Physical activity following acute concussion and persistent postconcussive symptoms in children and adolescents

The management of concussion in pediatric patients has always been guided by treatment guidelines that have been drawn from consensus statements rather than clinical research projects. Grool and colleagues conducted a clinical research project on an early return to physical activity and its effect on post-concussion symptoms. The study enrolled 3063 pediatric patients, age 5.0 to 17.99 years of age who presented to one of nine Pediatric Emergency Research Centers in Canada. 2413 patients completed the primary outcome for exposure. A total of 1677 patients (69.5%) instituted some level of early physical activity, including light aerobic exercise (n = 795 or 32.9%), sport-specific exercise (n = 214 or 8.9%), non-contact drills (n = 143 or 5.9%), full-contact practice (n = 106 or 4.4%), or full competition (n = 419 or 17.4%), while 736 (30.5%) instituted no physical activity. Patients were evaluated by a web-based survey or a telephone-based survey at days 7 and 28 after their initial visit, and their symptoms were evaluated by using the Post Concussive Symptom Inventory (PCSI). Early return to physical activity was associated with a lower risk of Persistent Post-Concussive Syndrome (PPCS) than in patients reporting no physical activity at 28 days (24.6% vs. 43.5%, Absolute risk difference, (ARD), 18.9% (95% CI 14.7-23.0%). Among the sub-group of patients who were symptomatic at day 28 (n = 803), PPCS was more present in the patients that reported no physical activity, (n = 584: PPCS 52.9%), than those with 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%], or full contact activity [n = 133 (36.1%; ARD, 16.8%; 95% CI 7.5%- 25.5%]. Therefore, in patients aged 5 to 18 years with acute concussion, a return to physical activity within 7 days of acute injury was associated with less symptoms at 28 days than in patients who had a period of prolonged rest rather than an early return to physical activity.