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Importance: Although concussion treatment guidelines advocate rest in the immediate postinjury period until symptoms resolve, no clear evidence has determined that avoiding physical activity expedites recovery. Objective: To investigate the association between participation in physical activity within 7 days postinjury and incidence of persistent postconcussive symptoms (PPCS). Design, Setting, and Participants: Prospective, multicenter cohort study (August 2013-June 2015) of 3063 children and adolescents aged 5.00-17.99 years with acute concussion from 9 Pediatric Emergency Research Canada network emergency departments (EDs). Exposures: Early physical activity participation within 7 days postinjury. Main Outcomes and Measures: Physical activity participation and postconcussive symptom severity were rated using standardized questionnaires in the ED and at days 7 and 28 postinjury. PPCS (≥3 new or worsening symptoms on the Post-Concussion Symptom Inventory) was assessed at 28 days postenrollment. Early physical activity and PPCS relationships were examined by unadjusted analysis, 1:1 propensity score matching, and inverse probability of treatment weighting (IPTW). Sensitivity analyses examined patients (≥3 symptoms) at day 7. Results: Among 2413 participants who completed the primary outcome and exposure, (mean SD age, 11.77 3.35 years; 1205 39.3% females), PPCS at 28 days occurred in 733 (30.4%); 1677 (69.5%) participated in early physical activity including light aerobic exercise (n = 795 32.9%), sport-specific exercise (n = 214 8.9%), noncontact drills (n = 143 5.9%), full-contact practice (n = 106 4.4%), or full competition (n = 419 17.4%), whereas 736 (30.5%) had no physical activity. On unadjusted analysis, early physical activity participants had lower risk of PPCS than those with no physical activity (24.6% vs 43.5%; Absolute risk difference ARD, 18.9% 95% CI,14.7%-23.0%). Early physical activity was associated with lower PPCS risk on propensity score matching (n = 1108 28.7% for early physical activity vs 40.1% for no physical activity; ARD, 11.4% 95% CI, 5.8%-16.9%) and on inverse probability of treatment weighting analysis (n = 2099; relative risk RR, 0.74 95% CI, 0.65-0.84; ARD, 9.7% 95% CI, 5.7%-13.7%). Among only patients symptomatic at day 7 (n = 803) compared with those who reported no physical activity (n = 584; PPCS, 52.9%), PPCS rates were lower for participants of light aerobic activity (n = 494 46.4%; ARD, 6.5% 95% CI, 5.7%-12.5%), moderate activity (n = 176 38.6%; ARD, 14.3% 95% CI, 5.9%-22.2%), and full-contact activity (n = 133 36.1%; ARD, 16.8% 95% CI, 7.5%-25.5%). No significant group difference was observed on propensity-matched analysis of this subgroup (n = 776 47.2% vs 51.5%; ARD, 4.4% 95% CI, -2.6% to 11.3%). Conclusions and Relevance: Among participants aged 5 to 18 years with acute concussion, physical activity within 7 days of acute injury compared with no physical activity was associated with reduced risk of PPCS at 28 days. A well-designed randomized clinical trial is needed to determine the benefits of early physical activity following concussion.
Grool et al. (2016) studied this question.