Exercise for concussion monitoring and rehabilitation; two recent studies
By Malayka Gormally. This article was initially published in our Concussion Update newsletter; please consider subscribing.
Research authors Benjamin M. Krainin MD et al. performed a retrospective study on a cohort of concussion patients to determine the impact of “initiating physical activity as soon as 24 to 48 hours after concussion to reduce persistent postconcussive symptoms.”
They found that adolescent concussion patients who initiated physical activity before their first clinic visit (clinic visits were an average of 9.8 days after concussion) were better off. These patients had a “lower proportion [of] persistent symptoms (44% vs. 22%) than the group that did not engage in physical activity before their first visit. The prior activity group also had a shorter time to symptom resolution (15.6 days vs. 27 days).
Also, the group that had no physical activity before their first visit had a greater proportion reporting a headache (85% vs. 60%) and higher reported symptom frequency at their initial clinic visit. The study, published in Journal of Neurosurgery, mentions that “low rates of early physical activity prior to the initial clinic visit were also observed, indicating that this approach may not be well known by acute care or primary care providers, or is not widely adopted by patients and families.”
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A study in the Journal of Athletic Training found that when evaluating adolescent patients' concussion recovery progress and making return-to-play decisions, "in-clinic supervised exercise challenges [should] include both aerobic and dynamic aspects." The stationary bike is ideal for the aerobic exercise challenge, as it limits movements of the head and body; stationary bike, treadmill, or elliptical machine are an option if the "patient is already tolerating stationary bike exercise." In the study, the dynamic exercise challenge began with "stationary medicine ball exercises that incorporated dynamic head movements with rotational maneuvers." If there was no symptom aggravation, the dynamic exercise challenge progressed to agility and sports-specific drills.
The authors Michael Popovich, MD, MPH, et al. found that aerobic supervised exercise challenges alone may “may not detect symptom provocation in a significant proportion of concussion patients who otherwise would develop symptoms” during a dynamic supervised exercise challenge. The researchers recommend including both aerobic and dynamic supervised exercise challenges when managing concussion recovery and making return-to-sport recommendations.
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For additional information about exercise as a concussion rehabilitation modality, see our page Graduated Exercise Therapy, and our blog posts (link 1, link 2).
