Rest and exercise early after sport-related concussion: a systematic review and meta-analysis

• Published in: British journal of sports medicine Vol. 57; no. 12; pp. 762 - 770
• Main Authors: Leddy, John J, Burma, Joel S, Toomey, Clodagh M, Hayden, Alix, Davis, Gavin A, Babl, Franz E, Gagnon, Isabelle, Giza, Christopher C, Kurowski, Brad G, Silverberg, Noah D, Willer, Barry, Ronksley, Paul E, Schneider, Kathryn J
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine 01.06.2023; BMJ Publishing Group LTD
• Subjects: Aerobics; Animals; athletes; brain concussion; Brain Concussion - therapy; Cohort analysis; Concussion; Exercise; Heart rate; Meta-analysis; Multiculturalism & pluralism; Physical fitness; Rest; Sleep; Sports; Systematic review; Canada; United States > US; meta-analysis; rest; exercise; athletes; brain concussion
• ISSN: 0306-3674; 1473-0480
• DOI: 10.1136/bjsports-2022-106676

ObjectiveTo synthesise the evidence regarding the risks and benefits of physical activity (PA), prescribed aerobic exercise treatment, rest, cognitive activity and sleep during the first 14 days after sport-related concussion (SRC).DesignMeta-analysis was performed for PA/prescribed exercise interventions and a narrative synthesis for rest, cognitive activity and sleep. Risk of bias (ROB) was determined using the Scottish Intercollegiate Guidelines Network and quality assessed using Grading of Recommendations, Assessment, Development and Evaluations.Data sourcesMEDLINE, Embase, APA PsycInfo, Cochrane Central Register of Controlled Trials, CINAHL Plus and SPORTDiscus. Searches were conducted in October 2019 and updated in March 2022.Eligibility criteriaOriginal research articles with sport-related mechanism of injury in >50% of study sample and that evaluated how PA, prescribed exercise, rest, cognitive activity and/or sleep impact recovery following SRC. Reviews, conference proceedings, commentaries, editorials, case series, animal studies and articles published before 1 January 2001 were excluded.Results46 studies were included and 34 had acceptable/low ROB. Prescribed exercise was assessed in 21 studies, PA in 15 studies (6 PA/exercise studies also assessed cognitive activity), 2 assessed cognitive activity only and 9 assessed sleep. In a meta-analysis of seven studies, PA and prescribed exercise improved recovery by a mean of −4.64 days (95% CI −6.69, –2.59). After SRC, early return to light PA (initial 2 days), prescribed aerobic exercise treatment (days 2–14) and reduced screen use (initial 2 days) safely facilitate recovery. Early prescribed aerobic exercise also reduces delayed recovery, and sleep disturbance is associated with slower recovery.ConclusionEarly PA, prescribed aerobic exercise and reduced screen time are beneficial following SRC. Strict physical rest until symptom resolution is not effective, and sleep disturbance impairs recovery after SRC.PROSPERO registration numberCRD42020158928.