Sex Differences in Heart Rate Recovery in Adolescents With Recent Concussion
Kiersten Mangold1, Jacob Kay1, Raouf S. Gharbo2, Jeffrey Holloway3, R. Davis Moore1
1Department of Exercise Science, University of South Carolina, 2Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, 3Prisma Health Children’s Hospital
Objective:
To examine sex differences in heart rate (HR) recovery following acute aerobic exercise in adolescents with recent concussion and its relation to performance on clinical concussion assessments.
Background:
HR recovery provides insight into the capacity of the parasympathetic branch of the autonomic nervous system (ANS) to adapt to changing situational demands. ANS dysfunction commonly occurs following concussion and may contribute to symptom presentation. Females often have poorer concussion outcomes than males and differ in pre-injury ANS function; however, sex differences in HR recovery post-concussion have yet to be elucidated.
Design/Methods:
We conducted a retrospective analysis of data from a pediatric specialty clinic. Participants completed the Buffalo Concussion Treadmill Test (BCTT) followed by a battery of clinical concussion assessments: the Vestibular Ocular Motor Screening tool (VOMS); Balance Error Scoring System (BESS); and the Cogstate neurocognitive assessment. HR, symptom severity, and perceived exertion (RPE) were recorded during exercise and for five minutes post-exercise.
Results:
Participants included 31 female and 41 male adolescents with recent concussion who completed the BCTT to 85% of their age-predicted maximal HR without symptom exacerbation. Male participants exercised for a longer duration than females (p=.003). There were no group differences in baseline HR or speed of HR recovery (p’s>.05), but females displayed a smaller percentage change from baseline HR when stopping exercise (p=.03). Females displayed slower reaction times and lower accuracy on a two-back working memory task, and higher odds of symptom provocation during horizontal vestibular ocular reflex (p’s<.05). Metrics of exercise recovery were not related to performance on clinical assessments (p’s>.05).
Conclusions:
In the exercise tolerant, our findings did not suggest HR recovery to be a primary mechanism underlying sex differences on clinical assessments of concussion for adolescents. Future research should examine HR recovery and additional parasympathetic metrics, such as heart rate variability, in an exercise intolerant and/or sedentary cohort.
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