Exercise to Treat Concussion?

Written by Clay Smith

Spoon Feed
Light aerobic activity that doesn’t evoke concussion symptoms speeds recovery vs rest.

Why does this matter?
The former way we treated concussion was to tell patients to rest and do nothing.  Last year, we learned this isn’t best; early physical activity speeds recovery.  This takes it a step further and prescribes an exercise regimen for patients with concussion.  Common concussion symptoms are headache, nausea, vertigo, or emotional changes.

Exercise for concussion
This was a multicenter RCT of 103 teenage athletes with sports-related concussion who were randomized to either placebo (mild stretching exercises) or aerobic exercise to just below the threshold of concussion symptoms, each for 20 minutes a day.  Both groups started around 5 days after concussion.  Patients in the exercise group recovered 4 days faster than placebo (13 vs 17 days).  There was a non-significant trend to fewer patients with prolonged, delayed recovery (> 30 days) in the exercise group as well, 2 patients; placebo group, 7 patients (p = 0.08). This is yet another paradigm change for concussion.  Doing light aerobic exercise actually hastens recovery.

Source
Early Subthreshold Aerobic Exercise for Sport-Related Concussion: A Randomized Clinical Trial.  JAMA Pediatr. 2019 Feb 4. doi: 10.1001/jamapediatrics.2018.4397. [Epub ahead of print]

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Reviewed by Thomas Davis

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