Aerobic exercise as therapy

In this blog post, we’ve assembled short articles from our Concussion Update newsletter. For an in-depth article covering exercise as a concussion treatment, see Graduated Exercise Therapy.

A detailed explanation of aerobic exercise as a therapy

Neurology Consultant interviewed John Leddy M.D., a clinician and pioneering researcher into the utility of exercise in concussion recovery. This interview will be particularly useful to healthcare providers, but can also help concussion advocates, as Dr. Leddy provides precise information on the therapeutic use of aerobic exercise. For example, Dr. Leddy discusses how to prescribe “subsymptom threshold exercise treatment.” He says that at the University at Buffalo, they are now prescribing aerobic exercise, performed with a target heart rate that is “90% of the heart rate achieved at the symptom exacerbation threshold on the Buffalo concussion treadmill test.” They recommend a frequency of 5 to 7 days per week.

In other recommendations, Dr. Leddy says that patients should begin cervical (neck) rehabilitation as soon as a cervical injury is identified. In contrast, vestibular and vision rehabilitation are typically not initiated until a delayed recovery is identified (2 weeks for adults, 4 weeks for adolescents) because usually, these subsystems heal on their own. (Originally published in our 10/3/19 newsletter.)

A new study by Dr. Leddy and Dr. Willer was published in January, Practical Management: Prescribing Subsymptom Threshold Aerobic Exercise for Sport-Related Concussion in the Outpatient Setting.

Supervised exercise helps concussion recovery

An article published on the Medical & Life Sciences News website reviewed a publication by Dr. Michael Popovich et al. that found regular activity and low-intensity exercise in the days following a concussion may aid recovery. In this retrospective study, the patients that entered into a supervised exercise program after sustaining a concussion were able to return to their sport more quickly (~9 days earlier) than those who didn’t. The original study was published in the Clinical Journal of Sport Medicine. (Originally published in our 9/12/19 newsletter.)

‘Dancing Well’ Program helps veterans with community reintegration

Veterans with PTSD and TBI saw improvements in their wellness scores after participating in “Dancing Well,” a 10-week community barn dance program. Robin Gustafson et al. aimed to alleviate the persistent social isolation and anxiety that occurs within the veteran population, and they turned to a community dance program run by dance educator Deborah Denenfeld.

Community dance has the benefits of increased social and family connections, as well as physical exercise, which is known to help reduce stress and increase cognitive plasticity. The comparison from the psychological testing (measuring connectedness, isolation, and optimism) found substantial increases after ten weeks of involvement in the program which leads to hope that a community-building focus for PTSD and TBI recover can aid veterans in their reintegration. The study was published in the Journal of Veterans Studies. (originally published in our 8/15/19 newsletter.)

College and elite athletes recover from a concussion more quickly with monitored, individualized aerobic exercise

The medical understanding of when to start exercising after a concussion is rapidly evolving. Drs. Ellis and Leddy (et al.) have published research indicating that collegiate and elite athletes recover from a concussion more rapidly if they begin a monitored, individualized exercise routine 24 to 48 hours after a concussion.

A recent clinical trial with 103 teenage athletes (starting within ten days of sport-related concussion) concluded that "moderate levels of physical activity, including prescribed sub-symptom threshold aerobic exercise, after the first 48 hours following sport-related concussion can safely and significantly speed recovery," 

Dr. Cameron Marshall DC, FRCCSS (C), in his Ask A Concussion Doc podcast, gives his exercise recommendations on a day-by-day post-concussion timeline, based on current medical understanding. Episode 31, Rest and Physical Activity After Concussion (1/9/2019). SoundCloud, iTunes, YouTube. (Originally published in our 4/4/19 newsletter.)