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Postconcussive Symptoms & Early Physical Activity

JAMA; 2016 Dec 20; Grool, Aglipay, et al

Publish date:

Physical activity within 7 days of acute concussion among children and adolescents was associated with reduced risk of persistent postconcussive symptoms (PPCS) at 28 days compared with no physical activity, a recent study found. This prospective, multicenter cohort study from August 2013 to June 2015 included 3,063 children and adolescents aged 5 to 18 years with acute concussion. Physical activity participation and postconcussive symptom severity were rated at days 7 and 28 postinjury. Researchers found:

  • PPCS at 28 days occurred in 733 (30.4%) of the 2,413 participants who completed the primary outcomes and exposure.
  • 1,677 (69.5%) participated in early physical activity, including light aerobic exercise (n=795), sport-specific exercise (n=214), noncontact drills (n=143), full-contact practice (n=106), or full competition (n=419), whereas 736 (30.5%) had no physical activity.
  • Early physical activity participants had lower risk of PPCS than those with no physical activity (24.6% vs 43.5%).

Citation:

Grool AM, Aglipay M, Momoli F, et al. Association between early participation in physical activity following acute concussion and persistent postconcussive symptoms in children and adolescents. JAMA. 2016;316(23):2504-2514. doi:10.1001/jama.2016.17396.

Commentary:

There are 1.5-3.8 million sports-related mild traumatic brain injuries each year, most of which are treated in primary care offices. The CDC recommends rest after a mild TBI with a stepwise return to activity.1 No one has actually determined the degree of rest or duration of rest after an injury. Some have advocated “cocoon therapy,” in which patients are restricted to several days in a darkened room with minimal activity or screen time. This concept has been subject to much debate. In fact, an excellent article almost 2 years ago randomized teenagers who presented to the emergency room with a concussion to strict rest vs usual care. The usual care group had 1-2 days of rest, followed by a step-wise return to activity. The study showed that the strict rest group had more daily post-concussive symptoms and slower resolution of symptoms.2 Using an observational cohort design, this current study supports the concept that strict rest is not beneficial and that a symptom driven graded response which incrementally increases physical activity is probably the optimal approach. —Neil Skolnik, MD

  1. Centers for Disease Control and Prevention. Heads Up to health care providers. https://www.cdc.gov/headsup/providers/index.html. Accessed December 26, 2016.
  2. Thomas DG, Apps JN, Hoffmann RG, McCrea M, Hammeke T. Benefits of strict rest after acute concussion: a randomized controlled trial. Pediatrics. 2015;135(2):213-223. doi:10.1542/peds.2014-0966.

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