In a new study conducted at the University of Michigan, researchers found that people who engaged in light exercise within 48 hours after experiencing a concussion recovered twice as fast as those who waited more than a week to exercise.
The findings counter previous recommendations for “cocoon therapy,” a practice which suggests bed rest in the dark with minimal mental stimulation post-concussion.
Landon Lempke, a research fellow at the U-M Concussion Center and the Exercise and Sport Science Initiative, was the first author of the study published in the journal Sports Medicine.
Light Exercise: Key to Faster Healing
The observational study monitored more than 1,200 college athletes from 30 institutions nationwide. The athletes were tracked pre-injury and post-injury until they received medical clearance.
Although the study wasn’t specifically designed to establish a cause-and-effect relationship between exercise and concussion recovery, the results align with previous randomized controlled trials showing a similar correlation.
Key findings from the study include:
Athletes who began light exercise within 48 hours were significantly more likely to see symptom resolution than those who did not exercise, recovering roughly 2.5 days faster.
Athletes who waited about eight days or longer to exercise after the injury were less likely to recover from their symptoms than those who did not exercise, taking approximately five additional days to recover.
The biggest beneficiaries of early exercise appear to be those at risk of developing persistent concussion symptoms (symptoms that linger past four weeks). The early exercise group had a significantly lower prevalence of persistent symptoms (3%-4%) compared to the no exercise group, whereas the late exercise group experienced an 11% higher prevalence of persistent symptoms.
Evolution of Concussion Recovery Practices
Historically, athletes with concussions were advised to avoid both physical and mental activities while recovering.
The main concern was the risk of second impact syndrome, a potentially fatal complication if athletes returned to play too soon. Some research also suggested that aggressive exercise could prolong recovery.
However, by 2017, the thinking evolved as the benefits of early, light exercise became clear.
International consensus guidelines were updated to recommend light physical and mental activities after the initial 24- to 48-hour recovery period, provided these activities didn’t worsen symptoms.
The Right Kind of Exercise Matters
Lempke stressed that their findings should not be taken to mean that athletes can return to play sooner. All exercise after a concussion should be supervised by a trained clinician.
The Buffalo Concussion Treadmill Test, a post-recovery exercise protocol, is the most studied. It involves exercising five to six times a week at 80% of the patient’s maximum heart rate that initially increased symptoms.
However, the “dosage” matters: both “too much, too soon” and “too little, too late” can be detrimental. The ideal balance may vary among individuals.
Recommendations for Athletes, Doctors, and Coaches
For athletes, it is crucial to report concussions promptly to reduce recovery times and prevent potential complications.
Health care providers should stay updated on current best practices for concussion assessment and management.
Despite its known harmful effects, some clinicians continue to use “cocoon therapy”. Current research supports early exercise before symptom resolution, if done safely and supervised by a trained clinician.
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The study was published in Sports Medicine.
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