After concussion, early subthreshold aerobic exercise returns teens to play sooner than stretching

Reference

Leddy JJ, Haider MN, Ellis MJ, et al. Early subthreshold aerobic exercise for sport-related concussion: a randomized clinical trial. JAMA Pediatr 2019;173(4):319-325.

Synopsis

These researchers randomized adolescents between 13 and 18 years of age with a sports-related concussion in the preceding 10 days to participate in a daily aerobic exercise program (n = 52) or a daily placebo-like stretching program (n = 51). The researchers excluded teens with focal deficits, the inability to exercise for reasons other than concussion, a Glasgow Coma Scale score of 12 or less, more than 3 prior concussions, a concurrent second head injury before enrollment, a baseline score of 5 points or less on a postconcussion symptom scale, an ability to tolerate maximal exercise without symptoms at the baseline visit, and those taking psychotropic medications. Once the diagnosis of concussion was confirmed, each participant underwent an exercise tolerance test to the point of developing concussion symptoms, at which point they were asked to rate the symptom severity. The teens randomized to do aerobic exercise were instructed not to stretch but to exercise for up to 20 minutes on an exercise bike or treadmill with a target heart rate of 80% of the point of symptom exacerbation at baseline. They were instructed to stop exercising if their symptoms increased by 2 or more points from their baseline. The control patients were given a booklet containing a 20-minute gentle, whole-body stretching program that would not elevate the heart rate. The main outcome was time to recovery, defined as lack of symptoms confirmed by a normal physical examination (including vestibular and oculomotor) and the ability to exercise to exhaustion without exacerbation concussion symptoms. Although neither the research assistants nor the participants were masked to exercise allocation, the treating physicians who made the clinical recovery determination were masked. The median time to recovery was 13 days in the teens treated with exercise compared with 17 days for the control patients. Additionally, the exercise group was less likely to have delayed recovery, although this was not statistically significant and likely reflects an inadequate sample size.