When to Use

• Assessment of physiological recovery and exercise tolerance post-concussion.
• Prescription of aerobic exercise ("The Buffalo Protocol") for symptomatic athletes.
• Differentiating concussion from other conditions (e.g., cervicogenic headache) in the sub-acute phase.

Absolute Contraindications

Test Protocol

1. 1Warm-up: 2 mins at 0% incline at a brisk walking speed (e.g., 3.2–3.6 mph).
2. 2Incline Increase: Increase incline by 1% every minute while maintaining speed.
3. 3Monitoring: Record HR, RPE (6-20 scale), and Symptom Severity (0-10) every minute.
4. 4Termination: Stop when a significant symptom increase occurs OR volitional exhaustion.

Stopping Threshold (Symptom Exacerbation)

Physiological Rationale

Concussion often causes autonomic nervous system dysfunction, leading to limited cerebral blood flow regulation during exercise. Identifying the Heart Rate (HR) threshold where symptoms resolve allows for safe, sub-threshold aerobic training that accelerates recovery.

Clinical Pearls

Exercise Prescription

1. 1Identify Threshold HR: The HR at the moment the test was stopped due to symptoms.
2. 2Calculate Training Zone: Prescribe aerobic exercise at 80% of the Threshold HR for 20 mins/day.
3. 3Progression: Increase the target HR by 5–10 bpm every 1–2 weeks if symptoms do not worsen.

Related Tools

Key Study