Exercise is medicine: Get moving after a concussion to heal faster

People who did light exercise within 48 hours after a concussion saw their symptoms resolve in about half the time compared to those who waited more than a week to exercise, a new University of Michigan study has found. .

The study adds to the growing body of science suggesting that “cocoon therapy”—bed rest in the dark with minimal mental stimulation after a concussion—is not good for patients.

Instead, when done under the guidance of a qualified physician, exercise is preferable, said Landon Lempke, a researcher with tenures at the UM Concussion Center and the Exercise and Sports Science Initiative, both hosted at the School of Kinesiology. Landon is first author of the study, which appears in the journal Sports medicine.

The results show that light exercise accelerates healing

The observational study monitored more than 1,200 college athletes at 30 institutions nationwide before injury and at the time of injury until medical clearance. The study was not designed to establish a causal relationship between exercise and concussion recovery, but the findings are in line with previous smaller randomized controlled trials identifying similar relationships.

• Athletes who started light exercise within 48 hours were significantly more likely to see symptoms resolve than those who didn’t exercise, with a quicker symptom recovery time of about 2.5 days.
• Athletes who started exercising about eight days or later after injury were significantly less likely to experience symptom recovery than those who didn’t exercise, and took about five days longer to recover.

The biggest beneficiaries of exercising early might be people who may develop lingering concussion symptoms — those that have persisted for the past four weeks, Lempke said.

• Athletes in the initial exercise group had a lower prevalence (3% 4%) of persistent symptoms than in the no exercise group.
• The group who exercised late experienced an 11% higher prevalence of persistent symptoms than the no-exercise group.

Thinking about exercise while recovering from a concussion has evolved

For two decades, it has been suggested that people with concussions should avoid physical and mental activity while they are symptomatic and recovering, Lempke said. The concern was that athletes who returned to play too soon risked another concussion and a more serious injury called second-impact syndrome, a rare but serious complication that can lead to death. Some research has also suggested that aggressive exercise might prolong recovery.

That viewpoint has evolved as the benefits of early exercise have become clear. In 2017, international consensus and return-to-play guidelines were changed to recommend light physical and mental activities after the 24- to 48-hour recovery window, as long as they did not worsen symptoms.

The best kind of exercise after the concussion

Lempke stressed that the results don’t mean athletes return to play sooner. Progressive return-to-play protocols should always be followed. All exercises after a concussion and during recovery should be supervised by an experienced physician.

The Buffalo Concussion Treadmill Test is the most frequently used and studied post-recovery exercise protocol. Participants begin walking at 3.3 mph and increase the incline until symptoms begin to increase, which is their exercise threshold. Patients then exercise five to six times a week at 80 percent of their maximum heart rate which initially increased those symptoms.

“Based on historical context, the adage ‘the dosage makes the poison’ applies to exercise after a concussion,” Lempke said.

“Too much, too soon” or “too little, too late” can both be harmful. This observational study did not identify the type, duration, or intensity of exercise, but it did identify a clear positive effect of exercise on recovery time.

“There is probably an area of ​​Goldilocks that is slightly unique to each individual,” Lempke said.

What is the benefit for athletes? Doctors? coaches?

“For athletes, delaying or choosing not to report concussion is directly tied to a longer recovery and potential negative consequences. So reporting is the first step,” Lempke said.

“For healthcare professionals, it is important to stay current on concussion assessment and management practices. Physicians still use ‘cocoon therapy’ despite known deleterious effects. Our current findings and many other studies indicate that exercise it can be started before symptoms resolve, if done in a safe and controlled manner as guided by a qualified physician.”