{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T02:12:48Z","timestamp":1779243168744,"version":"3.51.4"},"reference-count":45,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2023,2,15]],"date-time":"2023-02-15T00:00:00Z","timestamp":1676419200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PM&amp;R"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Both sleep duration and physical activity following concussion may influence subsequent recovery. Objective measurement of sleep and physical activity behavior via wearable technology may provide insights into their association with concussion recovery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine whether sleep behavior (eg, duration, timing) and\/or physical activity (steps\/day, or exercise frequency, duration, intensity) in the first month after adolescent sports\u2010related concussion are associated with developing persisting postconcussion symptoms (PPCS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Case\u2013control.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Outpatient sports medicine clinic.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>The study prospectively enrolled adolescent athletes who sustained a concussion (N\u00a0=\u00a049, age\u00a0=\u00a014.8\u2009\u00b1\u20091.8\u2009years; 51% female) who were evaluated within 14\u2009days of concussion (mean\u00a0=\u00a06.7\u2009\u00b1\u20092.7\u2009days) and followed uvia sleep\/physical activity monitoring for the subsequent 2\u2009weeks.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measures<\/jats:title><jats:p>Participants wore a monitor to track sleep (sleep time, wake time, and time spent awake in bed at night) and physical activity (average steps\/day, exercise frequency, exercise duration) behavior for 2\u2009weeks after initial assessment. Participants were followed until symptom resolution, and the main outcome of\u00a0interest was development of PPCS (symptom duration &gt;28\u2009days). A multivariable logistic regression model was used to examine associations between physical activity and sleep behavior with PPCS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 49 participants, 47% (<jats:italic>n<\/jats:italic>\u00a0=\u00a023, mean symptom resolution\u00a0=\u00a057\u2009\u00b1\u200923\u2009days post injury) developed PPCS and 53% (<jats:italic>n<\/jats:italic>\u00a0=\u00a026, mean symptom resolution\u00a0=\u00a015\u2009\u00b1\u20097\u2009days post injury) did not. Univariable analysis showed that the PPCS group took fewer steps\/day (7526\u2009\u00b1\u20092975 vs. 9803\u2009\u00b1\u20093786 steps\/day; <jats:italic>p<\/jats:italic>\u00a0=\u00a0.02), exercised less frequently (2.5\u2009\u00b1\u20092.2 vs. 4.4\u2009\u00b1\u20092.1\u2009days\/week; <jats:italic>p<\/jats:italic>\u00a0=\u00a0.005), and spent more time in bed awake (1.2\u2009\u00b1\u20090.3 vs. 0.8\u2009\u00b1\u20090.3\u00a0h\/night; <jats:italic>p<\/jats:italic>\u00a0=\u00a0.03) than the no PPCS group. Multivariable results indicated the odds of developing PPCS significantly increased with fewer exercise session\/week (adjusted odds ratio\u00a0=\u00a01.96, 95% confidence interval\u00a0=\u00a01.09, 3.51, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.024).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>More exercise sessions that were longer\u00a0than\u00a015\u2009minutes during concussion recovery was associated with a lower risk of developing PPCS, whereas sleep and other physical activity measures were not. Further studies regarding exercise duration and intensity are needed. Clinicians may consider advising patients to optimize sleep and physical activity during concussion recovery.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pmrj.12939","type":"journal-article","created":{"date-parts":[[2022,12,29]],"date-time":"2022-12-29T18:39:26Z","timestamp":1672339166000},"page":"1122-1129","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["The association between sleep and physical activity with persisting postconcussion symptoms among adolescent athletes"],"prefix":"10.1002","volume":"15","author":[{"given":"Linda M.","family":"Neely","sequence":"first","affiliation":[{"name":"Modern Human Anatomy Program University of Colorado School of Medicine  Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine L.","family":"Smulligan","sequence":"additional","affiliation":[{"name":"Department of Orthopedics University of Colorado School of Medicine  Aurora Colorado USA"},{"name":"Sports Medicine Center Children's Hospital of Colorado  Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mathew J.","family":"Wingerson","sequence":"additional","affiliation":[{"name":"Department of Orthopedics University of Colorado School of Medicine  Aurora Colorado USA"},{"name":"Sports Medicine Center Children's Hospital of Colorado  Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Corrine N.","family":"Seehusen","sequence":"additional","affiliation":[{"name":"University of New England School of Osteopathic Medicine  Biddeford Maine USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stacey L.","family":"Simon","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Colorado School of Medicine  Aurora Colorado USA"},{"name":"Pediatric Sleep Center Children's Hospital of Colorado  Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julie C.","family":"Wilson","sequence":"additional","affiliation":[{"name":"Department of Orthopedics University of Colorado School of Medicine  Aurora Colorado USA"},{"name":"Sports Medicine Center Children's Hospital of Colorado  Aurora Colorado USA"},{"name":"Department