A study explored the efficacy of aerobic exercise compared to a less intense stretching program to help adolescents recover from concussions related to sports injuries.
Concussions related to sports injuries are a significant public health problem without effective treatment. Up to 30% of children and adolescents have symptoms such as confusion, amnesia, dizziness, ringing in the ears, nausea, and vomiting up to one month after having a concussion.
Since exercise can make symptoms after a concussion worse, being able to return to normal exercise has been used as the primary way to determine when to return to sports after a concussion. As a result, the standard of care for treating concussion has been to rest until symptoms resolve, even though this approach is mostly based on animal research.
Aerobic exercise has beneficial effects on heart rate, digestion, and brain health
Aerobic exercise has beneficial effects on bodily functions such as the heart rate, digestion, and respiratory rate in addition to blood flow regulation along with cardiovascular and brain health. Therefore, it may be reasonable to consider recommending regular exercise performed at an intensity below that which worsens concussion symptoms to help patients with concussions recover more quickly. In fact, recent studies are demonstrating that there is no harm and potential benefit to using aerobic exercise to improve concussion symptoms quicker than rest.
A study published in JAMA Pediatrics assessed the effectiveness of aerobic exercise that does not worsen concussion symptoms versus a placebo-like stretching program prescribed to adolescents recovering from a sport-related concussion.
Comparing aerobic exercise with a “placebo-like” stretching program
This study was conducted at university concussion centers and included both male and female adolescent athletes ages 13-18 years old who presented within 10 days of having a concussion and were randomly assigned to either receive aerobic exercise or a placebo-like stretching program that did not significantly increase heart rate for concussion treatment.
For the adolescents receiving aerobic exercise for concussion treatment, the researchers first determined how well they tolerate treadmill exercise to make sure that their concussion symptoms did not get worse with exercise. Adolescents in each group performed their exercise for about 20 minutes a day and were asked to report daily symptoms along with their compliance with the regimen.
There was a total of 103 adolescents who participated in this study; 52 were included in the aerobic exercise group for concussion treatment and 51 were included in the stretching group for concussion treatment.
The researchers studied how many days it took the patients to recover from their concussion; defining recovery was as not having any concussion symptoms. A doctor who did not know which concussion treatment group the patients were in evaluated the patients to confirm that they were not experiencing any concussion symptoms and able to return to normal exercise tolerance on a treadmill. Each patient was classified to have a normal, i.e. less than 30 days, or delayed (greater than 30 days) recovery.
Aerobic exercise participants recovered faster
There were no differences in age, gender, previous concussions, time from injury, initial symptom severity scores, or initial exercise treadmill tests and physical examination results. Aerobic exercise patients recovered in an average of 13 days, whereas stretching patients recovered in an average of 17 days. However, the number of adolescents who participated in this study was small and including a stretching program as a comparison group is not a real placebo control.
As such, it is important to conduct similar research in a higher number of adolescents, perhaps even include children since they also commonly have sports-related concussions. In addition, it would be helpful to research how rest affects recovery time from concussions since this is the standard of care instead of stretching.
First trial to show aerobic exercise does not worsen concussion symptoms
This is the first clinical trial to show aerobic exercise which does not worsen concussion symptoms may potentially be a viable concussion treatment for adolescents with concussion symptoms to return to sports more quickly than resting. Moreover, this study demonstrated that aerobic exercise can also prevent adolescents from having a delayed recovery from their concussion, which is an important factor in determining when adolescents can return to school which can impact social and academic outcomes.
In summary, this study provides confidence that moderate levels of physical activity, such as aerobic exercise that does not worsen concussion symptoms may safely and significantly affect recovery time for concussion treatment.
Written by Tatsiana Verstak, M.S., B.S.
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Reference: Leddy J, et al. Early Subthreshold Aerobic Exercise for Sport-Related Concussion: A Randomized Clinical Trial. JAMA Pediatrics. Published online February 4, 2019. doi:10.1001/jamapediatrics.2018.4397