Treatment with controlled exercise is a safe program that appears to improve PCS symptoms when compared with a no-treatment baseline. A randomized controlled study is warranted.

Patients with PCS had a symptom-limited response to exercise, and the treadmill test was a potentially useful tool to monitor the recovery from PCS.

The Balke exercise treadmill protocol has very good IRR and sufficient RTR for identifying patients with symptom exacerbation from concussion.

Exercise assessment and aerobic exercise training for postconcussion syndrome (PCS) may reduce concussion-related physiological dysfunction and symptoms by restoring autonomic balance and improving cerebral blood flow autoregulation. In a descriptive pilot study of 91 patients referred to a university clinic for treatment of PCS, a subset of 63 patients were contacted by telephone for assessment of symptoms and return to full daily functioning. Those who experienced symptoms during a graded exercise treadmill test (physiologic PCS, n = 40) were compared to those who could exercise to capacity (PCS, n = 23). Both groups had been offered progressive exercise rehabilitation. Overall 41 of 57 (72%) who participated in the exercise rehabilitation program returned to full daily functioning. This included 27 of 35 (77%) from the physiologic PCS group, and 14 of 22 (64%) from the PCS group. Only 1 of the 6 patients who declined exercise rehabilitation returned to full functioning. Interpretation of these results is limited by the descriptive nature of the study, the small sample size, and the relatively few patients who declined exercise treatment. Nonetheless, exercise assessment indicates that approximately one third of those examined did not have physiologic PCS.

Although most patients with concussion recover within days to weeks, a small but significant minority develop persistent signs and symptoms of post-concussion syndrome (PCS). The standard treatments of PCS, rest and cognitive adaptation, have limited effectiveness. PCS patients are advised not to exercise because of the concern for symptom exacerbation. Prolonged rest, however, leads to deconditioning (especially in athletes) and may cause secondary effects including depressive symptoms. Concussion is associated with metabolic and physiological changes in the brain and in other organ systems (for example, autonomic function of the heart and altered cerebral autoregulation, sleep, and circadian rhythms). We propose that PCS results from ongoing central and systemic physiologic regulatory dysfunction after traumatic brain injury (TBI) and we further propose that this physiologic dysfunction may be reduced or alleviated by individualized controlled sub-symptom threshold aerobic exercise rehabilitation.