Early Physical Activity Better After Pediatric Concussion

At 2 weeks post-concussion, early physical activity was associated with reduced symptoms, according to a new study.

In the study, “Is early activity resumption after paediatric concussion safe and does it reduce symptom burden at 2 weeks post injury? The Pediatric Concussion Assessment of Rest and Exertion (PedCARE) multicentre randomised clinical trial,” published online on November 26, 2021, in the British Medical Journal of Sports Medicine, the researchers wanted to better understand how early physical activity affects concussion recovery.

They investigated real-life conditions to see if resuming physical activity at 72 hours post-concussion is safe and reduces symptoms at 2 weeks compared with resting until asymptomatic.

The patients, children between the ages of 10 and 18 with acute concussion, were enrolled in three Canadian pediatric emergency departments between March 2017 and December 2019. They were either randomized to return-to-physical activity protocol at 72 hours post-concussion even if symptomatic or to a return to physical activity once asymptomatic protocol.

The primary outcome was self-reported symptoms at 2 weeks using the Health and Behavior Inventory. The researchers measured adherence using accelerometers worn 24 hours/days for 14 days post injury. They also monitored adverse events.

In total 456 participants were included, 44.5% of whom were female. The mean age was 13.3 (2.1) years.

Overall, they didn’t identify adverse events. Intention to treat analysis showed no strong evidence of a group difference at 2 weeks (adjusted mean difference = -1.3 (95% CI: -3.6 to 1.1).

Overall, initiating physical activity 72 hours post injury significantly reduced symptoms 2 weeks post injury compared with rest (adjusted mean difference -4.3 (95% CI: -8.4 to -0.2).

“Symptoms at 2 weeks did not differ significantly between children/youth randomized to initiate physical activity 72 hours post injury versus resting until asymptomatic; however, many were non-adherent to the intervention. Among adherent participants, early physical activity was associated with reduced symptoms at 2 weeks. Resumption of physical activity is safe and may be associated with milder symptoms at 2 weeks,” the researchers wrote.