Introduction: Baseline neurocognitive assessments assist in return to play decision-making following sport-related concussion. Prior studies have assessed the effect of a variety of modifying factors on neurocognitive baseline test scores. However, there has been little investigation into the effect of pre-test exercise on baseline testing. Our aim was to determine the effect of pre-test exercise on baseline Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) scores in adolescent and young adult athletes.
Methods: The ImPACT records of 18245 adolescent and young adult athletes were retrospectively analyzed. After application of inclusion and exclusion criteria, participants were dichotomized into groups based on a positive (n= 664) or negative (n= 6609) self-reported history of strenuous exercise within 3 hours of baseline testing. Based on age, gender, education level, concussion history and hours of sleep prior to testing, these participants were randomly matched on a 2:1 basis with individuals from the control group in which there was no pre-test exercise. The ImPACT composite scores of the two groups were then compared.
Results: A significant decline in performance was observed on the ImPACT composite scores of verbal memory, visual memory, reaction time, and impulse control, and in the total reported symptom score for those who exercised prior to testing. No significant between-group difference was detected in the visual motor composite score. Further, pre-test exercise was associated with a significant increase in the overall frequency of invalid test results.
Conclusions: Our results suggest statistically significant differences in ImPACT composite scores between individuals who report strenuous exercise prior to baseline testing versus those who do not. Since return to play decision-making often involves documentation of return to neurocognitive baseline, baseline test scores must be valid and accurate. As a result, we recommend standardization of baseline testing such that no strenuous exercise takes place 3 hours prior to test administration.
Patient Care: The recommendations generated by this study should serve to limit the possibility of false-negative post-concussion ImPACT testing related to comparison to artificially poor baseline tests obtained following exercise.
Learning Objectives: 1. Understand the role of modifying factors on concussion baseline testing.
2. Describe the role of pre-test exercise on ImPACT baseline testing scores.
3. Describe the rationale for standardizing/eliminating pre-test exercise.