Therapeutic intervention for intimate partner violence survivors with PPCS

Women with a history of intimate partner violence will be contacted with consent from previous studies to confirm eligibility for this study. Only participants who meet all inclusion and exclusion criteria will be recruited for the initial visit. During the screening visit, participants will be interviewed in one-on-one sessions and asked to complete questionnaires for data collection and confirmation of the inclusion criteria described below: Rivermead Post Concussion Symptom Questionnaire (RPQ): Assess the presence of Persistent Post-Concussion Symptoms (PPCS) meeting the WHO 10th International Classification of Diseases (ICD-10) criteria. Participants will also be asked to perform the Buffalo Concussion Bike Test (BCBT), a graded exertion test for assessing exercise tolerance after a concussion. During this test, participants will cycle on a stationary bike. Every two minutes, the exercise intensity will increase for a maximum of 30 minutes. Every 2 minutes, participants will also indicate their symptom severity using the Visual Analogue Scale (VAS) and perceived exertion on the Borg Ratings of Perceived Exertion (RPE) scale (6-20). Heart rate will be recorded using a Fitbit (Inspire 3) and an electrocardiogram (ECG). This test identifies the heart rate (HR) at which symptom exacerbation occurs (i.e., Heart Rate Threshold [HRt]). Based on the results of the BCBT, participants will be allocated into three possible interventions: Exercise Intolerant Group: Participants who are exercise intolerant will be randomly assigned to one of two groups in a parallel design. One group will receive a 4-week sub-symptom threshold aerobic exercise (STAE) intervention (20 minutes per day), while the other group will receive a placebo-like passive stretching intervention (allocation ratio 1:1). The STAE target HR will be 80% of the HR achieved at symptom exacerbation during the most recent BCBT visit. Exercise Tolerant Group: Participants who are exercise tolerant will be randomly assigned to one of two groups in a parallel design. One group will receive a 4-week standard aerobic exercise intervention (AE), while the other will receive a placebo-like passive stretching intervention (allocation ratio 1:1). Participants will be instructed to complete 20 minutes of aerobic exercise daily at home or in a gym at the prescribed target HR, The prescribed heart rate will be 50-65% of the age-predicted maximum heart rate. Participants assigned to either the STAE intervention or the standard aerobic exercise intervention (AE) have the option to exercise at home or at a gym. They can choose to perform the STAE or AE intervention in any way they prefer, such as walking, jogging, or stationary cycling, but they will be advised to minimize neck motion during exercise. Both interventions consist of a 5-minute warm-up, a minimum of 20 minutes at the designated heart rate, and then a 5-minute cool-down. All participants will be provided with an activity tracker (Fitbit Inspire 3) to monitor their heart rate and adherence to the protocol. Using the Fitabase platform, research staff will have daily access to participants' activity tracker data, including intensity, heart rate, and exercise logs. Participants will also be asked to complete a weekly survey to confirm adherence to the protocol. All participants, regardless of the treatment group, will be reassessed weekly for exercise tolerance. Upon completing the initial 4 weeks, participants in either treatment group will be offered an additional 4 weeks of the intervention, with all processes repeated to assess any changes over an 8-week timeframe. Data from these optional assessments will be analysed together with the data from the first 4 weeks.