Exercise after concussion: Is it safe and when is it okay?

Exercise after a concussion

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. 

Why are recommendations changing?

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.

What are the benefits of earlier exercise post-concussion?

  • Decrease in post-concussion symptoms sooner
  • Improved sleep
  • Improvements in mental health, including decreasing anxiety and depression
  • Improvement in academics and cognitive performance

What are potential problems with prolonged rest and no physical activity?  

  • Fatigue
  • Depression
  • Deconditioning
  • Delayed recovery

How soon is too soon to exercise? 

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.


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, PhD1Mary Aglipay, MSc1Franco Momoli, PhD1; et alWilliam P. Meehan III, MD2Stephen B. Freedman, MDCM, MSc3Keith Owen Yeates, PhD4Jocelyn Gravel, MD5Isabelle Gagnon, PhD6Kathy Boutis, MD7Willem Meeuwisse, MD, PhD8Nick Barrowman, PhD1Andrée-Anne Ledoux, PhD1Martin H. Osmond, MDCM9Roger Zemek, MD9JAMA. 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 CC1Kutcher JSAshwal SBarth JGetchius TSGioia GAGronseth GSGuskiewicz KMandel SManley GMcKeag DBThurman DJZafonte R.  Neurology. 2013 Jun 11;80(24):2250-7.


Emily and Meredith

CPNP's at SportsSafe