of Pediatrics University of Colorado School of Medicine  Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2955-0191","authenticated-orcid":false,"given":"David R.","family":"Howell","sequence":"additional","affiliation":[{"name":"Department of Orthopedics University of Colorado School of Medicine  Aurora Colorado USA"},{"name":"Sports Medicine Center Children's Hospital of Colorado  Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,2,15]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports\u20102017\u2010097699"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports\u20102018\u2010100338"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmr.2016.12.006"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.3109\/02699052.2015.1045030"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.1538"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.1203"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546518796830"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1017\/S135561770808017X"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2016.2900"},{"key":"e_1_2_8_11_1","unstructured":"PRIME PubMed|Longitudinal Assessment of Health\u2010Related Quality of Life following Adolescent Sports\u2010Related Concussion. Accessed March 27 2022.https:\/\/neuro.unboundmedicine.com\/medline\/citation\/28077006\/Longitudinal_Assessment_of_Health_Related_Quality_of_Life_following_Adolescent_Sports_Related_Concussion_"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmrj.2013.02.012"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546515625045"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1249\/JSR.0000000000000008"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/JSM.0000000000000026"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.4172\/2155\u20109562.1000388"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports\u20102016\u2010097475"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2014\u20100966"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/JSM.0000000000000803"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/0009922816681603"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/JSM.0000000000000538"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2019.6761"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18147373"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/JSM.0000000000000923"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.4085\/1062\u20106050\u20100470.21"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0000000000002877"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2015.2374"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.7205\/MILMED\u2010D\u201014\u201000516"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1207\/s15324826an1303_4"},{"key":"e_1_2_8_30_1","unstructured":"Fitbit Development: Accelerometer Sensor Guide. Accessed September 29 2021.https:\/\/dev.fitbit.com\/build\/guides\/sensors\/accelerometer\/."},{"key":"e_1_2_8_31_1","unstructured":"Fitbit Technology | PurePulse. Accessed September 29 2021.https:\/\/www.fitbit.com\/global\/us\/technology\/heart-rate"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.2196\/30791"},{"key":"e_1_2_8_33_1","unstructured":"How do I track my workouts with my Fitbit device?Accessed September 29 2021.https:\/\/help.fitbit.com\/articles\/en_US\/Help_article\/1935.htm."},{"key":"e_1_2_8_34_1","unstructured":"Fitbit SmartTrack\u2122 Auto Exercise Recognition. Accessed September 29 2021.https:\/\/www.fitbit.com\/hu\/smarttrack."},{"key":"e_1_2_8_35_1","unstructured":"How do I track my sleep with my Fitbit device?Accessed September 29 2021.https:\/\/help.fitbit.com\/articles\/en_US\/Help_article\/1314.htm."},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.2196\/16273"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1155\/2017\/1364387"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.17396"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2018.4397"},{"key":"e_1_2_8_40_1","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1997.86.3.0425"},{"key":"e_1_2_8_41_1","doi-asserted-by":"publisher","DOI":"10.1097\/JSM.0b013e3181c6c22c"},{"key":"e_1_2_8_42_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.26082"},{"key":"e_1_2_8_43_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000000944"},{"key":"e_1_2_8_44_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2018.2853"},{"key":"e_1_2_8_45_1","doi-asserted-by":"publisher","DOI":"10.1097\/HTR.0000000000000238"},{"key":"e_1_2_8_46_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2019.01002"}],"container-title":["PM&amp;R"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pmrj.12939","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/pmrj.12939","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pmrj.12939","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,21]],"date-time":"2023-09-21T12:53:50Z","timestamp":1695300830000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pmrj.12939"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,15]]},"references-count":45,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2023,9]]}},"alternative-id":["10.1002\/pmrj.12939"],"URL":"https:\/\/doi.org\/10.1002\/pmrj.12939","archive":["Portico"],"relation":{},"ISSN":["1934-1482","1934-1563"],"issn-type":[{"value":"1934-1482","type":"print"},{"value":"1934-1563","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,15]]},"assertion":[{"value":"2022-04-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-12-11","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-02-15","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}