John J. Leddy
Teens who incorporated light aerobic activity into their concussion treatment plans recovered more quickly than those who did not exercise, according to results of a randomized clinical trial published in JAMA Pediatrics.
John J. Leddy, MD , FASCM, FACP, a primary care sports medicine physician at the University at Buffalo Concussion Clinic, told Infectious Diseases in Children that traditional treatment for concussion has been focused on rest until symptoms resolve.
“These findings should give pediatricians the confidence that it is OK to advise light levels of aerobic activity that do not significantly increase symptoms, even within a week of injury when the patient is still symptomatic,” he said. “After sports-related concussion, adolescents can walk, jog or ride a stationary bike at a heart rate that does not increase their symptoms beyond two points when compared with their pre-exercise resting values. This should be started only after at least 2 days of rest or when symptoms at rest are not getting worse and have started to stabilize.”
Leddy stressed that adolescents should be allowed to return to their sport only when they have recovered.
For the study, athletes aged 13 to 18 years were enrolled at several university concussion centers no more than 10 days after their concussion. They were randomly assigned to either aerobic exercise (n = 52) or a stretching regimen (placebo; n = 51).
Source: Douglas Levere/University at Buffalo
Teens who performed aerobic exercise recovered in a median of 13 days (interquartile range [IQR] = 10-18.5 days), and time to recovery for teens in the placebo group was a median of 17 days (IQR = 13-23 days; P = .009). Although patients who performed aerobic exercise were less likely to have delayed recovery (4% vs. 14%), the incidence was statistically nonsignificant.
“Pediatricians should stop telling patients to completely rest from all physical and cognitive activities until symptoms resolve,” Leddy said. “That approach clearly does not work. If pediatricians do not feel comfortable prescribing sub-symptom threshold aerobic exercise, they could refer the patient to another center or ask the patient to try to exercise at a low level that does not exacerbate symptoms for 15 minutes or until symptoms start to increase.” – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.