1 Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montréal, Québec, Canada.
2 École de Réadaptation, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada.
3 Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal (CRIR), Montréal, Québec, Canada.
4 Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA.
5 MassGeneral Hospital for Children Sports Concussion Program, Boston, Massachusetts, USA.
6 Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA.
7 Spaulding Research Institute, Charlestown, Massachusetts, USA.
8 School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada.
9 Division of Pediatric Emergency Medicine, Department of Pediatrics, Montréal Children's Hospital, McGill University Health Centre, Montréal, Québec, Canada.

Graded exertion testing (GXT) is an important tool for concussion management, as it is used to personalize post-concussion exercise prescription and return athletes to sport. However, most GXT requires expensive equipment and in-person supervision. Our objective was to assess the safety and feasibility of the Montreal Virtual Exertion (MOVE) protocol, a no-equipment, virtually compatible GXT, in healthy children and children with subacute concussion. The MOVE protocol consists of seven stages of bodyweight and plyometric exercises performed for 60 sec each. Twenty healthy (i.e., non-concussed) children completed the MOVE protocol virtually over Zoom Enterprise. Next, 30 children with subacute concussion (median: 31.5 days post-injury) were randomized to the MOVE protocol or Buffalo Concussion Treadmill Test (BCTT), which increases the incline or speed of the treadmill every minute until maximum exertion. Out of an abundance of caution, all concussed participants completed the MOVE protocol in an in-person clinical space. However, the test evaluator was stationed in a different room within the clinic and administered the MOVE protocol using Zoom Enterprise software to mimic telehealth conditions. Safety and feasibility outcomes were recorded throughout GXT, including heart rate, rate of perceived exertion (RPE), and symptom outcomes. No adverse events were recorded, and all feasibility criteria were successfully met in healthy youth and youth with concussion. Among concussed youth, increases in heart rate (MOVE: 82.4 ± 17.9 bpm, BCTT: 72.1 ± 23.0 bpm; t₍₂₈₎ = 1.36, p = 0.18), RPE (MOVE: 5.87 ± 1.92, BCTT: 5.07 ± 2.34, t₍₂₈₎ = 1.02, p = 0.32), and overall symptom presentation were similar between the MOVE and BCTT protocols. The MOVE protocol is a safe and feasible GXT in healthy youth and youth with subacute concussion. Future studies should assess the fully virtual administration of the MOVE in children with concussion, MOVE protocol tolerability in children with acute concussion, and whether the MOVE protocol can be used to guide individualized exercise prescription.