Over the years recommendations have changed considerably on when it’s okay to exercise after a concussion. When SportsSafe started in 2010, the literature recommended no physical activity until all concussion symptoms were gone at rest.
Recommendations then changed to endorse rest for at least 2 weeks after a concussion. As time passed, research gradually began to show us that prolonged rest without some exercise may not be the best plan. As of 2016, recommendations for return to light exercise have changed again.
In light of new and improved research, we now recommend light exercise as early as within 3-5 days post-injury.
We have known for quite some time that a concussion causes neurometabolic changes and blood flow dysregulation in the brain cells that are injured in a concussion. With time, these changes and blood flow normalize, but research is suggesting that blood flow may be improved with aerobic exercise and this may in turn lead to more rapid symptom resolution.
We still feel that 3 days of rest without exercise post-concussion is beneficial. “Available evidence suggests that gradual resumption of physical activity should begin as soon as tolerated following an acute concussion, with the exception of activities likely to increase the risk of re-injury.”
As with all activities attempted during a concussion, if the activity (cognitive or physical) worsens concussion symptoms, it is best to stop and rest. We definitely recommend no contact activity until cleared by a primary care provider or concussion specialist because there is an increased risk of repeat concussion (i.e reinjury).
Talk to your concussion provider before beginning any physical activity after a concussion about what is right for you or your child.
References:
Recommendation for Complete Rest Until Symptom-Free After Concussion May Not Be Best Approach for Recovery. https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/Recommendation-for-Complete-Rest-Until-Symptom-Free-After-Concussion-May-Not-Be-Best-Approach.aspx
Association Between Early Participation in Physical Activity Following Acute Concussion and Persistent Postconcussive Symptoms in Children and Adolescents Anne M. Grool, MD, PhD1; Mary Aglipay, MSc1; Franco Momoli, PhD1; et alWilliam P. Meehan III, MD2; Stephen B. Freedman, MDCM, MSc3; Keith Owen Yeates, PhD4; Jocelyn Gravel, MD5; Isabelle Gagnon, PhD6; Kathy Boutis, MD7; Willem Meeuwisse, MD, PhD8; Nick Barrowman, PhD1; Andrée-Anne Ledoux, PhD1; Martin H. Osmond, MDCM9; Roger Zemek, MD9; JAMA. 2016;316(23):2504-2514
Summary of evidence-based guideline update: evaluation and management of concussion in sports: report of the Guideline Development Subcommittee of the American Academy of Neurology. Giza CC1, Kutcher JS, Ashwal S, Barth J, Getchius TS, Gioia GA, Gronseth GS, Guskiewicz K, Mandel S, Manley G, McKeag DB, Thurman DJ, Zafonte R. Neurology. 2013 Jun 11;80(24):2250-7.
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Current evidence supports a brief rest period of about 3-5 days after injury. After this initial phase, light aerobic activity such as walking or stationary cycling can begin as long as symptoms do not significantly worsen. Every case is different, so it is important to follow guidance from a healthcare provider.
Low-intensity, non-contact aerobic activities are typically recommended first. These may include walking, light cycling, or gentle treadmill use. Activities with a high risk of falling, contact, or head impact should be avoided until full medical clearance is given.
Studies suggest that early sub-symptom aerobic exercise may reduce post-concussion symptoms more quickly, improve sleep, support mental health, and help with return to school or cognitive performance. It may also reduce the risk of prolonged recovery compared to strict inactivity.
Yes. Extended complete rest can sometimes contribute to fatigue, mood changes such as anxiety or depression, physical deconditioning, and delayed recovery. While rest is important in the first few days, gradual reintroduction of activity is now considered beneficial for most patients.
If physical activity significantly worsens symptoms such as headache, dizziness, nausea, or confusion, it should be stopped immediately. Mild temporary increases in symptoms may occur, but persistent or severe symptom flare-ups mean the intensity should be reduced. Always consult a concussion specialist or primary care provider for individualized guidance.
Returning to exercise after a concussion should be gradual, supervised, and tailored to the individual. With proper guidance, early controlled activity can be a safe and helpful part of recovery.
