Date of Graduation


Document Type


Degree Name

Doctor of Philosophy in Health, Sport and Exercise Science (PhD)

Degree Level



Health, Human Performance and Recreation


R. J. Elbin

Committee Member

Brendon McDermott

Second Committee Member

Matthew Ganio

Third Committee Member

Luzita Vela


Cardiorespiratory fitness, Concussion, Dysautonomia, Exercise Science


Background: Accurate assessment of concussion is crucial for creating a treatment plan. The Buffalo Concussion Bike Test (BCBT) is a 30-minute graded exercise protocol for a stationary bicycle. Previously this assessment has been reportedly used to screen for exercise intolerance secondary to autonomic dysfunction; however, the original purpose of the assessment was to find a sub-symptom threshold for exercise rehabilitation during concussion recovery. Starting resistance for the BCBT protocol is based solely on body mass. Other factors such as cardiorespiratory fitness level and sex have been noted to effect outcomes on similar assessments and are not considered in the BCBT protocol or interpretation.

Purpose: The primary purpose of this study is to determine the effects of cardiorespiratory fitness levels (CRF) on the time-to-test completion of the Buffalo Concussion Bike Test among adults with high and low CRF. The secondary purpose of this study is to document sex differences on time-to-test completion and heart rate at test completion on the BCBT.

Study design: This study employed a cross-sectional, extreme groups approach study design.

Methods: Forty-two healthy adults between 20-29 years of age (M = 22.31 ± 2.25 years) completed a VO2 max bike test at their first appointment to screen for eligibility and for placement into high and low groups. To assess for the effects of CRF level, only people with “excellent” and “superior” VO2 max scores were included in the HIGH CRF group (n = 21) and participants with “poor” and “very poor” VO2 max scores according to the American College of Sports Medicine cutoffs were included in the LOW CRF group (n = 21). Participants with “good” and “fair” VO2 max scores were excluded from the study. After eligibility was confirmed and they were assigned to their groups, participants completed the BCBT protocol within 3-14 days. Participants were also administered the Post-Concussion Symptom Scale (PCSS) and the Vestibular/Ocular Motor Screening (VOMS) immediately before and after the BCBT.

Results: Participants in the HIGH CRF group exhibited longer times-to-test completion (U = 15.00, p <.001) and had lower heart rates across the first four stages of the BCBT (F (1) = 40.20, p < .001, η2 = 0.30) compared to participants in the LOW CRF group. Participants in the HIGH CRF group exhibited significantly lower heart rates at rest (t (40) = -3.87, p = 0.01), stage 1 (t (40) = -6.25, p <.001), stage 2 (t (40) =-5.66, p <.001), stage 3 (t (40) = -5.87, p < .001), and stage 4 (t (40) = -6.35, p < .001) compared to those in the LOW CRF group. Males and females did not significantly differ on time-to-test completion (U = 148.00, p = 0.06), or for final heart rate (U = 159, p = 0.12).

Conclusions: Non-concussed individuals with high CRF levels exhibited a ceiling effect on the BCBT protocol. However, they did not exhibit significantly different scores on the PCSS before or after the BCBT compared to individuals in the low CRF group. Males and females did not differ on time-to-test completion or peak heart rate, additionally, they exhibited similar VOMS change scores before and after the BCBT protocol. The findings for the current study further support the literature on interpretation of exercise testing and highlight the need for CRF level considerations for the BCBT protocol.