Issue 32.3
The new paper , based on a systematic review of more than 30 international studies , confirms the validity of using prescribed sub-threshold aerobic exercise starting as soon as 48 hours after a sport-related concussion to facilitate recovery and prevent PPCS . It also confirms that strict rest is unnecessary and can even be detrimental to recovery .
“ I was pleasantly surprised by the consistency of the evidence ,” says Leddy . “ The studies clearly demonstrate a beneficial effect of early physical activity , such as walking and light activities of daily living , and of early prescribed exercise treatment for safely facilitating recovery from sport-related concussion and for preventing some athletes from having a delayed recovery .”
On average , the studies showed that early prescribed exercise resulted in recovery from concussion five days sooner than without prescribed exercise — a typical school week for adolescents , Leddy adds .
The paper notes that light physical activity is recommended starting within the first 48 hours after a concussion , provided it doesn ’ t exceed the mild-symptom exacerbation threshold . The paper defined “ mild ” as no more than a 2-point increase in concussion symptoms when compared with the pre-activity value on a 0-10 point scale .
But , Leddy points out , prescribed exercise treatment is different .
“ Prescribed exercise is based upon the individual ’ s response to exercise testing and uses progressive dosing of ‘ exercise as medicine ’ to treat concussion ,” Leddy says , adding that this type of exercise keeps the heart rate below the point where symptoms worsen more than mildly .
The data showed that prescribed aerobic exercise that begins within two to 10 days following concussion is beneficial and speeds recovery ; it also reduces the incidence of symptoms persisting beyond one month after injury , which is important because it is those students who suffer reduced quality of life and trouble returning to school and to sport .
“‘ Cocooning ’ is officially out ,” Leddy explains , “ and early , proactive advice and treatment are in . It is no longer acceptable for clinicians to tell athletes after concussion to rest from all cognitive and physical activity until all their symptoms resolve . Patients should stop cognitive or physical activity that more than mildly increases symptoms but can resume after a brief period of relative rest once the symptoms return to the former level . This is particularly important for female adolescent athletes , who appear to have been particularly harmed by ‘ cocooning .’”
Another major new message from the review and included in the new guidelines is that cognitive or physical activity that produces a mild increase in symptoms is safe . “ Mild symptom exacerbation does not harm the brain or delay recovery from sport-related concussion ,” he says . g
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