Accelerometer-measured habitual physical activity and sedentary time in pediatric concussion: A controlled cohort study.

ObjectivesTo characterize and quantify differences in accelerometer-measured physical activity and sedentary time between children with concussion (within the first month of injury) and 1:1 matched healthy controls. MethodsSecondary analysis of accelerometer data collected on 60 children with concussion and 60 healthy controls matched for age, sex, and season of accelerometer wear. Daily and hourly sedentary time, light physical activity (LPA), moderate physical activity (MPA), and vigorous physical activity (VPA) were compared between groups per independent samples t-tests. ResultsChildren with concussion (12.74 {+/-} 2.85 years, 31 females) were significantly more sedentary than controls (12.43 {+/-} 2.71 years, 31 females; mean difference [MD], 38.3 minutes/day, p=0.006), and spent less time performing LPA (MD, -19.5 minutes/day, p=0.008), MPA (MD, -9.8 minutes/day, p<0.001), and VPA(MD, -12.0 minutes/day, p<0.001); hour-by-hour analyses showed that these differences were observed from 8:00AM to 9:00PM. Sex-specific analyses identified that girls with concussion were less active and more sedentary than both boys with concussion (MD, 50.8 minutes/day; p=0.010) and healthy girls (MD, 51.1 minutes/day; p<0.010). Days post-injury significantly predicted MPA ({beta}=0.071, p=0.032) and VPA ({beta}=0.095, p=0.004), but not LPA or sedentariness in children with concussion. ConclusionClinical management should continue to advise against prolonged rest following pediatric concussion, given the activity debt observed within the first-month of injury. Currently, clinical management of concussion is shifting towards prescribing a single bout of daily sub-maximal aerobic exercise. Interventions aimed at reducing overall sedentary time and increasing habitual physical activity in pediatric concussion also warrant study. KEY FINDINGSO_ST_ABSWhat are the new findings?C_ST_ABSO_LIPer accelerometry, children with concussion are significantly more sedentary than healthy controls within the first-month of injury C_LIO_LIRelative to healthy controls, in the first-month of injury, children with concussion perform less accelerometer-measured light, moderate, and vigorous physical activity C_LIO_LIThese patterns of increased sedentary time and reduced physical activity are seen throughout the day, from 8:00 AM to 9:00 PM C_LIO_LIModerate and vigorous physical activity levels are predicted by days-post injury in children with concussion, and may increase naturally as a consequence of recovery C_LI How might it impact on clinical practice in the future?O_LIGiven the accumulating evidence that prolonged rest should be avoided following concussion, primary care clinicians should continue to advocate for light physical activity post-concussion to limit increased sedentary time C_LI