Cognitive Testing and Exercise to Assess the Readiness to Return to Play After a Concussion

Introduction: The decision to clear an athlete to return to play (RTP) after a concussion is critical given the potential consequences of premature RTP. Accordingly, this study aimed to investigate more sensitive ways to assess readiness for RTP. We examined postexercise cognitive assessment in recently concussed and asymptomatic university athletes who were cleared to RTP. Methods: Forty recently concussed athletes and 40 control athletes without a history of concussion participated in the study. Athletes completed a switch task preexercise and postexercise (20 min on an ergometer at 80% maximal heart rate). A series of one-way ANOVA were performed to compare accuracy and response time between the concussion and the control groups on the switch task. Given that the clinical recovery of the participants in the concussion group could be heterogeneous, we also ran chi(2) tests to identify the presence of subgroups. Specifically, we aimed to determine whether a group difference existed in the proportion of concussed participants who underperformed. Results: No difference between the concussion and control groups was observed for reaction time. However, a significant group difference was found for accuracy, with athletes from the concussion group exhibiting lower accuracy relative to the control group. Irrespective of condition (rest, postexercise), up to 30% of athletes from the concussion group were 2 SD lower when compared with the control group's average score. A third of the athletes only exhibited deficits after exercise. Conclusions: Our results highlight the importance of considering interindividual differences in recovery trajectories. Although asymptomatic and cleared to RTP, an important portion of athletes had not completely recovered from their concussion. Fortunately, these athletes can be readily identified by using sensitive cognitive tests administered after a moderate-to-vigorous exercise.