1. In this randomized control trial of pediatric sport-related concussion (SRC), a progressive sub-symptom threshold aerobic exercise program was linked to a shorter time to recovery compared to a placebo stretching program.
2. The sub-symptom threshold exercise program also demonstrated a non-significant trend towards reduced risk of delayed recovery.
Evidence Rating Level: 2 (Good)
Study Rundown: Sport-related concussion is a common form of mild traumatic brain injury which affects many adolescents and can have delayed recovery and possible long-term neurologic sequelae. As exercise typically worsens symptoms following SRC, current guidelines recommend rest and avoidance of aerobic activity until symptom resolution. Recent observational data have suggested that moderate exercise below the threshold for symptom development is associated with shorter recovery time. The current study sought to evaluate the effect of a personalized sub-symptom threshold exercise program in a randomized trial with a stretching program control and blinded evaluations of recovery from SRC. The study found that adolescents in the exercise group had a significantly lower median time to recovery, and a non-significant trend towards lower incidence of delayed recovery.
The main strengths of the study included its randomized control design and blinded assessment of the primary outcomes. The limitations of the study included lack of blinding of participants as a possible source of bias and the inability to generalize these results to adults, younger children, or traumatic brain injuries from other mechanisms.
In-Depth [randomized controlled trial]: This study was a randomized control trial of adolescents aged 13 to 18 years who presented within 10 days of SRC and diagnosed by a sports-medicine physician with concussion. Participants were excluded if they had focal neurologic deficit, inability to exercise due to injury or medical condition, moderate to severe traumatic brain injury, 3 or more prior concussions, history of depression or ADHD, a symptom severity score less than 5 post-concussion symptom scale, or limited English proficiency. The participants were randomized 1:1 to either progressive sub-symptom threshold aerobic exercise or a progressive placebo-like stretching program. The main outcomes were days from injury to recovery, as defined by resolution of symptoms as evaluated by a physician blinded to intervention, and incidence of delayed (>30 days) recovery.
Of the 103 participants, 52 were included in the aerobic exercise programs. The sub-symptom threshold group had significantly lower median time to recovery compared to the stretching control group (13, interquartile range [IQR] 10-18.5 days vs. 17 (IQR, 13-23) days [P = .009 by Mann-Whitney test]). The aerobic exercise group also demonstrated a trend towards lower incidence of delayed recovery (2 participants [4%] in theaerobic group vs 7 [14%] in the placebo group; P = .08).
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