Abstract
Objective
To compare a sample of adolescents with sport-related concussion (SRC) who were prescribed
rest with 2 arms of a randomized controlled trial comparing aerobic exercise with
placebo-like stretching. We also compared sex differences across the 3 approaches
to treatment.
Design
Quasi-experimental trial.
Setting
University concussion management clinics.
Participants
Adolescent athletes (aged 13-18 years) presenting within 10 days of SRC (mean, 5 days
after injury) received a recommendation for rest (rest group [RG], n=48, 15.4±1y,
25% female). Their outcomes were compared with matched samples of adolescents assigned
to aerobic exercise (exercise group [EG], n=52, 15.3±2y, 46% female) or placebo-like
stretching (placebo group [PG], n=51, 15.4±2y, 47% female) (N=151).
Main Outcome Measures
The primary outcome was median days from injury to recovery. The secondary outcome
was proportion classified as normal recovery (<30d) or delayed recovery (≥30d).
Results
The RG recovered in 16 days (interquartile range, 9.25-23.25d), which was significantly
delayed (P=.020) compared with EG (13d; interquartile range, 10-18.5d). The PG recovered in
17 days (interquartile range, 13-23d). Four percent of the EG, 14% of the PG, and
13% of the RG had delayed recovery (P=.190). There was no difference in recovery time or delayed recovery between male
participants and female participants across groups. Female participants prescribed
rest experienced an increase in symptoms vs the other groups (P=.013).
Conclusion
Relative rest and a placebo-like stretching program were very similar in days to recovery
and symptom improvement pattern after SRC. Both conditions were less effective than
subsymptom threshold aerobic exercise. Female adolescents appear to be susceptible
to symptom increase when prescribed rest.
Keywords
List of abbreviations:
ANOVA (analysis of variance), BCTT (Buffalo Concussion Treadmill Test), BDNF (brain-derived neurotrophic factor), EG (exercise group (adolescents prescribed subthreshold aerobic exercise)), PCSS (Post Concussion Symptom Scale), PG (placebo group (adolescents prescribed stretching exercises)), RCT (randomized controlled trial), RG (rest group (adolescents recommended to rest after diagnosis of concussion)), SRC (sport-related concussion)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Acceleration-deceleration sport-related concussion: the gravity of it all.J Athl Train. 2001; 36: 253-256
- The pathophysiology of concussion.PM R. 2011; 3: 359-368
- The epidemiology and impact of traumatic brain injury: a brief overview.J Head Trauma Rehabil. 2006; 21: 375-378
- Concussion in sport group: recommendations for the improvement of safety and helth of athletes who may suffer concussive injuries. Summary and agreement statement of the First International Conference on Concussion in Sport, Vienna 2001.Br J Sports Med. 2002; 36: 6-10
- Voluntary exercise following traumatic brain injury: brain-derived neurotrophic factor upregulation and recovery of function.Neuroscience. 2004; 125: 129-139
- Examining prescribed rest as treatment for adolescents who are slow to recover from concussion.Brain Inj. 2015; 29: 58-63
- Is rest after concussion “the best medicine?”: recommendations for activity resumption following concussion in athletes, civilians, and military service members.J Head Trauma Rehabil. 2013; 28: 250-259
- The effects of rest and treatment following sport-related concussion: a systematic review of the literature.Br J Sports Med. 2013; 47: 304-307
- Rest and treatment/rehabilitation following sport-related concussion: a systematic review.Br J Sports Med. 2017; 51: 930-934
- The effects of early physical activity compared to early physical rest on concussion symptoms.J Sport Rehabil. 2019; 28: 99-105
- Efficacy of immediate and delayed cognitive and physical rest for treatment of sports-related concussion.J Pediatr. 2012; 161: 922-926
- Benefits of strict rest after acute concussion: a randomized controlled trial.Pediatrics. 2015; 135: 213-223
- Early subthreshold aerobic exercise for sport-related concussion: a randomized clinical trial.JAMA Pediatr. 2019; 173: 319-325
- Predictors of clinical recovery from concussion: a systematic review.Br J Sports Med. 2017; 51: 941-948
- Safety and prognostic utility of provocative exercise testing in acutely concussed adolescents: a randomized trial.Clin J Sport Med. 2018; 28: 13-20
- Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016.Br J Sports Med. 2017; 51: 838-847
- SCAT2.Br J Sports Med. 2009; 43: i85-i88
- Standardized Assessment of Concussion (SAC): manual for administration, scoring and interpretation.CNS Inc, Waukesha, WI2000: 2
- Practical management: brief physical examination for sport-related concussion in the outpatient setting.Clin J Sport Med. 2018 Nov 7; ([Epub ahead of print])
