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Early physical activity following concussion may reduce persistent symptoms in children, teens
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Among children and adolescents who experienced an acute concussion, physical activity within 7 days of the injury was associated with reduced risk for persistent postconcussive symptoms compared with no physical activity, according to data published in JAMA.
“Although strenuous exercise in patients recovering from concussion may be deleterious and increase re-injury risk, recent literature suggests that protracted rest may hamper concussion recovery, leading to secondary symptoms of fatigue, depression, anxiety and physiological deconditioning,” Roger L. Zemek, MD, of the department of pediatrics at Children’s Hospital of Eastern Ontario Research Institute, and colleagues wrote. “Increasing evidence suggests the introduction of controlled, light aerobic physical activity following pediatric concussion may be safe while promoting recovery by enhancing physical, psychological and academic outcomes.”
To examine the relationship between participation in physical activity within 1 week postconcussion and the prevalence of persistent postconcussive symptoms (PPCS) in children and teens, Zemek and colleagues conducted a prospective cohort study including 2,413 children aged between 5 and 18 years who presented with acute concussion at nine Pediatric Emergency Research Canada network EDs. The researchers assessed participation in physical activity and severity of PPCS using ED standardized questionnaires and at days 7 and 28 following concussion. Additionally, the researchers evaluated PPCS symptoms at 28 days after study enrollment.
PPCS occurred at 28 days in 733 (30.4%) of the participants. As many as 1,677 (70%) participated in light aerobic exercise. Of the participants who engaged in physical activity within 3 days postconcussion, 31% were symptom-free and 48% had three persistent or worsening symptoms at day 7. Comparatively, 79.5% of children who did not participate in physical activity at day 7 experienced three or more persistent or worsening symptoms at day 7.
Overall, early physical activity correlated with reduced risk for PPCS compared with children who had not exercised at day 7 (24.6% vs. 43.5%; absolute risk difference = 18.9%; 95% CI, 14.7%-23%).
However, the researchers warn against full-contact physical activity during the recovery period.
“Early physical activity could mitigate the undesired effects of physical and mental deconditioning associated with prolonged rest,” Zemek and colleagues wrote. “Regardless of potential benefit, caution in the immediate postinjury period is prudent; participation in activities that might introduce risk for collision … or falls … should remain prohibited until clearance by a health professional to reduce the risk for a potentially more serious second concussion during a period of increased vulnerability.” – by Kate Sherrer
Disclosure: Zemek reports receiving support from the University of Ottawa Brain and Mind Research Institute as a clinical research chair in pediatric concussion; Meehan reports receiving royalties from ABC-Clio and from Wolters Kluwer for sales of authored publications, contracts with ABC-Clio and Springer International for a future book, and research funding, in part, by a grant from the National Football League Players Association and by philanthropic support from the National Hockey League Alumni Association through the Corey C. Griffin Pro-Am Tournament; and Freedman reports receiving support from the Alberta Children’s Hospital Foundation Professorship in Child Health and Wellness.
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