Un grand défi des cliniciens dans le domaine des commotions cérébrales est de déterminer le moment où l’athlète est prêt à retourner au jeu. Pour guider cette décision, plusieurs ont recours à l’évaluation cognitive pour accompagner l’évaluation des symptômes de l’athlète. Toutefois, plusieurs études appuient la nécessité de développer des tâches cognitives plus raffinées avec des propriétés psychométriques adéquates. Par ailleurs, une étude récente montre que des déficits cognitifs sont exacerbés par l’exercice physique chez 27,7 % des athlètes ayant reçu l’autorisation médicale de retourner au jeu et montrant des résultats normaux à l’état de repos, suggérant une récupération incomplète. Le but de cette thèse consiste en l’élaboration d’un outil, valide et accessible, pour évaluer la disposition d’un athlète à retourner au jeu à la suite d’une commotion, ainsi que pour évaluer les déficits à long terme (c.-à-d., plus de six mois) associés à la blessure. Cet outil comprend un protocole d’exercice standardisé (20 minutes à 80 % de la fréquence maximale théorique sur vélo) et une tâche cognitive, appelée la tâche d’alternance. Dans l’article I, nous avons examiné les propriétés psychométriques de la tâche cognitive. Les résultats suggèrent que la tâche d’alternance est une mesure valide des fonctions exécutives et montre une bonne fidélité test-retest. Ils indiquent aussi que les coûts d’alternance, traditionnellement calculés pour isoler les différentes composantes des fonctions exécutives, ne montrent pas d’aussi bonnes propriétés psychométriques que les variables primaires (vitesse de réaction, précision des réponses et score d’efficacité inverse). Dans l’article II, nous avons mesuré l’effet de pratique associé à la passation répétée de la tâche à des intervalles de 48 heures, dans le but de répliquer l’administration en série de cette tâche lors du suivi post-commotion. Les résultats indiquent que la performance s’améliore durant les trois premières passations de la tâche et que l’utilisation d’une version alternative ne permet pas d’éliminer l’effet de pratique. Dans l’article III, nous avons déterminé que notre outil détenait la capacité de détecter des déficits cognitifs chez des athlètes ayant réussi le protocole de retour au jeu de Zurich. Spécifiquement, notre outil a permis de créer trois sous-groupes : 80 % des athlètes qui ne montrent aucun déficit ; 20 % des athlètes qui montrent des déficits cognitifs au repos sur la tâche d’alternance ; 10 % des athlètes qui montrent des déficits seulement après l’exercice. Ainsi, lorsqu’utilisés ensemble, la tâche d’alternance et le protocole d’exercice permettent de détecter des déficits chez jusqu’à 30 % des athlètes, qui sont pourtant considérés comme rétablis. Dans l’article IV, nous avons montré que notre outil peut détecter les déficits persistants associés à la commotion. Alors qu’au repos aucun déficit n’est observé, l’évaluation post-exercice révèle des déficits chez 20 % des athlètes avec un historique de commotions. En somme, nos résultats soutiennent l’utilisation de notre outil pour l’évaluation du retour au jeu. Les résultats de cette thèse réaffirment la nécessité de changer la norme pour l’évaluation de la commotion. Sur la base des résultats actuels, l’utilisation de tâches cognitives valides et sensibles aux effets de la commotion au-delà de la phase symptomatique, associée à un protocole d’exercice, devrait devenir l’étalon-or. / Concussion is especially hard to detect because clinicians must rely on self-reported symptoms to diagnose the injury and to determine when an athlete is ready to safely return to play (RTP). To guide the latter decision, many use cognitive testing. However, several studies indicate the need to develop more refined cognitive tasks, with better psychometric properties than those currently used to assess concussion. Another option would be to perform the psychometric validation of experimental tasks frequently used in research settings. Further, a recent study suggests that physical exercise can reveal deficits that were not perceptible at rest in one in four athletes, thus indicating incomplete recovery in a significant minority of the concussed athletes. Accordingly, this dissertation aimed to develop a valid and easily accessible tool to assess the readiness of recently concussed athletes to safely return to play, as well as to assess deficits in the protracted phase of the recovery. The tool includes a standardized exercise protocol (20-min on an ergocycle at 80% theoretical maximum heart rate) and a cognitive task (color-shape switch task). In the first manuscript, we examined the construct validity and the test-retest reliability of the switch task. The results suggest that the switch task is a valid measure of executive functions that shows an adequate test-retest reliability. The results also suggest that the switch costs, which are traditionally computed to isolate the different components of executive functions, do not show as good psychometric properties as primary variables do (i.e., reaction time, accuracy, and inverse efficiency score). In the second manuscript, we measured the practice effect associated with serial administration of the switch task. The results indicate that the performance improves during the first three assessments when the task is completed every 48 hours. Also, they do not support the use of alternative versions of the task in order to eliminate the practice effect as it is still present. In the third manuscript, we determined that our tool has the requisite sensitivity for detecting cognitive deficits in recently concussed athletes who had successfully completed the RTP protocol. Specifically, our tool detected deficits in 20% of athletes when the switch task is completed at rest and in an additional 10% when it is completed post-exercise. Thus, our tool can detect deficits in up to 30% of athletes who had received their medical clearance to RTP. In the 4th manuscript, we showed that our tool can detect persistent deficits stemming from sports concussion. The post-exercise testing showed deficits in 20% of athletes, deficits that were not detected at rest. Thus, the use of an acute bout of aerobic exercise may increase the sensitivity of the cognitive testing. The results herein support the use of the switch task, before and after an acute bout of exercise of moderate intensity. Moreover, they reaffirm the necessity to change the standard for assessing sports concussion. Indeed, based on the current results, the use of valid and reliable cognitive tasks, sensitive to the effects of concussion beyond the symptomatic phase, in combination with an exercise protocol, should become the gold standard.

