Resuming physical activity 72 hours after concussion reduces symptoms and the risk of delayed recovery

By Malayka Gormally. This article was initially published in our Concussion Update newsletter; please consider subscribing.

A study has found that for youth ages 10 to 18, “Resuming non-contact physical activity 72 hours after a concussion is safe, and may also reduce symptoms and the risk of delayed recovery,” according to a CHEO Research Institute press release. “The findings of this study should give every healthcare professional who manages kids with concussions the confidence to prescribe early and controlled return to physical activity, even if they have symptoms,” according to the study’s corresponding author, Andrée-Anne Ledoux. 

The study, published in the British Journal of Sports Medicine, had several significant differences from previous studies on post-concussion exercise. This study was much larger (456 participants); it took place in real-world conditions (three pediatric emergency departments) instead of a lab; and it studied all youth entering the three ED departments, not just sports-related concussions.

The authors Andrée-Anne Ledoux et al. divided study participants into two groups. The control group received instructions to only return to physical activity once they were asymptomatic, which is advice healthcare providers still commonly give concussion patients. The experimental group was “randomly assigned to a 4-week stepwise return-to-PA [physical activity] protocol at 72 hours post concussion even if symptomatic.” 

The researchers concluded that the early return to physical activity was not harmful because the symptom burden between the two groups was comparable at two weeks. (Many of the participants in the experimental group did not adhere to the return-to-PA protocol.) Of those participants who did follow the protocol, “early PA was associated with reduced symptoms at 2 weeks” and “a reduced rate of delayed recovery.” The study authors note that the first 72 hours should be spent resting in a CBC video. 

The protocol for early return to physical activity, as explained in the press release: “For example, at 72 hours after the injury, the youth should start walking for 15 minutes at a moderate level. If symptoms are tolerable, the youth should increase their physical activity intensity the next day, for example, light jogging. If symptoms are not tolerable while doing physical activity or after physical activity, the next day the child or youth should return to the last well-tolerated physical activity intensity and re-attempt progression after 24 hours.”

We have more in-depth information about early return-to-PA protocol on our Concussion Management for Children and Adolescents page.