Impact of Moderate Exercise on Post-concussive Symptoms and Cognitive Function after Concussion in Children and Adolescents Compared to Healthy Controls

Abstract

Resolution of post-concussive symptoms (PCS) is a marker of recovery. However, it is unclear whether subtle impairments re-emerge in the context of increased demands. This study examined the effect of strenuous exercise on clinical symptoms and cognitive efficiency in children and adolescents after PCS resolution following concussion. We recruited concussed children and adolescents (n=30) on presentation to an Emergency Department (ED), and compared them to community-sourced non-injured controls (n=30), matched for age, and cognitive function. At Day 2 post symptom resolution, concussed participants (and controls) completed an exercise protocol, and pre- and post exercise assessments of PCS and computer-based cognitive efficiency. Findings demonstrated that, compared to controls, participants with recent concussion showed an overall reduction in PCS post-exercise (p=0.048), less impact of exercise on PCS than controls (p=0.021), and faster reaction times on computer-based cognitive tasks, even where cognitive demands were high (ps<0.05). These results provide preliminary support for the use of moderate exercise for the reduction of concussion post-symptom, as suggested in recent clinical guidelines.

Best Practices for Progressive Return to Activity after Concussion: Lessons Learned from a Prospective Study of U.S. Military Service Members

“…29,30,33 Additionally, an emerging literature suggests that guided physical activity can be an effective intervention in the post-acute and chronic phases of recovery. 34,35 Results from the DVBIC PRA study provided additional support for these findings, as SMs who engaged in higher levels of physical or vestibular activity during the sub-acute stage (1 month post-injury) reported lower levels of symptoms in the chronic stage (3 months post-injury). 36 This apparent reversal in the effects of activity over time highlights the importance of matching concussion patients' activity levels to their stage of recovery, with a graded increase in activity level as symptoms subside.…”

Literature Review: Post Traumatic Headache Interventions in the Pediatric Population

“…A single blind case series of 11 male retired NFL/CFL players diagnosed with PCS concluded that after ten sessions of specific craniosacral therapy, visceral manipulation, and neural manipulation (CST/VM/NM) therapy resulted in statistically greater improvements in perceived pain intensity, range of motion, memory, cognition, and duration of sleep [19]. Given the statistically significa t improvements seen in this study and the low risk associated with this intervention craniosacral therapy and visceral manipulation may be promising treatment options.…”

“…A review of observational and experimental data presented evidence for subthreshold aerobic exercise as a tool to safely evaluate concussion and speed recovery for patients with PCS [20]. Additionally, the article states that there is emerging evidence for the effectiveness of controlled aerobic exercise in the acute phase after adolescent sports-related concussion.…”

“…In another study by Cordingly D, et al use of tailored submaximal exercise treatment for physiologic post-concussive disorder in pediatric patients with sports-related concussion led to clinical improvement in 90% of patients, with 80% successfully returning to sports participation [8]. Further research into its potential effects on PTH in the pediatric population is warranted [20,21].…”

Physical activity after mild traumatic brain injury: What are the relationships with fatigue and sleep quality? Is physical activity a key to prevention of post-concussive symptoms?

“…Recently, Anderson et al reported reduction of post-concussive symptoms and faster reaction times on computer-based cognitive tasks in children and adolescents with recent concussion after moderate exercise. 8 Identification of PA as an important factor in relation to fatigue after mTBI is a first step to place PA also in the correct perspective in relationship to prevention and rehabilitation of long term post-concussive symptoms.…”