Post-Exertion Testing: The Protocol That Tests Your Brain After Your Body Is Tired

Here’s a cutting-edge approach to baseline and post-injury testing that most programs haven’t adopted yet: post-exertion cognitive assessment. It’s based on a simple but powerful insight — and the evidence is growing.

The problem with rest-state testing

Standard baselines test athletes at rest: sitting quietly in a chair, in a cool room, well-hydrated, and cognitively fresh. But athletes don’t compete at rest. They compete while physically exhausted, dehydrated, overheated, and cognitively stressed. A brain that performs well on a cognitive test in a quiet room at 9 AM might perform very differently after 45 minutes of high-intensity exercise.

The Gapski-Goodman Protocol

The Gapski-Goodman Protocol, developed in collaboration with professional sports teams including the Chicago Blackhawks (as reported in sports medicine conference proceedings), adds cognitive testing after a structured exercise session — typically moderate aerobic exercise sufficient to elevate heart rate to 70–80% of maximum. The concept is that a brain with lingering concussion deficits will show those deficits more clearly under physiological stress — deficits that might be completely masked during testing at rest.

The Buffalo Concussion Treadmill Test

This approach is supported by research on the Buffalo Concussion Treadmill Test (BCTT), developed by Leddy et al. at the University at Buffalo and published in the Clinical Journal of Sport Medicine. The BCTT, while primarily a treatment tool (identifying safe exercise intensity thresholds during recovery), demonstrates the principle that exercise stress reveals brain dysfunction that rest-state testing misses. Research published in PMC by Leddy et al. (2017) showed that supervised sub-symptom-threshold exercise can actually accelerate concussion recovery.

Why it matters for baseline and post-injury testing

Post-exertion testing has implications for both baseline and return-to-play assessment. At baseline, it establishes what cognitive function looks like when the athlete is tired — their realistic competition-state performance. Post-injury, it provides a more sensitive measure of recovery by stressing the system and checking whether cognitive function holds up under physical demand.

Our approach

At Headquarters, we’re incorporating post-exertion assessment elements into our advanced baseline protocols for athletes who want the most comprehensive evaluation possible. While not every athlete needs this level of testing, it’s especially valuable for athletes recovering from concussions who need to demonstrate cognitive resilience under physical stress before returning to contact competition. For the standard return pathway, see our graduated return-to-play protocol.

Frequently asked questions