Early physical activity post-injury may result in lower post-concussive symptom burden in children

1. In a secondary analysis of a prior study consisting of children and adolescents with concussions, engaging in higher volumes of cumulative moderate-to-vigorous physical activity (cMVPA) within the first 2 weeks of injury was associated with a lower burden of postconcussion symptoms. 

2. Patients who returned to physical activity within the first week had a 25% risk of persisting symptoms at four weeks compared to 44% in those who did not. 

Evidence Rating Level: 1 (Excellent)

Study Rundown:  Concussions not only have a burden on the individual experiencing them but also on the economy and health of the population. It is estimated that every year 50 to 60 million individuals have a traumatic brain injury (TBI) with the majority of them being concussions. Out of all the concussion cases, approximately 30 to 35% will show persisting symptoms after concussion (PSAC). Currently, there is controversy regarding the optimal amount of physical activity children and adolescents should partake in post-injury. To elucidate this gap in literature, researchers utilized multicenter cohort data from a previous randomized clinical trial from 3 Canadian pediatric emergency departments from 2017 to 2019 which included children aged 10 to 18. Researchers then correlated data of cMVPA and subsequent concussive symptoms as measured by the Health and Behaviour Inventory (HBI). It was found that, participating in 259 minutes of cMVPA during the first week post-concussion and 565 minutes of cMVPA during the second week were associated with a lower symptom burden. Overall, study findings suggest that in children and adolescents experiencing concussions, participation in a higher volume of cMVPA may be protective against postconcussive symptoms. Though further research is required in the area, this may suggest that earlier return to play and sport recommendations following concussion may results in better outcomes.  

Click here to read the study in JAMA Network Open

Relevant Reading:  Exercise is medicine for concussion 

In-Depth [prospective cohort study]:  This secondary analysis included data previously collected from a multi-center randomized controlled trial in the Pediatric Concussion Assessment of Rest and Exertion study (PedCARE). Those eligible for the study were youth between the ages of 10.00 and 17.99 years who had previously suffered from a concussion within 48 hours of their ED visit. Individuals with 1 highest level of certainty signs such as retrograde or anterograde amnesia, or 2 higher level of certainty signs such as nausea, or headache within one hour of the head injury were also included. There were many exclusion criteria such as abnormality in brain imaging, neurosurgical intervention, those who were previously enrolled, or insurmountable language barrier, to name a few. After meeting the criteria, 267 children (119 [44.6%] female, median [IQR] age, 12.9 [11.5-14.4] years) were included in the analysis. Significantly lower HBI scores were seen in participants with greater cumulative cMVPA at 1 week (75th percentile [258.5 minutes] vs 25th percentile [90 minutes]; difference, -5.45 [95% CI, -7.67 to -3.24]) and at 2 weeks postinjury (75th percentile [565.0 minutes] vs 25th percentile [237.0 minutes], difference; -2.85 [95% CI, -4.74 to -0.97]) but not at the 4-week mark (75th percentile [565.0 minutes] vs 25th percentile [237.0 minutes], difference, -1.24 [95% CI, -3.13 to 0.64]) (P=.20). For cMVPA, the symptom burden was not lower after the 75th percentile at 1 week or 2 weeks postinjury (1 week, 259 minutes; 2 weeks, 565 minutes). Overall, concussed children and adolescents who participated in 259 minutes of cMVPA during the first week and 565 minutes in the second week experienced fewer symptoms. 

Image: PD

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