Context: Following concussion, a multi-faceted assessment is recommended, including tests of physical exertion. The current gold standard for exercise testing following concussion is the Buffalo Concussion Treadmill Test (BCTT); however, there is a lack of validated tests that utilize alternative exercise modalities.

Objective: To assess the feasibility and concurrent validity of a novel cycling test of exertion compared to the BCTT.

Design: Crossover Study

Setting: University Sport-Medicine Clinic

Patients: Twenty adults (aged 18–60 years) diagnosed with a Sport-Related Concussion

Intervention: Participants completed the BCTT and a cycling test of exertion in a random order, approximately 48 hours apart.

Main Outcome Measures: The primary outcome of interest was maximum heart rate [HRmax; beats per minute (bpm)]. Secondary outcomes of interest included whether the participant reached volitional fatigue (yes/no), symptom responsible for test cessation (Post Concussion Symptom Scale), and Symptom Severity on a Visual Scale (/10).

Results: Of the 20 participants, 19 (10 male, 9 female) completed both tests. One participant did not return for the second test and was excluded from the analysis. No adverse events were reported. The median HRmax for the BCTT [171 bpm; (IQR: 139–184bpm)] was not significantly different than the median HRmax for the Cycle [173 bpm; (IQR: 160–182)] (z=–0.63, p=0.53). For both tests, the three most frequently reported symptoms responsible for test cessation were Headache, Dizziness, and Pressure in the head. Of interest, the majority of participants (64%) reported a different symptom responsible for test cessation on each test.

Conclusion: The novel cycling test of exertion achieved similar HRmax and test duration and may be a suitable alternative to the BCTT. Future research to understand the physiological reason for the heterogeneity in symptoms responsible for test cessation is warranted.

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