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Exercise After Concussion in Adults?

March 1, 2021

Written by Clay Smith

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Light exercise after mild traumatic brain injury (TBI) in adults did not reduce the percentage of patients with post-concussion syndrome at 30 days.

Why does this matter?
We used to teach that complete rest after concussion was best. Then we learned that children improve more quickly with light aerobic activity. What about adults with concussion?

Now that you’ve bonked your head, go walk a few miles.
In three Canadian EDs, 367 patients with mild TBI were randomized to discharge instructions which prescribed 30 minutes of light exercise (walking) each day vs usual instructions to gradually increase physical activity. There was no difference in a validated post-concussion symptom questionnaire score at 30 days. There was also no difference in return visits to the ED or primary care and there was no difference in missed work or school. It doesn’t seem like exercise hurt, but it also didn’t seem to help. In this study, discharge instructions were read to the patient and given in writing. But we know from prior studies that we’re lucky if patients understand half of our discharge instructions. And even if they did hear or read advice to exercise 30 minutes a day, how many would actually do it? These limitations may have biased results toward a null effect.

A randomized trial comparing prescribed light exercise to standard management for emergency department patients with acute mild traumatic brain injury. Acad Emerg Med. 2021 Jan 22. doi: 10.1111/acem.14215. Online ahead of print.

What are your thoughts?