Complete rest is a cornerstone of concussion treatment, but a
new study indicates that physical activity within a week of a youth's head
injury may hasten recovery.
Concussed children and teens were less likely to have persistent
symptoms four weeks later if they engaged in light aerobic exercise within the
first seven days, according to the new research from Canada.
Under current guidelines for concussion management, pediatricians
recommend a period of physical and mental rest until symptoms such as headache
resolve.
The new findings "call into question the standard operating
procedure where athletes have to be symptom-free before they are allowed to
start exertion," said Dr. John Kuluz.
Kuluz is director of traumatic brain injury and
neurorehabilitation at Nicklaus Children's Hospital in Miami. He wasn't
involved in the study.
Although the researchers found a link between early physical
activity and fewer long-term symptoms, Kuluz said the study can't prove
cause-and-effect.
"I'm not really going to change my practice based on
this," he said. In reality, he said, a lot of doctors are already
following this approach instead of advising total rest until symptoms
disappear.
And no one is advising vigorous exercise, Kuluz
said.
After a concussion, "I think getting up off the couch and
moving, at low intensity, for short duration, one or two times a day, is
important," he explained. "It helps to reduce the
deconditioning."
He also added, "It has to be done on an individualized
basis."
Based on the finding, study author Dr. Roger Zemek said light
jogging, walking or light activity on a stationary bike probably would be OK
after a concussion.
Zemek is a senior scientist and director of the clinical
research unit at Children's Hospital of Eastern Ontario in Ottawa.
Beyond expert input, he said, "there is very little
evidence'' to support the advice to avoid physical activity after a concussion.
To see what effect activity might have on recovery, Zemek's team
analyzed data on more than 2,400 Canadian kids, ages 5 to 17, who suffered a
concussion.
The researchers reviewed persistent post-concussive symptoms and
levels of physical activity in the month after the head injury. Persistent
post-concussive symptoms (PPCS) were defined as three or more symptoms, such as
headache or problems thinking or learning.
After 28 days, 25 percent of those who engaged in early physical
activity still had persistent or worsening symptoms, Zemek said. In the no-activity
group, 44 percent still had symptoms. That difference was significant
statistically, he said.
The study was published Dec. 20 in the Journal of the
American Medical Association.
Zemek isn't suggesting kids who suffer a concussion return to
athletic play quickly.
"What I don't want is someone to read this and say, 'Oh, I
will let Johnny play football tomorrow [right after a concussion] because there
is no harm,'" he said.
Light physical activity early on may help reduce persistence of
symptoms, Zemek noted.
While the study didn't assess the best intensity or duration of
exercise, Zemek thinks that engaging in light activity earlier than is
currently recommended by many experts could have physical and psychological
benefits.
The kids feel less like they are in jail at home, for one thing,
he said.
This approach is used successfully in post-stroke patients,
Zemek added, explaining doctors want them out of bed and moving as soon as
possible.
Why does this seem to help? Zemek couldn't say for sure, but
said he suspects activity may increase blood flow to the brain, which can help
healing.
More
information To learn more about
concussions, head to the American Academy of Pediatrics.
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