Teen athletes who sustained sports-related concussions recovered more quickly when they engaged in a supervised aerobic exercise regimen, according to a new study led by researchers at the University at Buffalo (UB).
The aim of the study was to evaluate progressive sub-symptom threshold exercise — physical activity that doesn’t worsen symptoms — as a treatment begun within the first week of a concussion following a few days of rest.
The researchers tracked 103 teens ages 13-18, with approximately the same number of males and females. All were seen within 10 days of sustaining a sport-related concussion at one of the UBMD Orthopaedics and Sports Medicine clinics in Western New York or at the Pan Am Clinic in Winnipeg.
The findings, published in the journal JAMA Pediatrics, show that the patients who followed the aerobic exercise program took on average 13 days to recover while those in the control group, who performed stretching exercises, took 17 days. In addition, fewer participants in the exercise group took longer than four weeks to recover compared to those in the control group.
“This research provides the strongest evidence yet that a prescribed, individualized aerobic exercise program that keeps the heart rate below the point where symptoms worsen is the best way to treat concussion in adolescents,” said John J. Leddy, M.D., first author, clinical professor of orthopaedics in the Jacobs School of Medicine and Biomedical Sciences at UB, and director of the UB Concussion Management Clinic at UBMD Orthopaedics and Sports Medicine.
To determine how much exercise each patient could engage in without exacerbating symptoms, the teens underwent the Buffalo Concussion Treadmill Test to see at what level their symptoms would worsen. As the patient walked on a treadmill, the incline was gradually increased and the heart rate recorded at the point where concussion symptoms intensified.
“We prescribed exercise at 80 percent of that threshold,” Leddy said, “so each patient’s exercise ‘dose’ was individually tailored.”
Around half (52) of the participants were randomly assigned to the aerobic exercise group and the other half (51) to a stretching group. Patients in both groups were sent home with a heart rate monitor so they could make sure they stayed below the threshold while exercising.
Both groups engaged in their assigned exercise for about 20 minutes per day and were required to report compliance and daily symptoms online. Teens in the aerobic group either walked on a treadmill, rode a stationary bike, or walked either inside or out.
Aside from the prescribed exercise, patients were told to refrain from contact sports, gym class or team practice. They were given advice about getting schoolwork done and told to avoid excessive use of electronic devices, since this can also worsen symptoms.
One surprising finding was that only two participants out of 52 (4 percent) in the aerobic exercise group took longer than four weeks to recover compared to seven out of 51 (14 percent) in the stretching group. While this does not reach statistical significance, research has shown by contrast that between 15 and 25 percent of adolescents who do not receive any treatment will be symptomatic past four weeks.
“Reducing the number of concussed adolescents who have delayed recovery has major implications,” said Barry S. Willer, Ph.D., senior author, director of research in the UB Concussion Management Clinic and professor of psychiatry in the Jacobs School.
He noted that delayed recovery creates more difficulty with schoolwork, can lead to depression and puts additional demands on the health care system and its costs.
The researchers emphasize that there is no proven treatment for concussion, especially among adolescents, who often take the longest to recover. The team plans to investigate if aerobic therapy is also effective in adults with concussion.
“Until now, nothing else has been proven in any way effective for treating concussion,” said Willer. “This is the best evidence so far for a treatment that works.”
The new findings stand in contrast to the current approach to concussion, which often consists of nearly total rest, eliminating most physical and mental activities, even schoolwork.
“Telling a teenager to go home and basically do nothing is depressing,” said Willer. “It can actually increase their physical and psychological symptoms, and we see that particularly among girls. But with our approach, you’re saying, sure, you can return to school and you should start doing these exercises. Their chins are up, Mom and Dad are happy and so is the student.”
Source: University at Buffalo