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Sex Differences in Physical Activity and Energy Expenditure after Adolescent Concussion
Katherine L Smulligan1, Mathew J Wingerson2,3, Aubrey M Armento2,3
1Division of Sports Medicine, Boston Children's Hospital, Boston, MA.
Medicine and Science in Sports and Exercise
|March 24, 2026
Summary
Female athletes expended fewer calories than males after concussion, though physical activity and calorie expenditure increased throughout the week for all adolescents. This study examined sex differences in physical activity (PA) post-concussion.
Area of Science:
- Sports Medicine
- Adolescent Health
- Neurology
Background:
- Physical activity (PA) is crucial for adolescent recovery after concussion.
- Understanding sex-based differences in PA engagement post-concussion is essential for tailored rehabilitation strategies.
- Previous research suggests potential variations in PA behavior between male and female adolescents.
Purpose of the Study:
- To investigate sex differences in physical activity (PA) engagement among adolescent athletes following a concussion.
- To quantify daily steps, caloric expenditure, and resting heart rate (RHR) in male and female adolescents post-concussion.
- To identify potential disparities in PA recovery patterns between sexes.
Main Methods:
- 122 adolescent athletes (62 female, 60 male) within 21 days of concussion diagnosis participated.
- Wrist-worn actigraphy devices were used for one week to measure steps/day, caloric expenditure, and RHR.
- Linear mixed models were employed to analyze sex differences, adjusting for covariates like symptom severity and BMI.
Main Results:
- Female athletes showed significantly lower caloric expenditure (β=-336 calories; p<0.001) compared to males.
- Daily step count and resting heart rate (RHR) were similar between sexes.
- Both steps/day and caloric expenditure increased over the monitoring week for the overall sample, irrespective of sex.
Conclusions:
- Female athletes exhibited lower caloric expenditure but comparable daily steps and RHR to males during the week post-concussion.
- The observed increase in PA and caloric expenditure throughout the week suggests symptom improvement or adherence to medical guidance.
- Findings highlight potential sex-specific considerations in PA recovery following adolescent concussion.
