Image: John Leddy and his colleagues at UB have spent years studying how concussions affect young athletes.
Credit: Douglas Levere / University at Buffalo
BUFFALO, NY – Teens can speed their recovery from an exercise-related concussion and reduce their risk of lengthy recovery by doing aerobic exercise within 10 days of the injury, according to a new study from the University at Buffalo.
The randomized controlled trial published September 30 in The Lancet Child & Adolescent Health, conducted by researchers at UB’s Concussion Management Clinic, reproduces and expands the team’s 2019 study published in JAMA Pediatrics.
The new study shows for the first time that aerobic exercise below the symptom threshold – that is, exercise that doesn’t make symptoms worse – when initiated within 10 days, reduced a participant’s risk of persistent symptoms after a concussion by 48%.
“The study clearly shows that strict physical rest until symptoms resolve spontaneously are no longer an acceptable method of treating sports-related concussion in adolescents,” said John J. Leddy, MD, lead author and clinical professor of orthopedics at the Jacobs School of Medicine and Biomedical Sciences at the UB and Director of the UB Concussion Management Clinic at the UBMD Orthopedics and Sports Medicine.
Prescription of physical activity
“Our results show that in order to speed recovery and reduce the risk of delayed recovery, doctors should not only allow but also consider prescribing below-symptom physical activity early after a sports-related concussion,” he said .
Teenagers are the most prone to concussions, and it takes them the longest to recover.
The new results are the result of extensive work by Leddy and colleague Barry S. Willer, PhD, professor of psychiatry at the UB’s Jacobs School, research director of the Concussion Management Clinic, and lead author of the article. Leddy and Willer spent years studying how concussions affect young athletes.
Her internationally renowned research has played a key role in developing guidelines that no longer mandate that athletes recovering from a concussion should be given complete rest.
They began this line of research in 2000 after jointly developing guidelines for returning to play after a concussion for the International Olympic Games. They were keen to develop a safe and systematic assessment of exercise tolerance as this was a known problem after a concussion.
“We based our approach on how patients with heart disease are prescribed exercise by identifying a safe threshold below which the patient can exercise,” said Leddy. “We developed our Buffalo Concussion treadmill test by adapting a cardiac treadmill test to stress the brain instead of the heart. Knowing that regular aerobic exercise is good for brain health, the goal was to do subsymptom threshold exercises to see if they could help the brain recover. “
Non-pharmacological, safe and effective
“As the current study shows, this approach is not pharmacological, safe and effective,” said Leddy, adding that no adverse events were reported.
Study participants were adolescents between the ages of 13 and 18 who had suffered a concussion while exercising. A total of 118 adolescents were enrolled, of whom 61 received the aerobic exercise treatment and 57 received the placebo treatment for stretching exercises that did not increase their heart rate.
Those who participated in the aerobic exercise group took a median of 14 days to recover from the concussion, compared with 19 days in the stretch group.
The current study differed from the team’s 2019 study in the following ways:
- Two new sites have been added. It was conducted with participants seen in UB-affiliated community sports medicine clinics as well as two hospital-affiliated clinics: one at Children’s Hospital of Philadelphia (affiliated with the University of Pennsylvania) and the Boston Children’s Hospital (affiliated with Harvard Medical School ). who tend to see patients with more serious injuries.
- While the previous study relied on participants reporting the amount and intensity of exercise they had undergone, the current study provided all participants with heart rate monitors that they could wear while exercising. This enabled the researchers to confirm that the participants were actually following the doctor’s prescription for aerobic exercise.
- The study used a different research design called “Intent to Treat” and included all participants, including those who dropped out of the study before completing treatment.
In particular, the use of heart rate monitors gave the UB researchers a more robust picture of the aerobic exercise participants were doing at home.
“What we found is that the participants followed their prescription very carefully and that those who followed the prescription or even exceeded the exercise prescription of 20 minutes a day recovered much faster than those who did not follow the prescription,” Called Willer. “This finding is important because delayed recovery has significant costs for adolescents, including academic difficulties, the risk of depression, and a reduced quality of life.”
According to Leddy and Willer, there are a number of possible reasons this approach is effective, related to the physiological and neurological benefits that result from aerobic exercise, including improving neuroplasticity (i.e., neuron repair).
“We are delighted that the results of this second study provide much stronger evidence that the Buffalo Protocol is not only effective, but also effective in the person administering the treatment and in all adolescent athletes who experience a concussion. is effective, ”said Willer. “It is important that the benefits of the prescribed aerobic exercises were perceived equally by both sexes.”
The UB research focused solely on teenagers recovering from an exercise-related concussion. Other research, focusing on adults who have had a concussion in a non-athletic setting, has found that such an approach can be effective, but it doesn’t work as quickly or effectively as it does in athletes. In adults, the aerobic exercise approach can work, but Leddy says it usually needs to be combined with other therapies.
“In contrast, this type of symptom-free aerobic exercise is often the only treatment adolescent athletes need,” he noted.
The research was funded by the American Medical Society for Sports Medicine.
UB co-authors with Leddy and Willer are Mohammad N. Haider, MD, PhD, Assistant Research Director of the UB Concussion Management Clinic, and Adam Cunningham of UBMD Orthopedics and Sports Medicine.
The Lancet Child and Adolescent Health
Randomized controlled / clinical study
Early Targeted Aerobic Exercise Using Heart Rate versus Placebo Stretching for Exercise-Related Concussions in Adolescents: A Randomized Controlled Trial
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