<p dir="ltr">Past research has extensively explored the benefits of acute aerobic exercise (AE) on memory and executive functions. Additionally, the cross-sectional relationship between muscle strength – a direct outcome of RE – and cognition is unknown, despite the simultaneous onset of muscle and cognitive decline in one’s thirties. However, the effects of acute resistance exercise (RE) on cognition remain understudied, despite the growing popularity of RE and evidence that RE may have distinct effects on cognition.. Therefore, the present study aimed to broaden our understanding of the connection between muscle strength and hippocampal-dependent memory and to investigate the influence of RE on memory and executive function.</p><p dir="ltr">A sample of 125 healthy young adults (18-50 years old) completed this study. On the first day of testing, subjects completed a cognitive battery testing aspects of hippocampal dependent memory, spatial abilities, and working memory, a maximal muscle strength testing session including handgrip strength and one-rep-max testing, and maximal aerobic capacity testing. Subjects completed a bioelectrical impedance assessment (BIA) body scan to measure body composition on Day 2. Day 3 consisted of a randomized controlled trial (RCT), where subjects completed either 42 minute moderate intensity RE (n = 62) or a seated rest (n = 61). Cognitive testing including a memory recognition task, an inhibitory control task, and a working memory task were performed both before and after the intervention. Subjects also completed lactate, blood pressure, and blood draw (only a subset of subjects (n = 59)) before and after intervention.</p><p dir="ltr">The results first revealed that after controlling for known covariates, those with greater handgrip strength performed better on mental rotation tasks (t = 2.14, p = 0.04, Δr2= 0.04), while those with higher upper-body relative strength did better on recognition (t = 2.78, p = 0.01, Δr2 = 0.06) and pattern separation (t = 2.03, p = 0.04, Δr2= 0.04) tasks. Further, while there was no acute effect of RE on memory performance, response times during measures of inhibitory control (t = 4.15, p < 0.01, d = 0.40) and working memory decreased after exercise (t = 7.01, p < 0.01, d = 0.46), along with decreases in P3 latency during the inhibitory control task (t =-5.99, p < 0.01, d = 0.58). Additionally, blood lactate (t =-17.18, p < 0.01, d = 2.06), serum brain derived neurotropic factor (BDNF) (t = -4.17, p < 0.01, d = 0.66), and systolic blood pressure (t = -10.58, p < 0.01, d = 0.99) all increased following RE, while diastolic blood pressure (t = 4.90, p < 0.01,d = 0.50) decreased. Notably, the change in systolic blood pressure (t = -2.83, p = 0.01, Δr2 = 0.06) was associated with improvements in behavioral measures of inhibitory control, changes in lactate (t = -2.26, p = 0.03, Δr2 = 0.04) and systolic blood pressure (t = -3.30, p < 0.01, Δr2 = 0.08) were also related to improved behavioral changes in working memory, and changes in lactate (t = -3.31, p < 0.01, Δr2= 0.08) and BDNF (t = -2.12, p = 0.04, Δr2= 0.08) related to faster P3 latency during inhibitory control. Importantly, these associations between physiological and cognitive changes were consistent across both exercise and rest groups, suggesting that physiological changes were linked to improved cognitive performance regardless of group assignment.</p><p dir="ltr">In conclusion, this study highlights the positive relationships between cross-sectional muscle strength and aspects of memory and spatial abilities, with distinct contributions from handgrip and upper body strength. Furthermore, acute RE was shown to enhance executive functions, particularly in terms of processing speed during inhibitory control (response time and P3 latency) and working memory (response time). This study suggests that RE can be a valid way to garner exercise-induced benefits on executive functions potentially through its influence on lactate, BDNF, and blood pressure, however, since these effects were evident regardless of intervention, more work is needed to determine if RE-induced changes have the same mechanisms. Overall, these findings underscore the potential benefits of muscle strength and RE on enhancing executive function in young and middle-aged adults.</p>