Effects of Aerobic Exercise for Improving Concussion Symptoms Compared to Traditional Rest or Placebo-Like Stretching in Adolescents: A Critically Appraised Topic

Clinical Scenario: Children under the age of 18 are still developing physically, cognitively, neurologically, and emotionally. When adolescents obtain a concussion, it can hinder their developmental skills and put them at high risk for future concussions and/or second impact syndrome, meaning sustaining another concussion before full recovery which can exacerbate symptoms to become even more severe. Recent studies have suggested that early activity within the first week of injury had decreases in rate of delayed recovery and reduction in concussive symptoms.

Clinical Question: Is sub-symptom aerobic exercise more effective at improving concussion symptoms in adolescents compared to traditional rest or placebo-like stretching?

Summary of Key Findings: Three articles were included to investigate the effectiveness of sub-symptom threshold aerobic exercise in adolescents with concussion. Two articles demonstrated level 2 evidence while one article demonstrated level 3. All articles concluded suggested that early sub-symptom aerobic exercise was the most effective treatment intervention compared to placebo-like stretching and traditional rest.

Clinical Bottom Line: Sufficient evidence has demonstrated that sub-symptom threshold aerobic exercise is more effective in self-reported symptom reduction than placebo-like stretching and traditional rest in adolescents with sport-related concussion.

Strength of Recommendation: According to the SORT scale, Level A evidence demonstrates that sub-symptoms threshold aerobic exercise decreases symptoms in adolescents with concussion more effectively than other interventions.