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Study: Leddy, J. J., Haider, M. N., Ellis, M. J., Mannix, R., Darling, S. R., Freitas, M. S., Suffoletto, H. N., Leiter, J., Cordingley, D. M., Willer, B. (2019). Early subthreshold aerobic exercise for sports related concussion: A randomized clinical trial. Journal of the American Medical Association Pediatrics. 173(4):319-325. doi:10.1001/jamapediatrics.2018.4397
Aim: A randomized clinical trial to assess the efficacy of subsymptom threshold aerobic exercise vs. a placebo-like stretching program for adolescents in the acute phase recovery from sports-related concussion (SRC).
Participants: Adolescents (13-18 years of age), presenting within 10 days of SRC injury. Participants were either assigned to a placebo-like stretching program, or subsymptom threshold aerobic exercise group.
- No intervention was prescribed for 48 hours from onset of injury
- Subsymptom threshold aerobic activity was determined through the Buffalo Concussion Treadmill Test (BCTT), by sports medicine physicians
- Daily 20 minutes of exercise was prescribed at target heart rate, or if concussion symptoms increased, whichever came first
- Rest included avoiding excessive computer or mobile phone use, gym class, team sports or practice, in addition to avoiding stretching before and after prescribed exercise.
Results: Aerobic exercise participants recovered in a median of 13 days, whereas stretching participants recovered in 17 days, in addition to a nonsignificant difference in delayed recovery in favour of the exercise group.
Conclusion: Individualized subsymptom threshold aerobic exercise treatment prescribed to adolescents
with concussion symptoms during the first week after SRC speeds recovery and may reduce
the incidence of delayed recovery.
- Study results should not be generalized to young children or adults with a history of cardiac conditions, or concussions sustained through other mechanisms (e.g. motor vehicle accidents)
- Delivering exercise intervention by health care providers without a nuanced understanding of exercise-based assessment and treatment for concussion may diminish intervention efficacy
- This RCT study adds to the body of evidence demonstrating that there is benefit to engagement of physical activity within one week for pediatric patients
- Standard of care for SRC was prescribed rest until symptom resolution, where exercise training is typically avoided
- Preventing delayed recovery is significant due to the negative impact of persistent symptoms on academic and social functioning in adolescence.
Post by Kay Chan, fieldwork student with CAOT-BC