Children and adolescents can safely exercise 72 hours after a concussion: study

Children and adolescents can safely return to gradual physical activity 72 hours after getting a concussion, according to new research. The findings provide further evidence to support existing guideline recommendations. “Our study is the first large real-world study that validates and supports the guidelines,” said Dr. Andrée-Anne Ledoux (PhD), a scientist at the Children’s Hospital of Eastern Ontario research institute and lead author of the study. “Healthcare providers should feel confident that it is okay to prescribe return to physical activity after 72 hours.” The study involved 456 children aged 10 to 18 years old who presented in Canadian pediatric emergency departments between March 2017 and December 2019. The children were randomized to either: a four-week gradual return to physical activity starting at 72 hours port-injury (even if they were symptomatic), or a gradual return to physical activity once concussion symptoms had resolved. Symptoms were measured using the Health and Behaviour Inventory (HBI), a 20-item survey with a four-point scale of symptom frequency. Activity was measured with an accelerometer. After two weeks, the group asked to exercise after 72 hours had fewer concussion symptoms compared to the group asked to delay activity until they were asymptomatic, although the difference was not statistically significant. Early exercise did not increase symptoms in children who initially had more symptoms or were more at risk of developing persistent post-concussion syndrome. Read: Brain injury endemic among homeless populations: Vancouver research The accelerometer data revealed that there was low adherence to protocol. Children who were meant to delay physical activity until after symptoms ceased got moving earlier. Regardless, the study shows that physical activity following concussion is safe for children aged 10 and older, and may even be associated with milder symptoms at two weeks, the authors conclude. “It is safe to return to activity at 72 hours post injury after a concussion,” Ledoux said. “Here, when we say returning to physical activity, we mean progressively returning to non-contact physical activity.” The steps for returning to physical activity were similar to those recommended in guidelines for pediatric concussion. The first step was a daily easy walk for 15 minutes. Rest in the first two days post-concussion remains important, the study authors state. The mean age of the study participants was 13 years old. At present, the guidelines for those under 10 are the same for older children and adolescents. Children under 10 years old recover well after a concussion and previous studies suggest they are less at risk for post-concussion complications, Ledoux said. “For us, it made a lot more sense to test physical activity in (ages) 10 to 18 because they are more at risk for prolonged post-concussive symptoms,” she said. Next, the researchers will examine the intensity of the participants’ physical activity and try to determine when it can become more vigorous. The accelerometer data will also allow researchers to study sleep habits of the participants while they recovered. Ledoux said the researchers will also look at ways to decrease stress following a concussion through psychological or behavioural therapies. The study results were published in a recent issue of British Journal of Sports Medicine. The living guideline for pediatric concussion care, a project co-led by scientists from CHEO and Holland Bloorview Kids Rehabilitation Hospital, can be found at pedsconcussion.com Read: Adventures of a summer camp doctor: More mental health issues but less viral disease this year

Children and adolescents can safely exercise 72 hours after a concussion: study

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