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Updated: Jun 17, 2026
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A Multi-Modal Approach to Assessing Recovery in Youth Athletes Following Concussion
Published on: September 25, 2014
A preliminary study of subsymptom threshold exercise training for refractory post-concussion syndrome
John J Leddy1, Karl Kozlowski, James P Donnelly
1Department of Orthopaedics, University at Buffalo, The State University of New York, Buffalo, NY 14214, USA. leddy@buffalo.edu
Summary
Controlled exercise safely improved post-concussion syndrome (PCS) symptoms in refractory patients. This subsymptom threshold training led to faster recovery, especially for athletes, with no adverse events reported.
Area of Science:
- Sports Medicine
- Neurology
- Rehabilitation
Background:
- Post-concussion syndrome (PCS) presents a significant challenge in recovery, often with refractory symptoms.
- Current treatment paradigms for PCS may not adequately address all patient needs, necessitating novel therapeutic approaches.
Purpose of the Study:
- To assess the safety and efficacy of subsymptom threshold exercise training for managing post-concussion syndrome (PCS).
- To evaluate the impact of a structured exercise program on PCS symptom resolution and patient recovery timelines.
Main Methods:
- A prospective case series involving twelve patients with refractory PCS (6 athletes, 6 nonathletes).
- Intervention included sub-symptom threshold exercise training (80% of symptom exacerbation threshold heart rate) 5-6 days/week for 2-3 weeks.
- Outcomes measured included PCS symptoms, heart rate, blood pressure, maximal exertion, and return to work/sport.
Main Results:
- Exercise training significantly increased exercise duration and peak heart rate and systolic blood pressure without symptom exacerbation (P < .001).
- Significant improvement in the rate of PCS symptom reduction was observed, with 8/11 subjects showing reduced mean symptom scores.
- Athletes demonstrated faster recovery times (25 days) compared to nonathletes (75 days) (P = .01), and all participants returned to their respective work or sport.
Conclusions:
- Sub-symptom threshold exercise training is a safe and effective intervention for improving PCS symptoms.
- The study suggests a positive correlation between peak exercise heart rate and symptom improvement rate.
- A randomized controlled trial is recommended to further validate these findings in a larger population.
