Clinical Question

Does early aerobic exercise following concussion improve or impair recovery in adolescent patients?

Evidence-Based Answer

Early aerobic exercise for symptoms of concussion more than 72 hours after injury may decrease symptom severity and frequency (Strength of Recommendation [SOR]: A, meta-analysis of three randomized controlled trials [RCTs]) and time to recovery from the day of injury (SOR: B, one prospective nonrandomized study). Early aerobic exercise does not impair recovery from sport-related concussions. (SOR: B, one small RCT and one multicenter, nonrandomized study.)

Evidence Summary

A 2020 systematic review and meta-analysis of seven RCTs (N = 326) assessed the effects of aerobic exercise on symptom intensity in sport-related concussions.¹ Patients 13 to 17 years of age had either an acute sport-related concussion or symptoms that persisted for more than 10 days. The interventions studied varied in exercise intensity and involved 10 to 30 minutes of aerobic exercise. The control groups included stretching programs, rest, and clinical management without aerobic exercise. Compared with those in the control group, patients with acute concussion who participated in aerobic exercise significantly reduced symptom intensity (three trials; n = 206; standardized mean difference = −0.35; 95% CI, −0.71 to −0.15). No significant differences in symptom intensity were observed between the aerobic exercise groups and control groups for patients with persistent symptoms of concussion. Three trials reported only mild adverse effects.