Early Moderate to Vigorous Physical Activity After Concussion Is Associated With Faster Symptom Resolution Time

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Jacob G. Rademacher Department of Biological Sciences, University of Denver, Denver, CO, USA

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Mathew J. Wingerson Sports Medicine Center, Children’s Hospital Colorado, Aurora, CO, USA
Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA

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Katherine L. Smulligan Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA

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Casey C. Little University of Virginia School of Medicine, Charlottesville, VA, USA

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Julie C. Wilson Sports Medicine Center, Children’s Hospital Colorado, Aurora, CO, USA
Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA

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David R. Howell Sports Medicine Center, Children’s Hospital Colorado, Aurora, CO, USA
Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA

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https://orcid.org/0000-0002-2955-0191 *
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Context: Early physical activity (PA) after concussion may promote symptom resolution. Prior studies have investigated exercise frequency/duration, yet precise PA intensity or volume required for optimal recovery requires further investigation. moderate to vigorous physical activity (MVPA) is beneficial for physical health. We investigated whether sedentary time, light activity time, MVPA time, or activity frequency in the weeks following concussion are associated with time to symptom resolution among adolescents. Design: Prospective cohort study. Methods: Adolescents 10–18 years of age were tested ≤14 days of concussion and followed until symptom resolution. At the initial visit, participants rated symptom severity and were provided wrist-worn activity trackers to monitor PA for the following week. PA behavior was categorized each day based on heart rate: sedentary (resting), light PA (50%–69% age-predicted max heart rate), and MVPA (70%–100% age-predicted max heart rate). Symptom resolution was defined as the date when participants reported cessation of concussion-like symptoms. Patients were not given specific PA instructions, though some may have received instructions from their physician. Results: Fifty-four participants were included in the study (54% female; mean age = 15.0 [1.8] y; initially assessed 7.5 [3.2] d after concussion). Female athletes recorded more sedentary time (900 [46] vs 738 [185] min/d; P = .01; Cohen d = 0.72), and less time in light PA (194.7 [64.5] vs 224 [55] min/d; P = .08; Cohen d = 0.48) and MVPA (23 [17] vs 38 [31] min/d; P = .04; Cohen d = 0.58) than male athletes. After adjusting for sedentary time, hours per day with >250 steps, sex, and initial symptom severity, more MVPA time was associated with faster symptom resolution time (hazard ratio = 1.016; 95% confidence interval, 1.001–1.032; P = .04). Conclusion: Our findings offer preliminary insight into how varying PA intensities affect concussion recovery, as MVPA may be a higher intensity than what is typically prescribed in concussion care.

Moderate- to vigorous-intensity physical activity may be beneficial for concussion recovery.

More than 30 minutes of moderate to vigorous physical activity per day was associated with a decreased time to symptom resolution.

Physical activity volume at lower intensities was not associated with symptom resolution time.

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