Associations Between Physician-Recommended Early Physical Activity and Concussion Recovery Outcomes in Pediatric Patients

To investigate the associations between physician recommendations for early physical activity (PA) after concussion and prolonged recovery in youth. Retrospective observational study. Seven concussion clinics affiliated with a children's hospital. Youth aged 10 to 18 years diagnosed with a concussion who visited a concussion clinic within 14 days of injury. Physician PA recommendations. Experiencing a prolonged recovery (yes/no). Of 3249 youth included, 63.1% were males and 79.0% were White, with more than half in the 15 to 18 age group (54.6%). From 2012 to 2019, the proportion of physicians recommending light aerobic activity or noncontact PA increased from 12.6% to 62.0% and from 19.3% to 72.5% for youth seen in week 1 and week 2 postinjury, respectively. Youth who received light aerobic activity adjusted odds ratio (aOR) = 0.37, 95% confidence interval (CI) = 0.29-0.48 or noncontact PA (aOR = 0.27, 95% CI = 0.12-0.64) recommendations had significantly lower odds of experiencing prolonged recovery than youth with recommendations for no PA. In addition, patients evaluated in the second week postinjury were more likely to experience prolonged recovery than those seen within 1 week postinjury (aOR = 2.52, 95% CI = 2.07-3.07). Youth who received recommendations for light aerobic or noncontact activities had a reduced likelihood of prolonged recovery compared with those recommended no PA, suggesting early PA may play a role in hastening concussion recovery in youth. Further research is needed to explore patient adherence to these prescriptions.