Laird Harrison

June 05, 2017

DENVER — Patients with a sports-related concussion who immediately resume noncontact exercise recover at the same pace as those instructed to rest, new research suggests.

"This is important, because if you can exercise, why would you not?" said Justin Stumph, a medical student at the Ohio University Heritage College of Osteopathic Medicine in Dublin. "There are so many benefits — physically and cognitively."

He presented the finding here at the American College of Sports Medicine 2017 Annual Meeting.

For years, medical practice guidelines have recommended that patients refrain from exercise after a concussion until symptoms resolve.

A lot of people think that someone with a concussion needs to lie in a dark room, but that's not what we think.

"A lot of people think that someone with a concussion needs to lie in a dark room, but that's not what we think," said Stumph.

Guidelines are shifting toward exercise earlier in the recovery period. A consensus statement issued by the Concussion in Sport Group (CISG) states that "patients can be encouraged to become gradually and progressively more active while staying below their cognitive and physical symptom-exacerbation thresholds. The activity level should not bring on or worsen symptoms" (Br J Sports Med. Published online April 26, 2017).

Stumph and his colleagues at a pediatric concussion clinic at Nationwide Children's Hospital in Columbus, Ohio, wanted to see the effect of exercise on concussion symptoms.

In their retrospective study, the team assigned the 204 patients prescribed noncontact exercise before symptom resolution to the intervention group and the 153 prescribed exercise at or after symptom resolution to the control group.

Noncontact exercise included activities such as walking, bicycling, and swimming. If the exercise exacerbated symptoms, patients were told to stop. "You don't want someone to try to exercise through their symptoms," Stumph explained.

The proportion of men was slightly lower in the intervention group than in control group.

Median symptom score at the time of injury was not significantly different between the intervention and control groups (37 vs 36; = .4719). And the interval between the injury and the visit to the concussion clinic was a median of 6 days in both groups.

Median time from injury to symptom resolution was significantly longer in the intervention group than in the control group (16 vs 12 days; = .0192). But time to recovery after the clinic visit was only slightly, and not significantly, longer in the intervention group than in the control group (7 vs 6 days; P = .1118).

On the basis of these data, Stumph and his colleagues conclude that exercise does not delay recovery.

One limitation of the work is that the researchers did not follow-up to see if the patients complied with their prescriptions.

Still, the study lends support to the CISG consensus statement, said Hugo Paquin, MD, pediatric sports medicine fellow at Boston Children's Hospital.

Paradigm Shift

"There has been a paradigm shift in the last few years," Dr Paquin told Medscape Medical News. "We tend to see improvements when we see a return to physical activity."

In fact, a recent study of 2413 children and adolescents with concussions showed that those who began exercising in the 7 days after injury were less likely to report persistent symptoms (JAMA. 2016;316:2504-2514), he reported.

Dr Paquin presented results from a separate study on prevention.

He and his colleagues examined whether children with stronger necks are less likely to experience concussions, which researchers have long speculated is the case.

They compared neck strength — calculated as the ratio of neck strength (assessed with dynamometry) to body mass — in 243 soccer players 8 to 18 years of age.

Each player completed a questionnaire and underwent a physical examination as part of an evaluation conducted at the Micheli Center for Sports Injury Prevention in Waltham, Massachusetts.

There was no difference in vertical jump height, agility, the amount of time participants could hold a front plank position, or aerobic capacity between the 76 patients (31%) who reported a history of concussion and the 167 (69%) who did not.

However, those in the concussion group had weaker necks.

No randomized clinical trials have been conducted to assess whether neck-strengthening exercises can reduce the risk for concussion, Dr Paquin pointed out. But "it's definitely something to look into and target."

Mr Stumph and Dr Paquin have disclosed no relevant financial relationships.

Follow Medscape on Twitter @Medscape and Laird Harrison @LairdH

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