title: Pilot study of the Sub-Symptom Threshold Exercise Program (SSTEP) for persistent concussion symptoms in youth.
abstract: BACKGROUND
  Prior studies suggest potential benefit using monitored aerobic exercise to treat youth with persistent concussion symptoms, but these studies have been small.
  
  
  OBJECTIVE
  To explore the safety and potential benefits of a rehabilitative exercise intervention, the Sub-symptom Threshold Exercise Program (SSTEP), for treating youth with persistent concussion symptoms >1 month.
  
  
  METHODS
  We conducted a retrospective cohort study of 83 youth who participated in SSTEP, completing trajectory analysis of concussion symptoms using the symptom subscale of the Sport Concussion Assessment Tool, version 2 (SCAT-2).
  
  
  RESULTS
  The average age of patients was 14.9+/-2.3 years and 54% were female. Most concussions (76%) were due to sports, the majority from football and girls' soccer, and 55% had a previous concussion. Comorbidity was not uncommon: 14% had history of ADHD and 16% history of depression and/or anxiety. Most patients improved following the intervention, and none reported worsening. Symptoms decreased exponentially following initiation of SSTEP, and trajectory did not differ by duration of symptoms at presentation (<6 weeks, 6-12 weeks, >12 weeks).
  
  
  CONCLUSIONS
  Monitored exercise programs appear to be safe and potentially beneficial for youth with persistent concussive symptoms. Large-scale controlled studies are needed to examine efficacy, ideal timing and duration.
authors.affiliation: Seattle Children's Research Institute, Center for Child Health, Behavior and Development, Seattle, WA, USA.|Adolescent Medicine, University of Washington, Seattle, WA, USA.|Harborview Injury Prevention and Research Center Seattle, WA, USA.
authors.forename: Sara P D
authors.initials: SPD
authors.lastname: Chrisman
authors.affiliation: Seattle Children's Research Institute, Center for Child Health, Behavior and Development, Seattle, WA, USA.
authors.forename: Kathryn B
authors.initials: KB
authors.lastname: Whitlock
authors.affiliation: Department of Physical Therapy Seattle, Seattle Children's Hospital, WA, USA.
authors.forename: Elissa
authors.initials: E
authors.lastname: Somers
authors.affiliation: Department of Pediatrics, Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, Seattle, WA, USA.
authors.forename: Monique S
authors.initials: MS
authors.lastname: Burton
authors.affiliation: University of Washington, Sports, Spine and Orthopedic Health, Seattle, WA, USA.
authors.forename: Stanley A
authors.initials: SA
authors.lastname: Herring
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, WA, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Rowhani-Rahbar
authors.affiliation: Seattle Children's Research Institute, Center for Child Health, Behavior and Development, Seattle, WA, USA.|Harborview Injury Prevention and Research Center Seattle, WA, USA.
authors.forename: Frederick P
authors.initials: FP
authors.lastname: Rivara
mesh_terms: D000293:Adolescent; D001265:Athletic Injuries / Q000150:complications; D001924:Brain Concussion / Q000175:diagnosis / Q000209:etiology / Q000534:rehabilitation*; D003071:Cognition; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D010865:Pilot Projects
keywords: Brain concussion; adolescent; child; exercise; prolonged concussion syndrome; sport; traumatic brain injury; treatment