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  • Writer's pictureDr. Jeff Bolton

Physical Exertion Testing: What You Should Know

July 13th, 2021

As mentioned in our previous blog post titled Is Concussion Baseline Testing Right for You & Your Team?, healthcare practitioners can’t rely on symptoms alone. We also know that symptoms and functional deficits may show up only after physical activity.

Remember, the safest thing that someone suffering from a concussion can do is to avoid returning to high-risk activity until they have fully recovered – this includes both from their symptoms as well as brain function. Some research studies suggest that this may take as long as 3 to 6 weeks.[1,2,3]

A handful of research studies have found that high-intensity, physical exertion, completed prior to physical and cognitive tests, can impact neurocognitive function.[4,5] As a result, the recommendation is to perform neurocognitive tests after intense, physical activity before making a return to play decision.


Because this may be a more sensitive measure of any ongoing, lingering symptoms or cognitive deficits caused by concussion. Complete Concussion Management is even more careful in our approach. We perform our entire series of baseline tests following a very intense, physical exertion test before making a return to play clearance decision. This particular physical exertion test is used by professional hockey players, and is recommended for high risk athletes, such as those involved in hockey, football, rugby, Australian football, and gymnastics, for example.

How does physical exertion testing work?

An injured athlete goes through a physical, anaerobic interval workout. This includes stationary bike, burpees, box jumps and much more. The idea is to tire them out while also assessing their visual systems, balance systems, and cardiovascular systems. And, then run them through the series of concussion baseline tests and compare against their original scores.

The physical exertion test adds one more layer that an injured athlete must pass before returning to activity.

Simply, the idea is safety. Longer recovery and holding an athlete back to ensure they’re healthy and fully recovered before putting them at risk for suffering another concussion. These tests are an objective measure for healthcare practitioners to show athletes and parents who pressure them to provide early clearance. It’s a way to identify whether or not the brain has fully recovered. It’s a way to make safer return to play decisions.

Our goal is to ensure and help injured athletes make a full recovery before they return to play!

Interested in learning more about our approach to concussion baseline testing or our physical exertion testing? Contact us today!


[1] Vagnozzi R, Signoretti S, Cristofori L, Alessandrini F, Floris R, Isgro E, et al. Assessment of metabolic brain damage and recovery following mild traumatic brain injury: a multicentre, proton magnetic resonance spectroscopic study in concussed patients. Brain. 2010;133(11):3232–42. [2] Vagnozzi RR, Signoretti SS, Tavazzi BB, Floris RR, Ludovici AA, Marziali SS, et al. Temporal window of metabolic brain vulnerability to concussion: a pilot 1H-magnetic resonance spectroscopic study in concussed athletes–part III. Neurosurgery 2008;62(6):1286–6. [3] Signoretti S, Vagnozzi R, Tavazzi B, Lazzarino G. Biochemical and neurochemical sequelae following mild traumatic brain injury- summary of experimental data and clinical implications. Neurosurg Focus. 2010;29(5):1–12. [4] Whyte EF, Gibbons N, Kerr G, Moran KA. The Effect of a High Intensity, Intermittent Exercise Protocol on Neurocognitive Function in Healthy Adults: Implications for Return to Play Management Following Sport Related Concussion. J Sport Rehabil. 2014 (Epub ahead of print). [5] McGrath N, Dinn WM, Collins MW, Lovell MR, Elbin RJ, Kontos AP. Post-exertion neurocognitive test failure among student-athletes following concussion. Brain Inj. 2013;27(1):103–13.

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