Use of Supervised Exercise During Recovery Following Sports-Related Concussion

Abstract

To assess the safety of supervised exercise (SE) in acute sport-related concussion (SRC) and its influence on recovery. Design: Retrospective cohort study. Setting: University SRC clinic at a tertiary care center. Patients: One hundred ninety-four consecutive new patient charts were reviewed. Patients were included if they were seen within 30 days of sustaining a SRC, and their medical records included all required data elements. One hundred twenty-six patients were included in the analysis. Interventions: Symptomatic patients who initiated SE within 16 days of SRC (n 5 24) were compared with those who did not undergo SE or initiated SE after postinjury day 16 (n 5 84). Age, sex, history of previous concussions, injury severity, relevant comorbidities, and other treatments received were included in the analysis. Main Outcome Measures: The association between early SE and clearance for return to sport was determined using a hazard ratio (HR). The number of days from SRC until clearance for return to sport and the number of days symptomatic from concussion were also compared between early SE and nonearly SE cohorts. Results: No serious adverse events occurred in the early SE group. Early SE was associated with earlier return to sport (HR 5 2.35, P 5 0.030). The early SE group had fewer days from SRC until clearance for return to sport (mean 26.5 6 11.2 days vs 35.1 6 26.5 days, P 5 0.020). There was a trend toward fewer symptomatic days in the early SE group (P 5 0.054). Conclusion: Early SE performed in the symptomatic stage of SRC was safe and associated with earlier return to sport.

Symptom Provocation During Aerobic and Dynamic Supervised Exercise Challenges in Adolescents With Sport-Related Concussion

“…The SECs were conducted as part of standard care for patients with SRC. 14 All SECs were led by an athletic trainer or physician in a dedicated exercise area of the clinic. The SEC did not occur until the patient's second visit to the clinic (ie, first follow-up visit).…”

“…Exercising within these guidelines has been considered safe and beneficial to recovery, even in the early symptomatic period. 8,14 The absence of symptom provocation during exercise was used as a sign of recovery to inform clinical decisions on initiating and completing a return-to-play protocol after concussion symptoms had resolved. 15,16 Whereas the standard protocols include a graduated course of aerobic and dynamic exercises, 1 it is notable that most exercise protocols studied for this purpose in a supervised clinic setting included only forms of basic aerobic exercise, such as the treadmill or stationary bike.…”

“…1 A supervised exercise challenge (SEC) that included both aerobic (ASEC) and dynamic (DSEC) aspects was safe and facilitated recovery when used in the early symptomatic period after concussion. 14 An SEC involving aerobic and dynamic exercises can mimic all stages of the return-to-play process and may offer advantages over a supervised exercise protocol of an ASEC alone. A better understanding of SECs, especially those including a DSEC, is needed to optimize concussionmanagement decisions that are based on performance during in-clinic SECs.…”

Systematic Review of Pre-injury Migraines as a Vulnerability Factor for Worse Outcome Following Sport-Related Concussion

“…A different adolescent concussion clinic study reported that those with a “history of headaches or migraines” (36% of the entire sample) showed a higher likelihood of prolonged recovery at 30 days (OR = 4.02) ( 42 ). Adolescents with concussion seen in university settings did not have a higher likelihood of prolonged recovery ( 43 ) or greater time to return to play ( 44 ). In a study that examined adolescent and young adult athletes recruited from a hospital-based concussion program, those with a pre-injury history of migraines were not more likely to have a prolonged recovery (i.e., return to play > 60 days; n = 2/10, 20%) compared to those who did not have a pre-injury history of migraines ( n = 18/77, 23.4%; p = 0.83) ( 18 ).…”

“…It is essential to appreciate that only one study was designed specifically to examine migraine as a risk factor ( 45 ). All other studies included migraine as a secondary or exploratory variable; some studies discussed their rationale for examining pre-injury migraines ( 10 , 20 , 34 – 37 , 41 – 43 , 46 ), while others did not ( 13 , 14 , 16 – 19 , 21 , 30 , 32 , 33 , 38 – 40 , 44 ). Most studies ( n = 19/25, 76%) did not find a statistically significant association between having pre-injury migraines and a prolonged recovery or worse clinical outcome following concussion, two studies had both significant and null findings, and four studies showed only significant findings.…”