Pilot study of the Sub-Symptom Threshold Exercise Program (SSTEP) for persistent concussion symptoms in youth

Prior studies suggest potential benefit using monitored aerobic exercise to treat youth with persistent concussion symptoms, but these studies have been small.

To explore the safety and potential benefits of a rehabilitative exercise intervention, the Sub-symptom Threshold Exercise Program (SSTEP), for treating youth with persistent concussion symptoms >1 month.

We conducted a retrospective cohort study of 83 youth who participated in SSTEP, completing trajectory analysis of concussion symptoms using the symptom subscale of the Sport Concussion Assessment Tool, version 2 (SCAT-2).

The average age of patients was 14.9+/-2.3 years and 54% were female. Most concussions (76%) were due to sports, the majority from football and girls' soccer, and 55% had a previous concussion. Comorbidity was not uncommon: 14% had history of ADHD and 16% history of depression and/or anxiety. Most patients improved following the intervention, and none reported worsening. Symptoms decreased exponentially following initiation of SSTEP, and trajectory did not differ by duration of symptoms at presentation (<6 weeks, 6-12 weeks, >12 weeks).

Monitored exercise programs appear to be safe and potentially beneficial for youth with persistent concussive symptoms. Large-scale controlled studies are needed to examine efficacy, ideal timing and duration.