Abstract
Concussion management has evolved to de-emphasize rest in favor of early introduction of post-injury physical activity. However, the optimal quantity, frequency and intensity of physical activity are unclear. Our objective was to examine the association between objective physical activity metrics and clinical recovery after concussion. We prospectively enrolled a cohort of 32 youth athletes with concussion, evaluated within 14 days of injury and after return-to-play (RTP) clearance. For two weeks after enrollment, we quantified steps/day and exercise frequency, duration, and intensity via wrist-worn actigraphy. We grouped participants by RTP clearance timing (<28 days vs. ≥28 days). Seventeen (53%) participants required ≥28 days post-concussion for RTP clearance. Groups were similar in age (14.9 ± 1.9 vs. 15.4 ± 1.5 years; p = 0.38), proportion of females (47% vs. 40%; p = 0.69), and concussion history (59% vs. 47%; p = 0.49). During the study period, the RTP ≥ 28 days group took fewer steps/day (8158 ± 651 vs. 11,147 ± 4013; p = 0.02), exercised fewer days/week (2.9 ± 2.4 vs. 5.0 ± 1.9 days/week; p = 0.01), and exercised fewer total minutes/week (117 ± 122 vs. 261 ± 219 min/week; p = 0.03). Furthermore, we observed ≥10,251 average steps/day, ≥4 exercise sessions/week, and exercising ≥134 total minutes/week were optimal cutpoints to distinguish between groups. These findings support the benefit of physical activity during concussion recovery.
Highlights
Concussions are a subset of mild-traumatic brain injury that result in a disruption of neuronal functions due to trauma [1], and result in a wide array of symptoms
The two groups were of similar ages, proportion of females, and past concussion history (Table 1). Those who required ≥28 days for RTP clearance were enrolled at a similar time post-injury but reported significantly greater symptom severity at the initial assessment than the group who received RTP clearance within 28 days of injury (Table 1)
Exercise metrics are associated with recovery time following concussion among pediatric due to the nature of our study design, we cannot determine casualty based on our findings
Summary
Concussions are a subset of mild-traumatic brain injury (mTBI) that result in a disruption of neuronal functions due to trauma [1], and result in a wide array of symptoms (e.g., headache, fatigue, or irritability [2]). 34% increased risk of subsequent musculoskeletal injury than those who did not sustain a concussion, even after they have received return to play clearance (i.e., permission to return to full contact game play or participation) from a medical provider [7]. This increased musculoskeletal injury risk may be linked in part to physical deconditioning as a result of removal from sport [8], and as such, physical activity during concussion recovery may be one approach to help mitigate subsequent injury risk
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