Adolescents with More Oculomotor and Vestibular Signs of Sport-Related Concussion Benefit from Aerobic Exercise: an Exploratory Analysis.

Early targeted heart rate (HR) aerobic exercise has been shown to reduce the duration of recovery from sport-related concussion (SRC) as well as the incidence of Persistent Post-Concussive Symptoms (PPCS). It is not known, however, if more severe oculomotor and vestibular presentations of SRC benefit from a prescription of aerobic exercise. The current study is an exploratory analysis of two published randomized controlled trials (RCTs) that compared aerobic exercise within 10 days of injury with a placebo-like stretching intervention. Combining the two studies yielded a larger sample size to stratify severity of concussion based on the number of abnormal physical examination signs present at the initial office evaluation, which were confirmed with self-reported symptoms and recovery outcomes. The most discriminant cut-off was between those who had ≤ 3 oculomotor and vestibular signs and those who had > 3 signs. Aerobic exercise (Hazard ratio = 0.621 [0.412, 0.936], p = 0.023) reduced recovery times even when controlling for site (Hazard ratio = 0.461 [0.303, 0.701], p < 0.001), severity (Hazard ratio = 0.528 [0.325, 0.858], p = 0.010) and the interaction term of intervention and severity (Hazard ratio = 0.972 [0.495, 1.909], p = 0.935). Adolescents who presented with >3 signs and were assigned to the placebo-like stretching group had a PPCS incidence of 38%, which was the highest of all subgroups (aerobic exercise and ≤ 3 findings: 8%; stretching and ≤ 3 findings: 11%; aerobic exercise and > 3 findings: 21%). This exploratory study provides pilot evidence that prescribed sub-symptom threshold aerobic exercise treatment early after SRC may be effective for adolescents with more oculomotor and vestibular physical examination signs and should be validated in future adequately powered trials.