The Safety and Efficacy of Sub-Symptom Threshold Exercise as a Treatment for Post-Concussion Symptoms in Adolescents

Abstract Introduction: Concussions are an unfortunately common injury sustained by many young athletes participating in a variety of sports throughout the country. Concussions are notoriously difficult to diagnose and may lead to serious, long-term difficulties if left untreated or treated incorrectly. Severe or repeated concussions can lead to many physical, psychological, neurological, and other symptoms that could potentially lead to death. Current concussion treatment is largely physical and cognitive rest. This research study aims to identify how limited exercise may decrease the duration of symptoms and make it safer for athletes to resume participation in their sport. Methods: A literature search was performed and completed in November of 2019 using the PUBMED and EBSCO search databases. 11 articles were chosen based on inclusion/exclusion criteria as well as the date they were completed. These articles were then analyzed and their data were compared. Results: The studies evaluated demonstrated benefits to the use of exercise in decreasing post concussive symptoms. Several studies also evaluated and demonstrated the safety and tolerability of exercise programs in adolescents with neurologic symptoms post tbi or concussion. These studies used a variety of metrics, evaluation tools, and statistical tests to demonstrate improvements. However, only a few studies were able to collect follow up data at various points post evaluation. Also, a few studies were not able to use an adequate control group to demonstrate the success of the treatment across different populations. Finally, almost all studies were done on too small of sample sizes to allow for broad extrapolation of data. Discussion: The data collected from the studies were able to show strong data in support of sub-symptom threshold exercise as a better treatment option for adolescents with post-concussion symptoms than strict rest. Despite this, there are many factors that limit the generalizability of the data to state adequately that the exercise treatment is always both safer and more efficacious. More data must be collected through studies with larger sample sizes that extend over much longer periods of time to evaluate future health outcomes must be completed. One important finding of these data is that the findings were found to be safe, and negative findings were extremely minimal. Future, more robust studies should continue to employ and evaluate sub-symptom threshold exercise as a treatment plan for adolescents with post-concussion symptoms. Conclusion: Concussions continue to be a very common issue in adolescent athletes, and a solution on how best to treat them continues to be a mystery. Previous treatment plans have stuck largely to a program of strict cognitive and physical rest until the symptoms improve. As demonstrated in the studies highlighted, properly implemented and monitored exercise has shown data indicating its efficacy as a superior treatment. However, further, more robust studies must be completed to show increased generalizability and long term success before these exercise treatments can be implemented as a mainstream treatment. The demonstrated safety of the exercise and positive findings shown make further research crucial and worthwhile to improve treatment for these millions of adolescent athletes