{
  "abstract": "Objective Optimal balances of sedentary behaviour, physical activity and sleep (collectively termed movement behaviours) for concussion management remain unknown. We sought to determine the optimal daily distribution of movement behaviours for reducing postconcussion symptom burden in children and adolescents.Methods This secondary analysis of the Paediatric Concussion Assessment of Rest and Exertion (PedCARE) study included participants aged 10 to <18 years with an acute concussion (>48 hours of presenting to emergency department). Health and Behaviour Inventory (HBI) concussion symptoms were measured at a 2-week post-emergency department follow-up. Persisting symptoms after concussion (PSAC) were classified through reliable change in total HBI scores. Movement behaviours were measured with accelerometers over 13 days. For each day of movement behaviours, compositional regression models were built to determine the optimal daily movement behaviours for predicting HBI scores and PSAC probability.Results Analyses included 259 participants (45% female, mean age 13.3 years). Compared with the average, movement behaviours associated with optimal postconcussion outcomes followed a trend of initially more rest (eg, day 2: 11.5 (95% CI 8.8 to 12.7) hours/day of sleep and 8.5 (95% CI 6.5 to 11.3) hours/day sedentary). Optimal patterns also included above-average moderate-to-vigorous physical activity across the 13 days (eg, days 2, 7, 13:0.6 (95% CI 0.2 to 1.2), 1.5 (95% CI 1.2 to 1.7), 1.1 (95% CI 0.2 to 1.7) hours/day, respectively), with increased light physical activity emerging as optimal later in recovery (eg, day 10:5.5 (95% CI 5.0 to 5.8) hours/day).Conclusions This is the first study to use compositional data analyses to identify an optimal distribution of movement behaviours for concussion symptom recovery in children and adolescents. Our results can inform concussion management protocols that balance rest and activity throughout recovery.",
  "authors": [
    {
      "affiliations": [
        "Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada"
      ],
      "name": "Nicholas Kuzik"
    },
    {
      "affiliations": [
        "Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada"
      ],
      "name": "Veronik Sicard"
    },
    {
      "affiliations": [
        "Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada",
        "Pediatrics, University of Ottawa, Ottawa, Ontario, Canada"
      ],
      "name": "Mark S Tremblay"
    },
    {
      "affiliations": [
        "Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada"
      ],
      "name": "Adrienne Davis"
    },
    {
      "affiliations": [
        "Emergency Department, London Health Sciences Centre Children’s Hospital, London, Ontario, Canada"
      ],
      "name": "Gurinder Sangha"
    },
    {
      "affiliations": [
        "Psychology, University of Calgary, Calgary, Alberta, Canada"
      ],
      "name": "Keith Owen Yeates"
    },
    {
      "affiliations": [
        "Pediatrics, University of Ottawa, Ottawa, Ontario, Canada",
        "Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada"
      ],
      "name": "Roger Zemek"
    },
    {
      "affiliations": [
        "Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada",
        "Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada"
      ],
      "name": "Andrée-Anne Ledoux"
    },
    {
      "affiliations": [],
      "name": "On behalf of the PERC PedCARE team"
    }
  ],
  "title": "Optimal movement behaviours for postconcussion symptom recovery in children and adolescents: a compositional analysis of the PedCARE cohort",
  "uid": "75ac4840-2f7a-5deb-bbb2-c789e8f76415"
}