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Use of Supervised Exercise During Recovery Following Sports-Related Concussion

Popovich, Michael MD, MPH*; Almeida, Andrea MD*; Freeman, Jeremiah BS, ATC; Eckner, James T. MD, MS; Alsalaheen, Bara PhD*; Lorincz, Matthew MD, PhD*; Sas, Andrew MD, PhD*

doi: 10.1097/JSM.0000000000000721
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Objective: To assess the safety of supervised exercise (SE) in acute sport-related concussion (SRC) and its influence on recovery.

Design: Retrospective cohort study.

Setting: University SRC clinic at a tertiary care center.

Patients: One hundred ninety-four consecutive new patient charts were reviewed. Patients were included if they were seen within 30 days of sustaining a SRC, and their medical records included all required data elements. One hundred twenty-six patients were included in the analysis.

Interventions: Symptomatic patients who initiated SE within 16 days of SRC (n = 24) were compared with those who did not undergo SE or initiated SE after postinjury day 16 (n = 84). Age, sex, history of previous concussions, injury severity, relevant comorbidities, and other treatments received were included in the analysis.

Main Outcome Measures: The association between early SE and clearance for return to sport was determined using a hazard ratio (HR). The number of days from SRC until clearance for return to sport and the number of days symptomatic from concussion were also compared between early SE and nonearly SE cohorts.

Results: No serious adverse events occurred in the early SE group. Early SE was associated with earlier return to sport (HR = 2.35, P = 0.030). The early SE group had fewer days from SRC until clearance for return to sport (mean 26.5 ± 11.2 days vs 35.1 ± 26.5 days, P = 0.020). There was a trend toward fewer symptomatic days in the early SE group (P = 0.054).

Conclusion: Early SE performed in the symptomatic stage of SRC was safe and associated with earlier return to sport.

*Department of Neurology, University of Michigan, Ann Arbor, Michigan;

Sports Medicine and Physical Therapy, University of Michigan, Ann Arbor, Michigan; and

Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan.

Corresponding Author: Andrew Sas, MD, PhD, Department of Neurology, University of Michigan, 4000 Ave Marie Drive, Lobby A, Suite 1000, Ann Arbor, MI 48105 (asas@med.umich.edu).

The authors report no conflicts of interest.

Statement of ethics approval: This work was reviewed and approved by IRB: HUM00094829.

Received July 27, 2018

Accepted December 21, 2018

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