Aerobic Exercise Speeds Concussion Recovery

The recommendations for activity following concussion have been changing with the current guidelines being a shorter period (24-48 hours) of rest following injury.  We are now finding that this shorter period of rest and early subthreshold aerobic activity are beneficial in speeding recovery after concussion.

A recent study by Leddy et al looked at adolescent males who came to a concussion clinic less than 10 days from injury.  They were grouped into an exercise and rest group.  The exercise group completed the Buffalo Concussion Treadmill Test (used to determine an appropriate submaximal heart rate) and performed 20 minutes of exercise daily on the bike or treadmill.  This was compared to the group that was advised to completely rest from physical activity.  The exercise group recovered in mean of 8.29 days from initial visit and 13.04 days from day of injury.  The rest group recovered in 23.93 days from initial visit and 28.43 days from day of injury.  These findings indicate recovery time from initial visit was significantly faster for the exercise group.  Also, none of the exercise group participants had delayed recovery (>30 days of symptoms) while four participants in the rest group had delayed recovery. From day 4 forward the exercise group had a significantly lower total symptom score compared with the rest group. 

This study is an excellent start in support of early subthreshold aerobic exercise following concussion injury.  The study also had some interesting discussion about the benefits of aerobic exercise including:

·         Enhances neuroplasticity acutely to promote neuron growth and repair

·         Reduces heart rate at rest and reduces submaximal exercise heart rate by reducing sympathetic activity

·        By improving Autonomic Nervous System balance aerobic exercise may also improve sleep (a big deal in many patients after a concussion injury)

The recommendations continue to move towards a more active approach to concussion management.  A Physical Therapist can assess you and help determine the appropriate prescription for aerobic exercise since too much can exacerbate symptoms and delay recovery. We say this for so many other types of injuries in Physical Therapy and now we can also apply it to concussions…Exercise is Medicine!!!

Leddy JJ, Haider MN, Hinds AL, Darling S, Willer BS. A Preliminary study of the effect of early aerobic exercise treatment for sport-related concussion in males. Clin J Spsort Med. 2018;1-8.