This BUFFALO, NY – Teens can speed up recovery from sports-related concussion and reduce their risk of prolonged recovery if they engage in aerobic exercise within 10 days of injury, new study from the University of Buffalo.
Published September 30 in The Lancet Child & Adolescent Health, the randomized controlled trial led by researchers at UB’s Concussion Management Clinic replicates and expands the team’s 2019 study published in JAMA Pediatrics.
New study shows for the first time that aerobic exercise below symptom threshold – that is, exercise that does not exacerbate symptoms – when initiated within 10 days, reduced by 48% a participant’s risk of having persistent symptoms after a concussion.
“The study clearly demonstrates that strict physical rest until symptoms resolve spontaneously is no longer an acceptable way to treat sports-related concussions in adolescents,” said John J. Leddy, MD, first author, clinical professor of orthopedics at the Jacobs School of Medicine. and Biomedical Sciences at UB, and Director of the UB Concussion Management Clinic at UBMD Orthopedics and Sports Medicine.
Prescription of physical activity
“Our results show that to speed recovery and reduce the risk of delayed recovery, doctors should not only allow, but they should also consider prescribing physical activity below symptom threshold soon after a sports-related concussion,” he declared.
Teens are the most vulnerable age group to concussions, and they take the longest to recover from them.
The new findings are the result of extensive work by Leddy and his colleague Barry S. Willer, PhD, professor of psychiatry at the Jacobs School at UB, director of research at the Concussion Management Clinic and senior author of the article. Leddy and Willer have spent years studying the impact of concussions on young athletes.
Their internationally recognized research was instrumental in evolving guidelines that no longer state that athletes recovering from concussions should be prescribed complete rest.
They started this line of research in 2000 after working together to develop concussion return to play guidelines for the International Olympics. They were interested in developing a safe and systematic assessment of exercise tolerance, as this was a known problem after concussion.
“We based our approach on how heart disease patients are prescribed exercise, identifying a safe threshold below which the patient can exercise,” Leddy said. “We developed our Buffalo Concussion treadmill test by adapting a treadmill heart test to stress the brain rather than the heart. Since we know that regular aerobic exercise is good for brain health, the goal was to use sub-symptom threshold exercise to see if it could help the concussed brain recover.
Non pharmacological, safe and effective
“As the current study shows, this approach is non-pharmacological, safe and effective,” Leddy said, adding that no adverse events had been reported.
The study participants were teenagers between the ages of 13 and 18 who had suffered a concussion while playing sports. A total of 118 adolescents were included, of which 61 received the aerobic exercise treatment and 57 received the placebo treatment of stretching exercises that did not increase their heart rate.
Those who participated in the aerobic exercise group took an average of 14 days to recover from a concussion compared to 19 days for those in the stretch exercise group.
The current study differs from the team’s 2019 study in the following areas:
· Two new sites have been added. It was conducted with participants seen at UB-affiliated community sports medicine clinics, as well as two hospital-affiliated clinics: one at the Children’s Hospital of Philadelphia (linked to the University of Pennsylvania) and at Boston Children’s Hospital (linked to Harvard Medical School), who tend to see patients with larger injuries.
While the previous study relied on participants self-reporting the amount and intensity of exercise they had undergone, in the current trial all participants were given heart rate monitors to wear for exercise. This allowed the researchers to confirm that the participants actually followed the doctor’s prescription for aerobic exercise.
The study used a different research design called ‘intention to treat’ and included all participants, even those who dropped out before the study was completed, an approach that makes it more difficult to achieve positive results. but that more closely reflects the real world concussion treatment.
The use of heart rate monitors, in particular, revealed to researchers at UB a more solid picture of the aerobic exercise sessions participants continued at home.
“What we found was that the participants were diligent enough to follow their prescription and furthermore, those who followed the prescription or may even have exceeded the 20 minute daily exercise prescription recovered significantly more. faster than those who didn’t follow the prescription, ”Willer mentioned. “This finding is important because delayed recovery carries substantial costs for adolescents, including difficulty in school, risk of depression and reduced quality of life.”
Leddy and Willer stated that there are a number of possible reasons why this approach is effective, related to the physiological and neurological benefits that arise from aerobic exercise, including improvements in neuroplasticity (i.e. say repairing neurons).
“We are very pleased that the results of this second study provide much stronger evidence that the Buffalo Protocol is not only effective, but is effective for anyone providing the treatment and with all adolescent athletes who experience concussion. cerebral, ”said Willer. “It is important to note that the benefits of prescribed aerobic exercise were felt by both sexes equally.”
UB’s research has focused exclusively on adolescents who are recovering from sports-related concussions. Other surveys, focused on adults who have suffered a concussion in a non-sport setting, have found that such an approach can be effective, but it does not work as quickly or effectively as it does for athletes. In adults, the aerobic exercise approach may work but, Leddy said, it usually needs to be combined with other therapies.
“In contrast, this type of sub-symptom aerobic exercise approach is often the only treatment adolescent athletes need,” he noted.
The research was funded by the American Medical Society for Sports Medicine.
UB’s co-authors with Leddy and Willer are Mohammad N. Haider, MD, PhD, Assistant Director of Research at the UB Concussion Management Clinic, and Adam Cunningham with UBMD Orthopedics and Sports Medicine.
The other co-authors are CL Master, MD; Matthew F. Grady, MD; Naomi J. Brown, MD; Kristy B. Arbogast, Ph.D.; Douglas J. Wiebe, Ph.D.; Rebekah Mannix, MD; William P. Meehan, MD; Danielle Hunt; Eileen P. Storey, MD; Brian T. Vernay, MD; A. Mallon; Fairuz Mohammed; Kate Rownd; and Andrew R. Mayer.