Concurrent Validity of a Stationary Cycling Test and Buffalo Concussion Treadmill Test in Adults with Concussion

• Published in: Journal of athletic training Vol. 56; no. 12; pp. 1292 - 1299
• Main Authors: Graham, Robert F, van Rassel, Cody R, Burma, Joel S, Rutschmann, Trevor D, Miutz, Lauren N, Sutter, Bonnie, Schneider, Kathryn J
• Format: Journal Article
• Language: English
• Published: United States National Athletic Trainers Association 01-12-2021
• Subjects: Concussion; Consent; Exercise; Fitness equipment; Heart rate; Likert scale; Likert Scales; Outcome Measures; Physical Activities; Physical fitness; Questionnaires; Research Assistants; Symptoms (Individual Disorders); Validity; Workloads; Rehabilitation; Concussion; Exercise Intolerance; Exercise Testing
• ISSN: 1062-6050; 1938-162X
• DOI: 10.4085/1062-6050-0003.21

Following concussion, a multi-faceted assessment is recommended, including tests of physical exertion. The current gold standard for exercise testing following concussion is the Buffalo Concussion Treadmill Test (BCTT); however, there is a lack of validated tests that utilize alternative exercise modalities.
To assess the feasibility and concurrent validity of a novel cycling test of exertion compared to the BCTT.
Crossover Study Setting: University Sport-Medicine Clinic Patients: Twenty adults (aged 18-60 years) diagnosed with a Sport-Related Concussion Intervention: Participants completed the BCTT and a cycling test of exertion in a random order, approximately 48 hours apart.
The primary outcome of interest was maximum heart rate [HRmax; beats per minute (bpm)]. Secondary outcomes of interest included whether the participant reached volitional fatigue (yes/no), symptom responsible for test cessation (Post Concussion Symptom Scale), and Symptom Severity on a Visual Scale (/10).
Of the 20 participants, 19 (10 male, 9 female) completed both tests. One participant did not return for the second test and was excluded from the analysis. No adverse events were reported. The median HRmax for the BCTT [171 bpm; (IQR: 139-184bpm)] was not significantly different than the median HRmax for the Cycle [173 bpm; (IQR: 160-182)] (z=-0.63, p=0.53). For both tests, the three most frequently reported symptoms responsible for test cessation were Headache, Dizziness, and Pressure in the head. Of interest, the majority of participants (64%) reported a different symptom responsible for test cessation on each test.
The novel cycling test of exertion achieved similar HRmax and test duration and may be a suitable alternative to the BCTT. Future research to understand the physiological reason for the heterogeneity in symptoms responsible for test cessation is warranted.