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Should You Prescribe Aerobic Exercise to Treat a Concussion?

Should You Prescribe Aerobic Exercise to Treat a Concussion?
02/07/2019
buffalo.edu

buffalo.edu 

Adolescent athletes who sustained concussions while playing a sport recovered more quickly when they underwent a supervised, aerobic exercise regimen, a study published Feb. 4 in JAMA Pediatrics has found. An editorial in the journal called it “a landmark study.”

The study, by University at Buffalo researchers and colleagues, is the first randomized clinical trial of a treatment in the acute phase after a sport-related concussion. The goal was to evaluate prescribed, progressive sub-symptom threshold exercise as a treatment within the first week of a concussion in adolescents after a few days of rest. Sub-symptom threshold exercise is physical activity that doesn’t exacerbate symptoms.

The researchers followed 103 participants ages 13-18, with nearly the same number of males and females. All were seen within 10 days after 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.

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 patients in the exercise program took longer than four weeks to recover than did patients 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, MD, 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.

The researchers plan to investigate if the treatment is also effective in adults with concussion.

No proven treatment

The researchers noted that there is no proven treatment for concussion, especially among adolescents, who typically take the longest to recover.

“Until now, nothing else has been proven in any way effective for treating a concussion,” 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. “This is the best evidence so far for a treatment that works.”

The findings directly contradict the conventional approach to concussion, which often consists of nearly total rest, eliminating most physical and mental activities, including 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.”

The fact that all states have now passed laws requiring schools to make accommodations for students who have sustained concussions is also helpful, said Willer, so that the student can opt out of some activities during the school day, if necessary.

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