A Preliminary Study of the Effect of Early Aerobic Exercise Treatment for Sport-Related Concussion in Males

Abstract

Objective: To study the effect of early prescribed aerobic exercise versus relative rest on rate of recovery in male adolescents acutely after sport-related concussion (SRC). Design: Quasi-experimental design. Setting: University sports medicine centers. Participants: Exercise group (EG, n = 24, 15.13 ± 1.4 years, 4.75 ± 2.5 days from injury) and rest group (RG, n = 30, 15.33 ± 1.4 years, 4.50 ± 2.1 days from injury). Interventions: Exercise group performed a progressive program of at least 20 minutes of daily subthreshold aerobic exercise. Rest group was prescribed relative rest (no structured exercise). Both groups completed daily online symptom reports (Postconcussion Symptom Scale) for 14 days. Main Outcome Measures: Days to recovery after treatment prescription. Recovery was defined as return to baseline symptoms, exercise tolerant, and judged recovered by physician examination. Results: Recovery time from initial visit was significantly shorter in EG (8.29 ± 3.9 days vs 23.93 ± 41.7 days, P = 0.048). Mixed-effects linear models showed that all symptom clusters decreased with time and that there was no significant interaction between treatment group and time. No EG participants experienced delayed recovery (>30 days), whereas 13% (4/30) of RG participants experienced delayed recovery. Conclusions: These preliminary data suggest that early subthreshold aerobic exercise prescribed to symptomatic adolescent males within 1 week of SRC hastens recovery and has the potential to prevent delayed recovery.

Does Early Low-Intensity Aerobic Exercise Hasten Recovery in Adolescents With Sport-Related Concussion?

“…The review was limited to adolescent athletes (aged 10-19 y), because, historically, this group experiences high rates of SRC and appears to be more vulnerable to prolonged recovery. 1,7 Focused Clinical Question Does subsymptom exacerbation LIAEX within the first 4 weeks following SRC hasten symptom resolution in adolescent athletes?…”

“…• The literature was searched for studies on the effects of early (within 4 wk) subsymptom exacerbation LIAEX after medically diagnosed SRC in adolescents. • The search yielded 3 articles 2,7,8 that fit inclusion/exclusion criteria. One level 1b randomized controlled trial (RCT), 2 and 1 level 2b nonrandomized trial (NRT) 7 compared LIAEX initiated within 10 days after SRC with usual care (ie, rest).…”

“…Regarding the posed clinical question, evidence from 1 level 1b RCT 8 and 1 level 2b NRT 7 suggests subsymptom exacerbation LIAEX started within 10 days after SRC is associated with a faster overall recovery time when compared with rest or placebo stretching, although additional data are needed to substantiate this conclusion. Moderately strong (level 1 and 2) evidence from all 3 studies indicates that SRC symptom severity decreased across the study interval in response to LIAEX.…”

“…In the reviewed studies, no adverse effects were reported when LIAEX was performed 5 to 7 days per week on a stationary bike or treadmill for 10 to 20 minutes at 50% to 70% of age-predicted maximal heart rate 2 or at 80% of symptom-threshold heart rate. 7,8…”

Post Concussion Syndrome

“…This growing body of evidence has changed the management of concussions and PCS and the most recent CISG guidelines [21] recommend a short period of rest (24-48 hours) post-injury, followed by a graded return to sub-threshold activity. There have been more studies [106] that have shown the benefits of early sub-threshold aerobic activity in concussion and PCS since guideline came out. A recent randomized controlled trial [107] of over a hundred acutely concussed adolescents showed a significant reduction in recovery time from a median of 17 days in the placebo group to a median of 13 days in the aerobic exercise group (p = 0.006).…”