A study confirms the ‘Goldilocks’ approach: not too much, but not too little, moderate-to-vigorous exercise shortly after concussion.

Early initiation of physical activity following concussion is associated with fewer symptoms, but the optimal activity level is unclear. This study was a planned secondary analysis of a Canadian randomised trial of early exercise initiation in children and adolescents with concussion. The exercise patterns of 267 patients (age range, 10 to 18 years) were assessed with accelerometers for 14 consecutive days postconcussion.

The following outcomes were noted:

• on a standardised 60-point assessment of patient-reported somatic and cognitive symptoms, initial median score was 21, and median scores declined to 18, 14 and 10 points, respectively, at one, two and four weeks (lower score indicates fewer symptoms)
• cumulative moderate-to-vigorous physical activity was associated significantly with lower postconcussion symptom burden. For example, children with 259 minutes (75th percentile) of moderate-to-vigorous physical activity in the first week scored an average of five points lower than children with 90 minutes (25th percentile)
• across two weeks, children with 565 minutes (75th percentile) of cumulative activity scored three points lower than those with 237 minutes (25th percentile)
• no further improvement was noted at activity levels higher than 565 minutes, and a slight increase in symptoms occurred in children who exceeded this level.

Comment: These results suggest that more than 40 minutes daily of moderate-to-vigorous physical activity for the first two weeks postconcussion confers no additional benefits for reducing somatic and cognitive symptoms in children and adolescents, and less than 15 minutes daily is too little. For simplicity, I would recommend 30 to 40 minutes of moderate-to-vigorous physical activity daily.

Thomas L. Schwenk, MD, Professor Emeritus, Family and Community Medicine, University of Nevada School of Medicine, Reno, USA.

Ledoux A-A, et al. Optimal volume of moderate-to-vigorous physical activity postconcussion in children and adolescents. JAMA Netw Open 2024; 7: e2356458.

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine, Pediatrics and Adolescent Medicine, Neurology.