Concussion GYM-T: Graded exercise in Youth to Maximise early recovery using Tele-exercise model: A Randomised Control Trial

A randomized controlled trial of a 4-week tele-exercise program compared to standard care to improve recovery from concussion in children and youth. The study will be conducted as a randomized controlled study to determine if the additional of supervised and graded return to aerobic exercise has an impact on the reduction in symptoms of children/adolescents following a concussion. The RCT design was chosen as it is considered to provide the most reliable evidence on the effectiveness of the interventions because the processes we will use during the conduct of the RCT minimizes the risk of other factors influencing the results. Our study will assess a home-based individualized graded exercise program tailored for the child and family circumstances (using telehealth) for 4 weeks. This will involve weekly tele-exercise check-in sessions with a study physiotherapist. Here, aerobic exercise activity will gradually increase until pre-injury exercise is achieved. Exercise will be gradually increased based on the child/youth’s perceived exertion (as informed by the 10m Modified Shuttle Test (MST) - ACTR12622001051730). The OMNI (Omnibus) perceived exercise scale has been shown to be comparable to a heart rate monitor. This design allows the exercise program to be developed and tailored to fit patient tolerance levels but also to fit within the family circumstances and equipment. The gradual resumption of activities is based upon the Return to Sport – General Guidelines and Sport Concussion Return to Play Guidelines. The program includes 4 physiotherapy telehealth/phone calls updating a home program, updated weekly in line with symptoms. Our study will differ from other studies as we will be aiming to complete all sessions via a Tele-health model without the need for a heart rate monitor or any other specialized equipment other than access to the internet/video phone. The telehealth sessions with take between 20-45 minutes. These appointments will be conducted weekly, with a minimum of 6 days between appointments and a maximum of 8 days between appointments. The sessions will be run using the same telehealth platform. The physiotherapist will review the participants progress by looking at their Symptom Progress Exercise Diary. If the participant has been able to complete the exercise at the required level for 3 or more days, the exercise intensity will be increased for the following week. If the participant was unable or did not complete the required exercise intervention over the week, the therapist will troubleshoot with the participant to determine the barriers to exercise. The level of exercise intensity prescribed will initially be low (as per results from the 10m MST) with increasing intensity dependent on the participants recovery and symptoms as per the Return to Sport Guidelines for Concussion. Week 1: 15 minutes of exercise at least 3 days per week at their sub-symptomatic OMNI level. Week 2: 20 minutes of exercise at least 3 days per week at their baseline OMNI + 1 level Week 3: 20 minutes of exercise at least 3 times per week at their week 2 OMNI + 1 level Week 4: 30 Minutes of exercise at least 3 times per week at their week 3 OMNI + 1 level The exercises will be based on participant previous physical activities/available home equipment but can include walking around the block, using a stationary bike, using a stationary rowing machine, boxing using a boxing bag - any activity which increases their aerobic output to a level that is comparable to the MST. A specific exercise will not be uniform between patients.