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Updated: Dec 28, 2025
Autonomic Function Following Concussion in Youth Athletes: An Exploration of Heart Rate Variability Using 24-hour Recording Methodology
Published on: September 21, 2018
Practical Management: Prescribing Subsymptom Threshold Aerobic Exercise for Sport-Related Concussion in the
Itai Bezherano1, Mohammad N Haider1,2, Barry S Willer3
1UBMD Department of Orthopedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York.
Abstract:
Exercise intolerance is an objective biomarker of the physiological dysfunction after sport-related concussion (SRC). Several trials have established the safety and clinical efficacy of subsymptom threshold aerobic exercise prescribed within 1 week of injury as treatment for SRC. Clinicians, however, may not be comfortable prescribing aerobic exercise after SRC. This article presents 3 methods of exercise prescription for patients with SRC. The first requires a graded exertion test plus a home-based exercise program requiring a heart rate (HR) monitor. The second requires a graded exertion test but no HR monitor for home-based exercise. The third requires solely an HR monitor to safely progress through the home-based exercise prescription. Patients are encouraged to keep a symptom and exercise diary and return for re-evaluation every 1 to 2 weeks. Delayed recovery should prompt the clinician to evaluate for other potential symptom generators (eg, cervical, vestibular, oculomotor, mood, or migraine disorders).
