Subthreshold Aerobic Exercise as a Strategy for Concussion Management: A Critically Appraised Topic


Subthreshold Aerobic Exercise as a Strategy for Concussion Management: A Critically Appraised Topic



Faculty Mentor

Jennifer Savage, Kinesiology; Christopher Clark, Kinesiology


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2:45-2:55pm | Houston Cole Library, 11th Floor


Context: Healthcare providers not only have to be able to recognize when a concussion appears, but they also must recognize how to manage and treat the injury properly in order to prevent further damage to the brain and ensure a safe return to play for the athlete. Previously, the most commonly utilized management strategy to resolve a concussion was rest, but currently, research demonstrates how controlled aerobic exercise can provide a faster recovery, while respecting safety protocols. The purpose of the critically appraised topic is to compare the effectiveness of subthreshold aerobic activity utilizing the Buffalo Concussion Treadmill Protocol (BCTT) vs. rest, in athletes with a sport-related concussion (SRC)

Methods: A computerized search was completed in October 2022. The search terms used were “Buffalo Concussion Treadmill Test”, “rest”, and "subthreshold activity in concussion management”. Electronic databases used were Jacksonville State University Library, PubMed, SportsDiscus, and Google Scholar. Inclusion criteria: Individuals with SRCs and published articles within the last five years, that were in the English language. Exclusion criteria: Articles that utilized other threshold protocols or exercises. Validity of the selected studies was determined using the Physiotherapy Evidence Database scale and the Mixed Methods Appraisal Tool. One author independently reviewed the studies, scored each paper, and reviewed the completed appraisals to come to a consensus on study quality.

Results: The literature search retrieved seven total articles and three were excluded based on exclusion criteria, resulting in four studies. Subthreshold aerobic activity is found to be reliable and effective in diagnosing and managing SRCs. When compared to rest, the BCTT promotes healing and speeds up the recovery process without further damaging the brain or worsening symptoms. The BCTT is safe to use with athletes and is found reliable with a multitude of sports.

Conclusion: The BCTT is a valid and realizable test that can be utilized in managing SRCs. Further research is needed to determine how to correctly use the protocol in the earlier stages of SRC management.


student research, kinesiology


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Subthreshold Aerobic Exercise as a Strategy for Concussion Management: A Critically Appraised Topic