The Effect of Aerobic Exercise on Recovery in Adolescents who Report Emotional and Cognitive Symptoms after Sport-Related Concussion

Research Objectives: Aerobic exercise speeds recovery from sport-related concussion (SRC) and reduces the incidence of prolonged symptoms; however, evidence for emotional and cognitive symptom recovery among this population is limited. This study determined whether aerobic exercise following SRC improved recovery in adolescents who reported emotional and cognitive symptoms.

Design: Meta-analysis of two published randomized control trials.

Setting: Four sports medicine clinics specializing in concussion management.

Participants: Male and female adolescents (13-18 years, n=212, 59% male) who were diagnosed with SRC within ten days of injury and reported emotional or cognitive symptoms on the Post-Concussion Symptom Scale (PCSS) or Post-Concussion Symptom Inventory (PCSI).

Interventions: Participants were assigned to individualized aerobic exercise (n=109) or to a placebo-like stretching program (n=103).

Main Outcome Measures: Recovery from SRC, defined as a participant having no concussion-like symptoms, a normal physical examination, and a return to normal exercise tolerance.

Results: A fixed-effects meta-analysis determined the probability of recovery between aerobic vs. stretching exercise. Participants with high emotional (≥1/24), low emotional (=0/24) and low cognitive (≤10/30) symptom scores had a higher probability of recovering when prescribed aerobic exercise, respectively (61% p=0.028, 60% p=0.030, 47%, p=0.025). However, results were inconclusive regarding recovery in those with high cognitive (>10/30) symptoms when prescribed aerobic exercise (p=0.175).

Conclusions: Our data suggest that participants with emotional symptoms and with low cognitive symptom burden benefited from aerobic exercise more than from stretching. Clinicians ideally should manage SRC based on individual clinical profiles and should recommend aerobic exercise for patients with significant emotional symptoms. Patients with high cognitive symptoms also benefit from aerobic exercise but appear to need specialized intervention.

Author(s) Disclosures: Authors have no disclosures.