NEW YORK (Reuters Health) - Low-level aerobic exercise soon after a sports-related concussion is safe and can reduce recovery time and risk for post-concussion symptoms in adolescent athletes, a randomized controlled trial indicates.
"These results suggest that physicians should not only permit, but consider prescribing, early subsymptom threshold physical activity to adolescents as treatment for sport-related concussion and to reduce the risk of persistent post-concussive symptoms," researchers write in The Lancet Child and Adolescent Health.
Until recently, guidelines had recommended complete physical and cognitive rest after concussion until symptoms resolved. However, there was a lack of evidence to indicate that complete rest enhanced recovery.
There is now growing evidence that low-level physical and mental activity may be beneficial, "which is leading to a paradigm shift to a more active approach to management of sport-related concussion," write Dr. John Leddy with the State University of New York at Buffalo and colleagues.
The current study was conducted at three community and hospital-affiliated sports-medicine concussion centers. Study participants were adolescents between the ages of 13 and 18 who were within 10 days of sustaining a concussion while playing a sport.
A total of 118 adolescents were included, with 61 randomly assigned to individualized low-level aerobic exercise that didn't exacerbate symptoms and 57 to stretching (placebo) exercise for at least 20 minutes daily for up to four weeks after injury.
Adolescents in the aerobic exercise group were more likely to recover within four weeks after injury than peers in the stretching exercise, with a 48% reduced risk of persistent post-concussive symptoms (P=0.039), the researchers found.
Those in the aerobic-exercise group took a median of 14 days to recover from concussion versus 19 days for those in the stretching-exercise group. Adherence was good, with no adverse events reported.
"The study clearly demonstrates that strict physical rest until symptoms spontaneously resolve is no longer an acceptable way to treat sport-related concussion in adolescents," Dr. Leddy said in a news release.
The current study reproduces and expands on the team's 2019 study published in JAMA Pediatrics (https://bit.ly/3lh8pjt).
The authors of a linked comment say this new study could have "substantial public health effects by reducing youth sport-related concussion burden."
"Beyond demonstrating that early subthreshold aerobic exercise can reduce recovery time and risk of persistent post-concussion symptoms, the authors also showed that early subthreshold aerobic exercise had high adherence and was safe to prescribe to adolescents with sport-related concussion. These findings are important as adolescents with delayed recovery can experience consequences of concussion such as academic challenges, depression, and reduced quality of life," write Dr. Carolyn Emery and Dr. Jonathan Smirl with the Sports Injury Prevention Research Center, in Alberta, Canada.
Looking ahead, they say "sport-related concussion research evaluating the efficacy of early subthreshold aerobic exercise should also consider younger age groups (<13 years) and potential differential treatment effects across sex and gender, given that concussed adolescent females often have longer recoveries than males."
The research was funded by the American Medical Society for Sports Medicine.
SOURCE: https://bit.ly/3aiMORe and https://bit.ly/3BeoJae The Lancet Child and Adolescent Health, online September 30, 2021.
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