dysfunction ◽  
Return To Play ◽  
Additional Time ◽  
Level Of Evidence ◽  
Symptom Resolution ◽  
Kaplan Meier ◽  
Prolonged Recovery ◽  
Return To Learn

Background: Vestibular dysfunction, characterized by nausea, dizziness, imbalance, and/or gait disturbance, represents an important sport-related concussion (SRC) subtype associated with prolonged recovery. Vestibular physical therapy promotes recovery; however, the benefit of earlier therapy is unclear. Hypothesis: Earlier vestibular therapy for young athletes with SRC is associated with earlier return to play (RTP), return to learn (RTL), and symptom resolution. Study Design: Retrospective cohort study. Level of Evidence: Level 3. Methods: Patients aged 5 to 23 years with SRC who initiated vestibular rehabilitation therapy (VRT) from January 2019 to December 2019 were included and patient records were reviewed. Therapy initiation was defined as either early, ≤30 days postinjury, or late (>30 days). Univariate comparisons between groups, Kaplan-Meier plots, and multivariate Cox proportional hazard modeling were performed. Results: Overall, 23 patients (10 early, 13 late) aged 16.14 ± 2.98 years and 43.5% were male patients. There was no difference between group demographics or medical history. Median initial total and vestibular symptom scores were comparable between groups. The late therapy group required additional time to RTP (110 days [61.3, 150.8] vs 31 days [22.5, 74.5], P = 0.03) and to achieve symptom resolution (121.5 days [71, 222.8] vs 54 days [27, 91], P = 0.02), but not to RTL (12 days [3.5, 26.5] vs 17.5 days [8, 20.75], P = 0.09). Adjusting for age and initial total symptom score, earlier therapy was protective against delayed symptom resolution ( P = 0.01). Conclusion: This pilot study suggests that initiating VRT within the first 30 days after SRC is associated with earlier RTP and symptom resolution. Further prospective trials to evaluate if even earlier VRT should be pursued to further improve recovery time. Clinical Relevance: Clinicians should screen for vestibular dysfunction and consider modifying follow-up schedules after SRC to initiate VRT within a month of injury for improved outcomes.

scholarly journals The physical activity paradox: a longitudinal study of the implications for burnout

2021 ◽  
Author(s):  
Juriena D. de Vries ◽  
Arnold B. Bakker
Keyword(s):  
Physical Activity ◽  
Longitudinal Design ◽  
Time Lag ◽  
Job Demands ◽  
Activity Level ◽  
Survey Study ◽  
Full Time ◽  
Cross Sectional ◽  
Positive Effects ◽  
Physical Job Demands

Abstract Purpose This study investigates the independent and interactive associations of physical job demands and three types of off-job physical activity (during transportation, household, and recreation) with burnout. We use a recently proposed new conceptualization and assessment of burnout including core and secondary burnout symptoms. We predicted that physical job demands would be positively and the three types of off-job physical activity would be negatively related to burnout. Further, we hypothesized that the negative relations between the three types of off-job physical activity and burnout would be stronger for employees with low (vs. high) physical job demands. Methods To test our hypotheses, we conducted a two-wave survey study among a heterogeneous sample of full-time workers (N = 355), using a longitudinal design with a half-year time lag. We tested cross-sectional, prospective and longitudinal relations. Results Hierarchical regression analyses partly confirmed our predictions. Cross-sectionally and prospectively, it was shown that physical job demands were positively related to burnout symptoms. In addition, off-job physical activity was negatively related to primary and secondary burnout symptoms among employees with low physical job demands and positively related to burnout symptoms among employees with high physical job demands. However, these relationships disappeared when investigated longitudinally. Conclusion Together, these findings suggest that not all off-job physical activities can prevent burnout, and that potential positive effects of physical activity during off-job time may depend on employees’ physical activity level at work.

scholarly journals Implementation Tells Us More Beyond Pooled Estimates: Secondary Analysis of a Multicountry mHealth Trial to Reduce Blood Pressure (Preprint)

2018 ◽  
Author(s):  
Rodrigo M Carrillo-Larco ◽  
Safia S Jiwani ◽  
Francisco Diez-Canseco ◽  
Rebecca Kanter ◽  
Andrea Beratarrechea ◽  
...  
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
Readiness To Change ◽  
Secondary Analysis ◽  
Text Messages ◽  
Phone Calls ◽  
Health Related Behaviors ◽  
Stage Of Readiness ◽  
Health Related ◽  
Intervention Uptake

BACKGROUND The uptake of an intervention aimed at improving health-related lifestyles may be influenced by the participant’s stage of readiness to change behaviors. OBJECTIVE We conducted secondary analysis of the Grupo de Investigación en Salud Móvil en América Latina (GISMAL) trial according to levels of uptake of intervention (dose-response) to explore outcomes by country, in order to verify the consistency of the trial’s pooled results, and by each participant’s stage of readiness to change a given lifestyle at baseline. The rationale for this secondary analysis is motivated by the original design of the GISMAL study that was independently powered for the primary outcome—blood pressure—for each country. METHODS We conducted a secondary analysis of a mobile health (mHealth) multicountry trial conducted in Argentina, Guatemala, and Peru. The intervention consisted of monthly motivational phone calls by a trained nutritionist and weekly tailored text messages (short message service), over a 12-month period, aimed to enact change on 4 health-related behaviors: salt added to foods when cooking, consumption of high-fat and high-sugar foods, consumption of fruits or vegetables, and practice of physical activity. Results were stratified by country and by participants’ stage of readiness to change (precontemplation or contemplation; preparation or action; or maintenance) at baseline. Exposure (intervention uptake) was the level of intervention (<50%, 50%-74%, and ≥75%) received by the participant in terms of phone calls. Linear regressions were performed to model the outcomes of interest, presented as standardized mean values of the following: blood pressure, body weight, body mass index, waist circumference, physical activity, and the 4 health-related behaviors. RESULTS For each outcome of interest, considering the intervention uptake, the magnitude and direction of the intervention effect differed by country and by participants’ stage of readiness to change at baseline. Among those in the high intervention uptake category, reductions in systolic blood pressure were only achieved in Peru, whereas fruit and vegetable consumption also showed reductions among those who were at the maintenance stage at baseline in Argentina and Guatemala. CONCLUSIONS Designing interventions oriented toward improving health-related lifestyle behaviors may benefit from recognizing baseline readiness to change and issues in implementation uptake. CLINICALTRIAL ClinicalTrials.gov NCT01295216; http://clinicaltrials.gov/ct2/show/NCT01295216 (Archived by WebCite at http://www.webcitation.org/72tMF0B7B).

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