Quantifying Activity Levels After Sport-Related Concussion Using Actigraph and Mobile (mHealth) Technologies

Context: Interest in identifying the effects of physical and mental activity on recovery after sport-related concussion is growing. Clinical studies of concussed athletes' activities require well-validated methods for tracking their intensity and timing. Objective: To develop and validate a novel multimodal approach to monitoring activity postconcussion using mobile (mHealth) technologies. Design: Cohort study. Setting: Translational research unit. Patients or Other Participants: A total of 40 high school and collegiate football players were evaluated at preseason and followed longitudinally after either concussion (n = 25; age = 17.88 +/- 1.74 years, height = 182.07 +/- 8.08 cm, mass = 98.36 +/- 21.70 kg) or selection as a nonconcussed control (n = 15; age = 18.27 +/- 1.83 years, height =180.01 +/- 7.19 cm, mass = 93.83 +/- 24.56 kg). Main Outcome Measure(s): Participants wore a commercial actigraph and completed a daily mobile survey for 2 weeks. Analyses focused on comparisons between groups for actigraph-based physical activity and self-reported physical and mental activity during the follow-up period. Results: For the first 2 days postinjury, objective measures showed fewer daily steps in concussed (6663 +/- 2667 steps) than in control (11 148 +/- 3381 steps) athletes (P < .001), and both objective and self-reported measures indicated less moderate to vigorous physical activity in concussed (27.6 +/- 32.6 min/d and 25.0 +/- 43.6 min/d, respectively) than in control (57.3 +/- 38.6 min/d and 67.5 +/- 40.1 min/d, respectively) athletes (both P values < .05). Correlations between objective and self-reported measures of moderate to vigorous physical activity were moderate across select 1-week and 2-week averages. We observed no group differences in self-reported mental activities. Conclusions: Physical activity after sport-related concussion varied widely across athletes but on average was reduced during the acute and early subacute postinjury periods for both objective and self-reported measures. The lack of differences in mental activities between groups may reflect limited change in mental exertion postconcussion or difficulty accurately measuring mental activities. Assessing concussed athletes' activities using actigraphy and self-reported scales may help monitor their compliance with activity recommendations and be useful in studies aimed at better understanding the effects of physical activity on concussion recovery.