- Derivation of a focused, brief concussion physical examination for adolescents with sport-related concussion.Clin J Sport Med. 2018 Oct 29; ([Epub ahead of print])
- Rehabilitation of concussion and post-concussion syndrome.Sports Health. 2012; 4: 147-154
- Evidence-based approach to revising the SCAT2: introducing the SCAT3.Br J Sports Med. 2013; 47: 289-293
- Reliability and validity of the Sport Concussion Assessment Tool–3 (SCAT3) in high school and collegiate athletes.Am J Sports Med. 2016; 44: 2276-2285
- The predictive capacity of the Buffalo Concussion Treadmill Test after sport-related concussion in adolescents.Front Neurol. 2019; 10: 395
- Summary and agreement statement of the Second International Conference on Concussion in Sport, Prague 2004.Phys Sportsmed. 2005; 33: 29-44
- A systematic review of criteria used to define recovery from sport-related concussion in youth athletes.Br J Sports Med. 2018; 52: 1179-1190
- Measurement of symptoms following sports-related concussion: reliability and normative data for the post-concussion scale.Appl Neuropsychol. 2006; 13: 166-174
- What is the difference in concussion management in children as compared with adults? A systematic review.Br J Sports Med. 2017; 51: 949-957
- Exercise treatment for postconcussion syndrome: a pilot study of changes in functional magnetic resonance imaging activation, physiology, and symptoms.J Head Trauma Rehabil. 2013; 28: 241-249
- Cognitive rest and school-based recommendations following pediatric concussion: the need for primary care support tools.Clin Pediatr. 2013; 52: 397-402
- Association between early participation in physical activity following acute concussion and persistent postconcussive symptoms in children and adolescents.JAMA. 2016; 316: 2504-2514
- Sample size required to observe at least k rare events.Psychol Rep. 1967; 21: 70-72
- Effects of voluntary physical exercise, citicoline, and combined treatment on object recognition memory, neurogenesis, and neuroprotection after traumatic brain injury in rats.J Neurotrauma. 2015; 32: 739-751
- Exercise increases neural stem cell proliferation surrounding the area of damage following rat traumatic brain injury.J Neural Transm (Vienna). 2011; 118: 193-202
- Exercise inhibits neuronal apoptosis and improves cerebral function following rat traumatic brain injury.J Neural Transm (Vienna). 2011; 118: 1263-1272
- Exercise is medicine for concussion.Curr Sports Med Rep. 2018; 17: 262-270
- A randomized controlled trial of multicomponent exercise in older adults with mild cognitive impairment.PloS One. 2013; 8e61483
- Autonomic dysfunction after mild traumatic brain injury.Brain Sci. 2017; 7: 100
- Cerebrovascular regulation is impaired immediately post concussion and associated with increased estimated ICP.FASEB J. 2015; 29 (800.11)
- Acute stages of concussion: suppression of blood pressure during postural hemodynamic drives.J Cereb Blood Flow Metab. 2016; 36: 292
- The impact of concussion on cardiac autonomic function: a systematic review.Brain Inj. 2016; 30: 132-145
- Cerebral blood flow during treadmill exercise is a marker of physiological postconcussion syndrome in female athletes.J Head Trauma Rehabil. 2016; 31: 215-224
- A physiological approach to prolonged recovery from sport-related concussion.J Athl Train. 2017; 52: 299-308
- Regulatory and autoregulatory physiological dysfunction as a primary characteristic of post concussion syndrome: implications for treatment.NeuroRehabilitation. 2007; 22: 199-205
- Examining recovery trajectories after sport-related concussion with a multimodal clinical assessment approach.Neurosurgery. 2016; 78: 232-241
- Sex differences in concussion symptoms of high school athletes.J Athl Train. 2011; 46: 76-84
- Gender differences in recovery from sports-related concussion in adolescents.Clin Pediatr (Phila). 2016; 55: 771-775
- Gender differences in rumination: a meta-analysis.Pers Individ Diff. 2013; 55: 367-374
- Rumination and symptom reports in children and adolescents: results of a cross-sectional and experimental study.Psychol Health. 2013; 28: 1032-1045
- Self-reported mild traumatic brain injuries in relation to rumination and depressive symptoms: moderating role of sex differences and a brain-derived neurotrophic factor gene polymorphism.Clin J Sport Med. 2016 Nov 21; ([Epub ahead of print])
Article Info
Publication History
Published online: August 01, 2019
Footnotes
Supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health (award no. 1R01NS094444 ) and the National Center for Advancing Translational Sciences of the National Institutes of Health (award no. UL1TR001412 ) to the State University of New York at Buffalo. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health .
Clinical Trial Registrations Nos.: NCT02714192 and NCT02710123.
Disclosures: none.
Identification
Copyright
© 2019 by the American Congress of Rehabilitation Medicine
