{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T16:42:48Z","timestamp":1792341768123,"version":"4.4.0"},"reference-count":70,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Restorative Neurology and Neuroscience"],"abstract":"<jats:p>Mild traumatic brain injury (mTBI) often creates a sequela of symptoms that complicate safely participating in aerobic exercise. Although exertional assessments have been used to evaluate exercise tolerance, data on the feasibility of using test-derived metrics to guide the intensity of aerobic exercise interventions in community-dwelling adults is yet to be presented. This secondary analysis of a wider pilot randomized control trial examined whether a modified exertional bike test (MEBT) could be used to effectively individualize supervised virtual aerobic exercise without exacerbating symptoms in individuals with a mTBI. Adults (18\u201355 years) diagnosed of mTBI within the previous 12 months completed the MEBT and were randomized to either a 12-week supervised virtual aerobic exercise intervention or active balance control. Those randomized to the aerobic group exercised at 65\u201380% of HR at MEBT-derived symptom threshold or volitional exhaustion. Descriptive session outcomes, Spearman correlations, and Fisher's z tests assessed (1) the feasibility of symptom-threshold HR intervention metrics, (2) changes in the HR\u2013symptom relationship over time, and (3) the influence of mTBI-related confounders on HR-symptom associations. Participants completed 95.6% of aerobic sessions, with symptom exacerbation (\u22653-unit increase) reported in just 3.8% of sessions. Ten of 12 participants displayed a decreased, or negative, HR\u2013symptom severity association over time. In addition, Fisher's z tests revealed confounding variables did not meaningfully modify the HR-symptom association. Sub-symptom-thresholded exercise sessions limited symptom exacerbation, uncoupled the HR\u2013symptom relationship, and improved exercise tolerance over time. These findings highlight the feasibility of exertional symptom-guided virtual aerobic exercise following mTBI and support progression towards larger efficacy trials.<\/jats:p>","DOI":"10.1177\/09226028261496160","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T11:27:12Z","timestamp":1792150032000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Feasibility of a Modified Exertional Bike Test to Threshold Supervised Virtual Aerobic Exercise in Community-Dwelling Individuals with Mild Traumatic Brain Injury"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6442-0356","authenticated-orcid":false,"given":"Mark C","family":"Nwakamma","sequence":"first","affiliation":[{"name":"Institute for Cognitive &amp; Brain Health, Northeastern University, Boston, MA, USA"},{"name":"Department of Physical Therapy, Movement, &amp; Rehabilitation Sciences, Northeastern University, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7960-9844","authenticated-orcid":false,"given":"Emma M","family":"Tinney","sequence":"additional","affiliation":[{"name":"Institute for Cognitive &amp; 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