Feasibility of a Continuous Aerobic Resistance Exercise (CARE) Protocol for Concussion Rehabilitation Delivered Remotely via a Mobile App (Preprint)

BACKGROUND The benefits of aerobic exercise to assist in alleviating symptoms following concussion have consistently been reported in recent years. However, exercise modality recommendations have been limited by the requirement of equipment (e.g., treadmills and stationary bikes). Advances in digital technologies may help to overcome this limitation, as mobile technologies can provide users with high-quality instructional videos, programs, and monitoring capabilities using resistance exercises. OBJECTIVE To determine the feasibility of a mobile app to deliver an exercise protocol to individuals following concussion at a specified intensity based on age-adjusted percentage of heart rate (HR) maximum. METHODS A two-week prospective single-arm pilot study in 21 adults diagnosed with a concussion. Users were provided a Continuous Aerobic Resistance Exercise (CARE) protocol via mobile app. The objective of the study was to determine feasibility, defined by retention and adverse events, as well as reaching a target heart rate of 60% +/-5% (age-adjusted percentage of max: 220 – age). We also evaluated symptoms before and after the three exercise sessions. RESULTS 18 participants (female, n = 14, male, n = 4) completed a three-session exercise plan. Heart rate data was acquired via Apple watch (Series 6). The median age-adjusted % of HR Max for session one was 55.5% (IQR = 49 – 63%), 58.1% (IQR = 50.8 – 65.2%) for session two, and 57.4% (IQR = 49.5 – 64.7%) for session three. Individual median HR% across all sessions ranged from 46.9% to 67.4%; 10 participants (55.5%) had a total mean HR% within the target HR%, seven participants had a mean HR% below 55%, and one participant had a mean HR% above 65%. In addition, adherence to the plan resulted in a decrease in reported symptom burden with 94% posterior probability. CONCLUSIONS Following concussion, a CARE protocol delivered via a mobile app resulted in no adverse effects with 14% attrition over three sessions. CARE was successful in achieving an aerobic exercise intensity of 55-65% of age-adjusted maximum heart rate in the majority of participants and resulted in a decrease in reported symptom burden. The potential for this platform in concussion rehabilitation warrants further investigation.