Aerobic Exercise May Aid Recovery from Persistent Concussion Symptoms

Published March-April 2017
Journal of Head Trauma Rehabilitation

The 10 to 30 percent of children who continue to experience symptoms after a mild traumatic brain injury (mTBI) can benefit from a tailored form of exercise called subsymptom exacerbation aerobic training.

“We found that specific types of aerobic exercise are potentially beneficial for kids with persistent symptoms after concussion or a mild traumatic brain injury,” says Brad Kurowski, MD, MS, lead researcher for the study.

Of the estimated 3.8 million sports-related TBIs suffered each year, 75 to 85 percent are mTBIs or concussions. The study addresses whether brain-injured children should rest, return to activity slowly, or engage in more-normal activity levels to increase cerebral blood flow and cerebral metabolic function.

For five to six days a week for up to eight weeks, 30 mTBI-screened teens were randomly assigned to full-body stretching programs or aerobic training on exercise bicycles at 80 percent of the duration that exacerbated their symptoms during study assessment.

Based on Post-Concussion Symptom Inventory (PCSI) self-assessments, teens who underwent aerobic training reported improved scores compared to teens in the stretching program, with the largest benefits appearing in the fourth week.

“This is early research, and future work should focus on determining the optimal type, timing, and intensity of active rehabilitation programs and characteristics of individuals most likely to benefit,” points out Kurowski, who collaborated on the study with colleague Shari Wade, PhD. “Both groups demonstrated improvement from baseline, indicating that even minimal activity may be beneficial.”

Intervention overview: Once evaluated for eligibility in Weeks 0-1, teens in the Week 1 run-in period were monitored for improvement in symptoms that may occur as part of natural recovery. At the initial intervention visit, participants were re-evaluated for eligibility and then randomized to the subsymptom exacerbation aerobic training or full-body stretching intervention for 5-6 days a week during Weeks 2-9. Participants were monitored weekly. A run-out period included additional visits to determine whether longer duration of the study would improve symptoms for individuals who did not return to baseline at Week 7. For the Final Assessment, participants and their parents completed the Post-Concussion Symptom Inventory (PCSI) to rate symptoms pre-injury, pre-intervention, at internal visits and after the run-out period.

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Trajectory of self-reported Post-Concussion Symptoms Inventory ratings. Means and standard deviations (represented by error bars) are reported for each weekly visit. The magnitude of difference between the groups peaks at approximately four weeks (5th visit).

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Citation

Kurowski BG, Hugentobler J, Quatman-Yates C, Taylor J, Gubanich PJ, Altaye M, Wade SL. Aerobic Exercise for Adolescents With Prolonged Symptoms After Mild Traumatic Brain Injury: An Exploratory Randomized Clinical Trial. J Head Trauma Rehabil. 2017 Mar/Apr;32(2):79-89.