Exercise is essential for healing after a concussion

Light exercise within 48 hours reduces symptoms of concussion.

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According to a new study, those who undertook modest exercise after 48 hours of a concussion saw their symptoms disappear roughly half the time as those who waited more than a week. 

The observational study followed over 1,200 college athletes from 30 colleges nationwide before and after injury until medical clearance. However, the study was not intended to prove a causal relationship between exercise and concussion recovery.

The findings are consistent with prior smaller, randomized controlled trials that found similar associations. Athletes who began modest exercise within 48 hours were significantly more likely to see symptoms subside than those who did not, with symptom recovery taking roughly 2.5 days less.

Athletes who began exercising eight days or later after injury were considerably less likely to experience symptom recovery than those who did not exercise, and it took them around five days longer to heal.

Athletes in the early exercise group showed a lower prevalence of persistent symptoms (3%-4%) than those in the no exercise group.

The late-exercise group had an 11% higher prevalence of persisting symptoms than the no-exercise group.

People likely to have chronic concussion symptoms that last more than four weeks may benefit the most from early activity. In 2017, international consensus and return-to-play guidelines were revised to recommend light physical and mental activities after the 24- to 48-hour recovery window, as long as they did not worsen symptoms.

The Buffalo Concussion Treadmill Test is the most widely utilized and researched post-concussion exercise technique. This observational study did not specify the type, duration, or intensity of exercise. However, it did find that exercise had a definite favorable influence on recovery times.

The conclusion for athletes, doctors, and coaches is that delaying or failing to report a concussion is strongly related to a longer recovery time and potential negative repercussions.

Healthcare providers must stay current on concussion assessment and management procedures. Exercise can begin before symptoms resolve if done in a safe and controlled manner under the supervision of a skilled clinician.

The Buffalo Concussion Treadmill Test is the most widely utilized and researched post-concussion exercise technique. Participants begin walking at 3.3 mph and gradually increase the incline until symptoms worsen, which is their exercise threshold. Patients are then instructed to exercise five to six times per week at 80% of their maximum heart rate, initially exacerbating their symptoms.

Lempke from the University of Michigan said, “Based on the historical background, the adage ‘the dosage makes the poison’ applies to exercise after the concussion.” 

“Too much, too soon” or “too little, too late” can be detrimental. This observational study did not identify the type, duration, or intensity of exercise. However, it did identify a clear positive effect of exercise on recovery times.

Lempke said, “For athletes, delaying or choosing not to report your concussion is directly tied to longer recovery and potential negative consequences. So reporting is the first step,” “For health care providers, staying current on concussion assessment and management practices is important. Clinicians still use ‘cocoon therapy’ despite known deleterious effects. Our present findings and many other studies indicate exercise can be started before symptoms resolve if done in a safe and controlled manner as guided by a trained clinician.”

Journal Reference:

  1. Lempke, L.B., Teel, E.F., Lynall, R.C. et al. Early Exercise is Associated with Faster Concussion Recovery Among Collegiate Athletes: Findings from the NCAA-DoD CARE Consortium. Sports Medicine. DOI: 10.1007/s40279-023-01861-w
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