Audio file
File
P. Langevin1, P. Frémont1, P. Fait2, M.-O. Dubé1, M. Bertrand-Charette1, J.-S. Roy1
1Université Laval, Rehabilitation, Quebec City, Canada, 2Université du Québec à Trois-Rivières, Human Kinetics, Trois-Rivières, Canada
Background: Approximately 25% of people with sport-related concussion (SRC) experiences persistent symptoms. The 2016 Berlin consensus on SRC recommends symptom-limited aerobic exercise as a rehabilitation option for persistent symptoms after concussion. However, this recommendation is based on a limited body of knowledge as there is uncertainty about the effectiveness of such interventions.
Purpose: The objective of this systematic review is to assess the effects of symptom-limited aerobic exercise programs compared to control interventions, on symptom intensity, time to recovery, balance, cognitive capacity and adverse events in individuals with sport-related concussion (SRC).
Methods: A structured search was conducted in MEDLINE, EMBASE, CINHAL, EBM Reviews. Randomized clinical trials (RCTs) including aerobic exercise programs as an intervention for SRC were included. Following selection, the risk of bias and GRADE recommendations were applied to pooled studies for quantitative analysis. Standard mean differences (SMD 95% CI) were calculated. A descriptive analysis was also performed.
Results: Seven RCTs (326 participants) in adolescent populations were included. Three out of seven RCTs had a high risk of bias. Symptom-limited aerobic exercise programs have a significant beneficial effect on the perception of symptoms (6 studies, 277 participants, low quality evidence, pooled SMD 95%CI: -0.44 [-0.68, -0.19]). When introduced in the acute phase, symptom-limited aerobic exercise programs have a significant beneficial effect on symptomatic recovery compared to control interventions (3 studies, 206 participants, moderate quality evidence, pooled SMD 95%CI: -0.43 [-0.71, -0.15]). Qualitative analysus showed that following sport-related concussion, gradual physical activity can progress towards moderate intensity aerobic exercise as long as activity does not result in an increase of symptoms neither produce new symptoms.
Conclusion(s): Since the 2016 Berlin consensus on SRC, several RCTs on aerobic exercises for SRC emerged from the literature. Our review adds major findings on the efficacy and safety of aerobic exercise programs in the management of SRC. A moderate level of evidence indicates that graded symptom-limited aerobic exercise is effective to improve symptoms and is safe when used at the acute phase following SRC in adolescent populations. Moreover, the intensity of the exercise programs used in the published studies suggest that a gradual progression of symptom-limited aerobic activity towards moderate intensity exercise or step 3 of the graded return-to-sport strategy proposed by the 2016 Berlin consensus can be recommended. Further studies are needed
1) to improve the level of certainty of these findings;
2) on adult populations; and 3) with better ways of reporting exercise programs and adverse events.
1) to improve the level of certainty of these findings;
2) on adult populations; and 3) with better ways of reporting exercise programs and adverse events.
Implications: This study provides further support for the early introduction of gradual symptom-limited aerobic activity towards moderate intensity exercise following sport-related concussion in adolescents.
Funding, acknowledgements: Not applicable
Keywords: sport-related concussion, symptoms, aerobic exercise
Topic: Sport & sports injuries
Did this work require ethics approval? No
Institution: N/A
Committee: N/A
Reason: Our work is a systematic review
All authors, affiliations and abstracts have been published as submitted.
