Quatman-Yates CC, Hunter-Giordano A, Shimamura KK et al (2020) Physical therapy evaluation and treatment after concussion/mild traumatic brain injury. McCrory P, Meeuwisse W, Dvořák J et al (2017) Consensus statement on concussion in sport-the 5th international conference on concussion in sport held in Berlin, October 2016. However, the specific mechanisms of impairment and relationship to symptoms and recovery require additional investigation. The reviewed studies support current clinical suspicion of autonomic dysfunction as an important component of exercise intolerance. There was wide variability in approach to autonomic/exercise tolerance testing, as well as inclusion criteria/testing timelines, which limited comparisons across studies. ResultsĪ total of 3116 publications were screened 17 were included in the final review. Exclusion criteria included confounding central or peripheral nervous system dysfunction beyond those stemming from the concussion, animal model studies, and case reports. Studies were required to include both autonomic and exercise intolerance testing. Studies including injuries classified as mild traumatic brain injury (mTBI)/concussion, regardless of mechanism of injury, were included. The protocol was developed a priori, and conducted in five stages results were collated, summarized, and reported according to PRISMA guidelines. The purpose of this review was to (1) summarize published data linking exercise intolerance to autonomic dysfunction, and (2) summarize key findings, highlighting opportunities for future investigation.

Systematic summarization and synthesis of prior work is needed to best understand current evidence, allowing identification of common themes and gaps requiring further study. Signs of altered cardiovascular autonomic regulation-a potential contributor to exercise intolerance-have been reported following concussion, although it is not clear how these findings inform underlying mechanisms of post-concussive symptoms.

Improved understanding of the underlying mechanisms of post-concussive exercise intolerance could help guide mechanism-directed rehabilitation approaches. Concussion commonly results in exercise intolerance, often limiting return to activities.

Cardiac coherence post concussion