The Dynamic Exertion Test for Sport-Related Concussion: A Comparison of Athletes at Return-to-Play and Healthy Controls

Purpose: To describe the Dynamic Exertion Test (EXiT) by comparing physiological, performance, and clinical outcomes between athletes medically cleared following sport-related concussion (SRC) and healthy controls. Methods: One hundred four (female = 41, 39.4%) participants (14???21 y of age) including 52 medically cleared for return to play at 21.48 (15.40) days following SRC and 52 healthy athletes completed the EXiT involving (1) 12-minute aerobic component and (2) 18-minute dynamic component including 2 functional movement and 5 change-of-direction (COD) tasks. Physiological (heart rate and blood pressure), clinical (endorsed symptoms and rating of perceived exertion), and performance (COD-task completion time and errors) outcomes were collected throughout EXiT. Participants also completed the Postconcussion Symptom Scale and vestibular/ocular motor screening before EXiT. Independent-samples t tests were used to compare groups on resting heart rate and blood pressure, COD-task completion time, and Mann???Whitney U tests on Postconcussion Symptom Scale, vestibular/ ocular motor screening, and EXiT symptoms, rating of perceived exertion, and errors. Results: COD-task completion time and resting systolic blood pressure and heart rate were similar between groups (P .05). SRC reported greater rating of perceived exertion during the aerobic component (P < .05) and lower total dizziness (P = .003) and total symptoms (P = .021) during EXiT and had lower near point of convergence distance (P < .001) and total symptoms (P = .007) for vestibular/ocular motor screening than healthy athletes. Conclusion: Physiological, performance, and clinical EXiT outcomes were equivocal between athletes at medical clearance following SRC and healthy controls. The multidomain EXiT may help to inform safe return-to-play decision