“Rest Until Symptom Recovery” May Not be the Best Medicine for Children and Adolescents Recovering from Acute Concussion
In a study published in the Journal of the American Medical Association (JAMA) on December 20, 2016, Canadian researchers found that children and adolescents who returned to exercise within seven days of experiencing a concussion had nearly half the rate of persistent post-concussive symptoms a month later. This finding challenges the current cornerstone of pediatric concussion management, which is physical and cognitive rest until acute symptoms have resolved.
The study involved more than 3,000 children treated for concussions in emergency rooms across Canada. It found that children who did aerobic exercise within the first week had better outcomes. Forty–four percent of patients who relied on bed rest during their first week of recovery continued to have three or more concussion symptoms after a month. In contrast, only 25 percent of those who did some aerobic activity during the first week of recovery reported persistent symptoms. Dr. Roger Zemek, who directed the research, cautioned that the results should not be used to justify return to activity before it can be tolerated or a return to activity that puts children at risk of re-injury, consistent with research indicating that the consequences of a second concussion can be particularly severe where the symptoms of the first concussion have not resolved.
The results of this study are consistent with other research discussed in this blog on the benefits of light aerobic exercise in concussion recovery, for both children and adults. The researchers in the recent JAMA study propose that the mechanism by which exercise improves recovery may be both physical and psychological.
- From a physical perspective, they explain that the improvement may be “through the promotion of neuroplasticity mechanisms and from possible effects on cardioregulatory mechanisms, possibly leading to improved cerebral blood flow.”
- From a psychological perspective, they explain that inactivity can remove children and adolescents from “life validating” activities and lead to depression and anxiety, which can compound concussion symptoms.
The researchers do caution that the study has several limitations and note that “a well-designed randomized clinical trial is needed to determine the benefits of early physical activity following concussion.”