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. 2021 Apr 9;6(1):CNC88.
doi: 10.2217/cnc-2020-0018.

A pilot study on exertional tasks with physiological measures designed for the assessment of military concussion

Julianna H Prim  1   2 , Maria I Davila  2 , Karen L McCulloch  1   3
Affiliations

A pilot study on exertional tasks with physiological measures designed for the assessment of military concussion

Julianna H Prim et al. Concussion. .

Abstract

Background: Guidelines for clinicians treating military concussion recommend exertional testing before return-to-duty, yet there is currently no standardized task or inclusion of an objective physiological measure like heart rate variability (HRV).

Methodology & results: We pilot-tested two clinically feasible exertional tasks that include HRV measures and examined reliability of a commercially available heart rate monitor. Testing healthy participants confirmed that the 6-min step test and 2-min pushup test evoked the targeted physiological response, and the Polar H10 was reliable to the gold-standard electrocardiogram.

Conclusion: Both tasks are brief assessments that can be implemented into primary care setting including the Polar H10 as an affordable way to access HRV. Additional research utilizing these tasks to evaluate concussion recovery can validate standardized exertional tasks for clinical use.

Keywords: autonomic dysfunction; exercise intolerance; exertional tasks; heart rate variability; military concussion; primary care; return to activity.

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Conflict of interest statement

Financial & competing interests disclosure This research was supported by the Carolina Digital Health Research Initiative (CaDHRI) and Research Electronic Data Capture (REDCap). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript.

Figures

Figure 1.
Figure 1.. Layout of testing session.
HR: Heart rate; PU: Pushup; RPE: Rate of perceived exertion.
Figure 2.
Figure 2.. Bland-Altman and scatter plot for inter-beat interval from the Faros 180 electrocardiogram and Polar H10.
(A) Plot of the IBI differences versus the means for the Faros 180 and Polar H10. Outer lines indicate the 95% confidence interval. (B) Scatter plot of the Faros versus Polar H10 IBIs with regression and R2. IBI: Inter-beat interval.
Figure 3.
Figure 3.. First row: Scatterplots between sensors for heart rate variability components, color-coded by time point with regression and R2.
(A) RSA. (B) LF. (C) HP. D–F: Mean of HRV measures at baseline, exertion, and rest after exertion for Faros 180 electrocardiogram and Polar H10. (D) RSA. (E) LF. (F) HP. BL: Baseline; ECG: Faros 180; HP: Heart period; HRV: Heart rate variability; LF: Low-frequency; POLAR: Polar H10; R: Recovery period after STEP; RSA: Respiratory sinus arrhythmia; STEP: Step task. *Statistically significant at p < 0.05.
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