Evidence for your Practice: Early subthreshold aerobic exercise for sports related concussion

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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.

Intervention:

• 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.

Limitations:

• 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

Clinical Relevance:

• 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.

Read the article abstract here

Post by Kay Chan, fieldwork student with CAOT-BC

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