In previously published research we demonstrated that concussions cause significant alteration of the patient’s autonomic nervous system (ANS). Prior research has also demonstrated that the best way to regain control of the ANS is through aerobic exercise. However, as part of the ANS response, concussed athletes demonstrate exercise intolerance.  We designed an exercise program that is individualised to the patient and is based on the heart rate (HR) threshold at which the patient becomes symptomatic during exercise. We recently completed a Randomised Clinical Trial (RCT) with adolescents where they were randomly assigned to a sub-threshold aerobic exercise program or a placebo-like stretching exercise program.  The RCT demonstrated that sub-threshold aerobic exercise significantly reduced the days to recovery for these adolescents with sports related concussion. Our study will be published in JAMA Pediatrics in February 2019.  In this presentation we will describe the recovery of those who received aerobic exercise (N=52) along with a third group of adolescents (N=48) who were given instructions to rest until asymptomatic (until recently the standard of care for concussion). Adolescents in the rest only group took significantly longer to recover, much like the placebo like control group in the RCT.  Interestingly, female adolescents appeared to do worse with prescribed rest than their male counterparts. The conclusion from this research is that adolescents who are prescribed sub-threshold exercise will recover faster than those prescribed stretching (placebo group) or relative rest. There was also a decrease in the number of adolescents who had delayed recovery in the aerobic exercise group.  Limitations of the research will also be presented.

Comparison of prescribed rest to aerobic exercise as a treatment recommendation for adolescents with sports related concussion