Abstract / Summary
Abstract Persistent mild traumatic brain injury (mTBI)-related symptoms (PMRS) jeopardize operational readiness and can impede recovery in active-duty service members (ADSMs). Sub-symptom threshold aerobic exercise targets physiological dysregulation driving symptom persistence and exercise intolerance (EI). This rehabilitation strategy has shown promise in sports-related concussion, but its effectiveness in treating PMRS in military personnel has been understudied. This prospective, two-armed randomized controlled trial evaluated the efficacy of an 8-week Adaptable Sub-Symptomatic Exercise Treatment (ASSET) rehabilitation program against an active control condition (guided mobility/stretching) in 61 ADSMs with PMRS. The Buffalo Concussion Treadmill Test (BCTT) identified 26 (43%) participants with baseline EI. Primary outcome was global symptom burden (Neurobehavioral Symptom Inventory); secondary outcomes included chronic pain, PTSD, depression, global cognitive functioning, and postural stability. Participants receiving ASSET (n = 29) saw a significant decrease over controls (n = 32) in global symptom burden ( p = .030, ηp² = .084), pain intensity ( p = .004, ηp² = .144), and PTSD symptoms ( p = .017, ηp² = .102). Baseline EI significantly moderated PTSD symptom response ( p = .029, ηp² = .086), with participants with lower exercise capacity experiencing the greatest benefits from ASSET. These findings support integrating BCTT-based phenotyping into military concussion care.