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Study Calls into Question Pediatric Concussion Return-to-Activity Guidelines

OTTAWA, CANADA – Should emergency physicians instruct children with sports-related head injuries to avoid returning to play and all other physical activities until all concussion symptoms, including headache, have resolved?

That’s what the guidelines recommend, but a research abstract presented at the Pediatric Academic Societies (PAS) 2016 Meeting suggests otherwise. Researchers from the Children's Hospital of Eastern Ontario and the University of Ottawa report that those who exercise within a week of injury, despite symptoms, have nearly half the rate of concussion symptoms that last more than a month.

For the study, researchers surveyed 3,063 children between the ages of 5 and 18 — or parents/caregivers — who visited Canadian EDs about their level of physical activity and severity of symptoms 7, 14, and 28 days after injury.

Despite the widely followed recommendations, most (58%) of the children still experiencing concussion symptoms reported that they resumed exercising a week after being injured, with 76% reporting physical activity two weeks later.

Rather than suffering ill effects from defying medical guidelines, the patients’ non-compliance tended to be linked to faster recovery, according to the report.

"Exercise within seven days of injury was associated with nearly half the rate of persistent post-concussive symptoms, or those that last beyond a month," said principal investigator Roger Zemek, MD. He said the findings were in line with some previous smaller studies questioning the benefits of prolonged physical rest — essentially longer than three days — following an acute concussion.

"This is the first large-scale study to provide support for the benefits of early exercise on symptom recovery following acute pediatric concussion, shifting away from conservative rest towards more active physical rehabilitation recommendations," Zemek said.

He added that children shouldn’t resume activities “that could put them at risk of re-injury, like contact sports drills or games, until they are cleared by a doctor" but might try light aerobic activity such as walking, swimming, or stationary cycling.

The researchers called for more studies on the issue but suggest that re-introducing exercise sooner after injury could help reduce the undesired effects of physical and mental deconditioning.

"If earlier re-introduction of physical activities is, in fact, confirmed to be beneficial to recovery," Zemek said in an American Academy of Pediatrics press release, "this would have a significant impact on the well-being of millions of children and families worldwide and cause a major shift in concussion management."