Early physical activity helps children after concussions, study finds

New research from Ottawa's pediatric hospital could have significant implications for older children suffering from a concussion as it encourages physical activity within days of a brain injury.

The study from the CHEO Research Institute, which included 450 participants ages 10 to 18, found resuming non-contact physical activity — such as walking or light exercise — 72 hours after a concussion is safe and may reduce symptoms and the risks of a delayed recovery.

"Many physicians are still prescribing rest after having a concussion — and prolonged rest after having a concussion —and this actually is doing more harm than good," said scientist Andrée-Anne Ledoux, one of the study's co-authors.

Until the study's inception in 2017, she said little evidence existed to guide health-care professionals on how and when to best re-introduce physical activity after a brain injury.

While Canada has more up-to-date guidelines, apart from the recently published CHEO study, the topic remains under-researched, Ledoux said. 

"This is why we thought it was very important to conduct a randomized clinical trial to prove that early progressive return to physical activity is safe and also [may be] important to having better recovery," she said.

This new research, peer-reviewed and published in the British Journal of Sports Medicine, gives credence to some of the newer best practices in Canada, which recommend 10 to 15 minutes of daily walking or other light exercise after 24 to 48 hours of rest, unless there are red flags.

Study findings 'essential'

The study participants were divided into two groups: one where participants rested until symptoms resolved, and another where the young people were introduced to some level of physical activity after 72 hours. 

At two weeks, symptoms were comparable between the groups, meaning early physical activity was not harmful. Those who were re-introduced to physical activity also demonstrated an easing of symptoms and a reduced rate of delayed recovery.

Previous studies were smaller in scope and more heavily focused on people who play sports, according to a news release from CHEO, eastern Ontario's children's hospital in Ottawa.

"It's great to see this kind of concussion research coming out of Canadian institutions," said Stephanie Cowle, who speaks on behalf of Parachute, a national charity dedicated to preventing serious and fatal injuries, including concussions.

"The findings of this study — looking at an earlier introduction of some physical activity with children and youth after concussion — is essential, reflecting a trend that we've been seeing in the research for for a number of years now."

The study's senior author, Roger Zemek, says this study was needed to prove physical activity was the better approach and doesn't worsen symptoms "because there were still people out there who believed that exercise will make them worse."

Ledoux says the CHEO team wasn't surprised by the results. A previous observational trial in 2016 showed an association between youth who resumed physical activity within the first seven days and a lower risk of having or developing persistent post-concussive symptoms at four weeks. 

'You don't need to be stuck in your room'

Limited physical activity is used in a wide array of rehabilitation, she said, and may help relieve stress a child is feeling after a concussion. That stress, mixed with the anxiety of being unable to see friends, can compound a child's symptoms.  

Physical activity also assists the brain's ability to change through growth and reorganization, she said, as well as in the formation of new neurons and reducing inflammation. 

"It actually helps create this protein in your brain," Ledoux said. "It helps to heal, if you want, the brain after having a concussion."

Ledoux believes more research is needed to examine the potential benefits of early light exercise for adults or even younger children.

"This is important for the quality of life of the patients," she said. "We're telling them that, 'Yeah, you know what? You are able to go outside and start walking, for instance, for 15 continuous minutes. You don't need to be stuck in your room doing nothing.'"