Earlier time to aerobic exercise is associated with faster recovery following acute sport concussion

Abstract

ObjectiveTo determine whether earlier time to initiation of aerobic exercise following acute concussion is associated with time to full return to (1) sport and (2) school or work.MethodsA retrospective stratified propensity score survival analysis of acute (≤14 days) concussion was used to determine whether time (days) to initiation of aerobic exercise post-concussion was associated with, both, time (days) to full return to (1) sport and (2) school or work.ResultsA total of 253 acute concussions [median (IQR) age, 17.0 (15.0–20.0) years; 148 (58.5%) males] were included in this study. Multivariate Cox regression models identified that earlier time to aerobic exercise was associated with faster return to sport and school/work adjusting for other covariates, including quintile propensity strata. For each successive day in delay to initiation of aerobic exercise, individuals had a less favourable recovery trajectory. Initiating aerobic exercise at 3 and 7 days following injury was associated with a respective 36.5% (HR, 0.63; 95% CI, 0.53–0.76) and 73.2% (HR, 0.27; 95% CI, 0.16–0.45) reduced probability of faster full return to sport compared to within 1 day; and a respective 45.9% (HR, 0.54; 95% CI, 0.44–0.66) and 83.1% (HR, 0.17; 95% CI, 0.10–0.30) reduced probability of faster full return to school/work. Additionally, concussion history, symptom severity, LOC deleteriously influenced concussion recovery.ConclusionEarlier initiation of aerobic exercise was associated with faster full return to sport and school or work. This study provides greater insight into the benefits and safety of aerobic exercise within the first week of the injury.

Pediatric Post‐Traumatic Headache and Implications for Return to Sport: A Narrative Review

“…Although outside the scope of this study, multiple authors have demonstrated that symptom‐limited aerobic exercise aids recovery of post‐concussive symptoms 70,73‐76,78‐83 . The rationale for potential benefit of exercise post‐injury is outlined in prior animal and human studies.…”

“…If symptom freedom is not an achievable goal, and we aim for “symptom stability” how does one reconcile this with existing consensus guidelines and state regulations regarding medical clearance for sport? 31,62‐64 There is a paucity of evidence to support the idea that ongoing inactivity or rest aids recovery and prevents re‐injury beyond the acute window of vulnerability (>~10 days) 31,78,79,101,102 . In fact, we know that exercise actually aids recovery of post‐concussive symptoms 70,73‐76,78‐83 and helps in management of primary headache disorders, such as migraine (see below). How should we approach the development of a new or worsened headache post‐injury in an adolescent with the goal of return to sport?…”

“…As such, treatment of migraine through pharmacologic and non‐pharmacologic interventions including exercise may facilitate recovery from persistent PCS rather than prolong it. Therefore, it is the authors' recommendation that the presence or treatment of migraine should not prohibit the return to activity, as exclusion from these activities may further perpetuate one's sense of disability and lead to persistent PCS symptoms, and involvement in activity may actually hasten recovery 70,73‐76,78‐83 …”

Early Controlled Exercise and Timing of Treatment Following Concussion: A Critically Appraised Topic

“…14 • One article 15 demonstrated that initiating aerobic exercise had a positive effect on returning to school/work and sport sooner rather than delayed exercise. • All 5 articles [14][15][16][17][18] demonstrated that implementing early controlled aerobic exercise did not have a detrimental effect on recovery. • One article 17 demonstrated that although the early implementation of controlled aerobic exercise resulted in temporary increases in symptoms, it did not lengthen the overall duration of symptoms and the number of days to return-to-play.…”

“…5 Based upon 2 articles included in this review, early controlled aerobic exercise initiated within 3 to 11 days postconcussion is safe but may not be effective at decreasing symptom duration and overall recovery. 17,18 The other 3 studies demonstrated early controlled aerobic exercise from 3 to 6 days postinjury had a positive effect, [14][15][16] meaning the earlier one started exercise the quicker the symptom resolution within the first 2 weeks. These findings may encourage a shift in current rehabilitation techniques from a conservative, rest-centered approach to a more active and progressive approach.…”