21 Dec Early Participation in Physical Activity Following Acute Concussion in Children
MedicalResearch.com Interview with:
Roger Zemek, MD, FRCPC
Associate Professor, Dept of Pediatrics and Emergency Medicine, Clinical Research Chair in Pediatric Concussion, University of Ottawa
Director, Clinical Research Unit,
Children’s Hospital of Eastern Ontario
MedicalResearch.com: What is the background for this study?
Response: While current concussion protocols endorse the conservative view that children should avoid physical activity until completely symptom-free, there is little evidence beyond expert opinion regarding the ideal timing of physical activity re-introduction. In fact, while rest does play a role in concussion recovery, protracted physical rest may actually negatively impact concussion recovery. Further, physiological, psychological, and functional benefits of early physical rehabilitation are observed in other disease processes such as stroke (which is an example of a severe traumatic brain injury). Therefore, our objective was to investigate the relationship between early physical activity (defined within 7 days of the concussion) and the eventual development of persistent post-concussion symptoms at one month.
MedicalResearch.com: What are the main findings?
Response: 2413 children completed this study that recruited across 9 Pediatric emergency departments in Canada. Those children who had early participation in physical activity (within one week following their concussion) had a significantly reduced risk of persistent symptoms at one month compared to those who had no physical activity (25% versus 43%). The risk remained significantly lower regardless of the self-reported intensity of exercise. In this study, we also matched those children who did activity to those who did not. After matching to ensure balance between the groups, early participation in physical activity remained associated with lower risk for ongoing symptoms at one month.
MedicalResearch.com: What should readers take away from your report?
Response: Among children and adolescents aged 5 to 18 years with acute concussion, participation in physical activity within 7 days of acute injury compared with no physical activity was associated with lower risk of having persistent symptoms at one month. Our findings suggest that there may need to consider moving away from recommendations for strict conservative rest towards more active physical rehabilitation following concussion. However, regardless of potential benefit, it is still important to have caution in the immediate post-injury period; patients should always be removed from the field of play if a concussion is suspected. Further, return to participation activities that might introduce risk for collision (such as contact sports) or falls (such as skiing, skating) should remain prohibited until the patient has been cleared by a qualified health professional.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Randomized clinical trials are urgently needed to confirm these findings and to determine the optimal timing of the initiation of physical activity following concussion.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Grool AM, Aglipay M, Momoli F, Meehan WP, Freedman SB, Yeates KO, Gravel J, Gagnon I, Boutis K, Meeuwisse W, Barrowman N, Ledoux A, Osmond MH, Zemek R, for the Pediatric Emergency Research Canada (PERC) Concussion Team. Association Between Early Participation in Physical Activity Following Acute Concussion and Persistent Postconcussive Symptoms in Children and Adolescents. JAMA.2016;316(23):2504-2514. doi:10.1001/jama.2016.17396
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