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. 2019 Nov/Dec;11(6):492-497.
doi: 10.1177/1941738119870189. Epub 2019 Sep 5.

The Buffalo Concussion Bike Test for Concussion Assessment in Adolescents

Mohammad N Haider  1   2 , Samantha L Johnson  1 , Rebekah Mannix  3 , Alexander J Macfarlane  4 , Dylan Constantino  4 , Blair D Johnson  5 , Barry Willer  6 , John Leddy  1
Affiliations

The Buffalo Concussion Bike Test for Concussion Assessment in Adolescents

Mohammad N Haider et al. Sports Health. 2019 Nov/Dec.

Abstract

Background: The Buffalo Concussion Treadmill Test (BCTT) is a graded exertion test for assessing exercise tolerance after concussion, but its utility is limited for certain populations.

Hypothesis: We developed the Buffalo Concussion Bike Test (BCBT) and tested its comparability with the BCTT. We hypothesize that heart rate (HR) at symptom exacerbation on the BCBT will be equivalent to the BCTT.

Study design: Case-control study.

Level of evidence: Level 3.

Methods: Adolescents with acute concussion (AC) (n = 20; mean age, 15.9 ± 1.1 years; 60% male) presenting to a concussion clinic within 10 days of injury and age- and sex-matched healthy controls (n = 20; mean age, 15.9 ± 1.1 years; 60% male) performed the BCTT at first visit and returned within 3 days to perform the BCBT. Test duration, HR, symptom severity (measured using a visual analog scale), and exertion (measured using the Borg Rating of Perceived Exertion) were collected during each test.

Results: Adolescents with AC who were exercise intolerant on the BCTT were also intolerant on the BCBT, with symptom exacerbation occurring at a mean 8.1 ± 2.8 minutes on the BCTT versus 14.6 ± 6.0 minutes on the BCBT (P < 0.01). Two 1-sided t tests showed that the HR at symptom exacerbation in AC patients (137 ± 28 bpm on BCTT vs 135 ± 25 bpm on BCBT; 95% CI, <0.01-0.03) and at voluntary exhaustion for controls (175 ± 13 bpm on BCTT vs 175 ± 13 bpm on BCBT; 95% CI, 0.03-0.03) on each test were statistically equivalent.

Conclusion: The HR at symptom exacerbation on BCBT is equivalent to the BCTT for the assessment of exercise tolerance after concussion in adolescents.

Clinical relevance: The BCBT can be used in patients with limited mobility or for research interventions that require limited participant motion.

Keywords: BCBT; BCTT; Buffalo Concussion Bike Test; Buffalo Concussion Treadmill Test; exercise test; sport-related concussion.

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Conflict of interest statement

The authors declared the following potential conflicts of interest: The University at Buffalo received support for this study from the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under award number 1R01NS094444 and from the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR001412.

Figures

Figure 1.
Figure 1.
Mean heart rate (HR) in patients with acute concussion (AC) at each stage of Buffalo Concussion Treadmill Test and Buffalo Concussion Bike Test with 95% CIs. No significant differences were found at each stage.
Figure 2.
Figure 2.
Mean symptom severity (visual analog scale [VAS; range, 0-10]) in patients with acute concussion (AC) at each stage of Buffalo Concussion Treadmill Test and Buffalo Concussion Bike Test (BCBT) with 95% CI. **95% CI for BCBT on stage 10 is −5.39 to 12.06 (n = 3). No significant differences were found at each stage.
Figure 3.
Figure 3.
Mean heart rate in healthy control subjects (HC) at each stage of Buffalo Concussion Treadmill Test and Buffalo Concussion Bike Test with 95% CIs. No significant differences were found at each stage.
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