Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA.
Department of Health, Kinesiology & Applied Physiology, Concordia University, Montreal, QC, Canada.
Sports Med. 2023 Oct;53(10):1987-1999. doi: 10.1007/s40279-023-01861-w. Epub 2023 May 20.
Growing evidence indicates early exercise may improve symptoms and reduce clinical recovery time after concussion, but research examining collegiate student-athletes is scarce.
The aim of this study was to compare symptom recovery time, clinical recovery time, and persisting post-concussion symptom (i.e., symptoms ≥ 28 days) prevalence by the timing of light exercise initiation before the graded return to play (RTP) protocol among concussed participants.
Collegiate student-athletes (n = 1228; age 18.4 ± 0.9 years; 56.5% male, 76.3% division I; 33.7% ≥ 1 prior concussion) across 30 institutions enrolled in the CARE Consortium completed post-concussion assessments and were monitored over time. Symptom recovery (days from injury to symptom resolution) and clinical recovery (days from injury to return to play protocol completion) was determined by the student-athletes' clinicians. Student-athletes were categorized by timing of light exercise initiation. Early (< 2 days post-concussion; n = 161), typical (3-7 days post-concussion; n = 281), and late exercise (≥ 8 days post-concussion; n = 169) groups were compared with the no-exercise group (n = 617; i.e., did not exercise prior to beginning the RTP protocol) for all analyses. Multivariable Cox regression models with hazard ratios (HR) and survival curves and a multivariable binomial regression model with prevalence ratios (PR) compared recovery outcomes between exercise groups while accounting for covariates.
Compared to the no-exercise group, the early exercise group was 92% more probable to experience symptom recovery (HR 1.92; 95% CI 1.57-2.36), 88% more probable to reach clinical recovery (HR 1.88; 95% CI 1.55-2.28) and took a median of 2.4 and 3.2 days less to recover, respectively. The late exercise group relative to the no-exercise group was 57% less probable to reach symptom recovery (HR 0.43; 95% CI 0.35-0.53), 46% less probable to achieve clinical recovery (HR 0.54; 95% CI 0.45-0.66) and took 5.3 days and 5.7 days more to recover, respectively. The typical exercise group did not differ in hazard for symptom or clinical recovery (p ≥ 0.329) compared with the no-exercise group. The prevalence of persisting post-concussion symptoms in the combined sample was 6.6%. Early exercise had 4% lower prevalence (PR 0.96, 95% CI 0.94-0.99) and typical exercise had 3% lower prevalence (PR 0.97, 95% CI 0.94-0.99) of persisting post-concussion symptoms, while the late exercise group had an elevated prevalence (PR 1.11, 95% CI 1.04-1.18) compared with the no-exercise group.
Exercise < 2 days post-concussion was associated with more probable and faster symptom and clinical recovery, and lower persisting post-concussion symptom prevalence. When considering our findings and existing literature, qualified clinicians may implement early exercise into their clinical practice to provide therapeutic treatment and improve student-athlete recovery.
越来越多的证据表明，早期运动可能会改善脑震荡后的症状并缩短临床康复时间，但针对大学生运动员的研究却很少。
本研究旨在比较在分级重返运动（RTP）方案前开始轻度运动的时间对脑震荡参与者的症状恢复时间、临床康复时间和持续性脑震荡后症状（即症状持续时间≥28 天）发生率的影响。
来自 30 个机构的 1228 名大学生运动员（年龄 18.4±0.9 岁；56.5%为男性，76.3%为一级联盟；33.7%≥1 次脑震荡史）参加了 CARE 联盟研究，并接受了长期监测。症状恢复（从受伤到症状缓解的天数）和临床康复（从受伤到完成 RTP 方案的天数）由运动员的临床医生确定。根据轻度运动开始的时间，运动员分为早期（<2 天；n=161）、典型（3-7 天；n=281）和晚期（≥8 天；n=169）运动组，与不运动组（n=617；即在开始 RTP 方案前不运动）进行比较。多变量 Cox 回归模型的风险比（HR）和生存曲线，以及多变量二项式回归模型的优势比（PR）用于比较运动组之间的恢复结果，同时考虑了协变量。
与不运动组相比，早期运动组更有可能在症状恢复方面获得 92%的可能性（HR 1.92；95%置信区间 1.57-2.36），在临床康复方面获得 88%的可能性（HR 1.88；95%置信区间 1.55-2.28），分别减少了 2.4 和 3.2 天的恢复时间。与不运动组相比，晚期运动组更有可能在症状恢复方面获得 57%的可能性（HR 0.43；95%置信区间 0.35-0.53），在临床康复方面获得 46%的可能性（HR 0.54；95%置信区间 0.45-0.66），分别需要 5.3 和 5.7 天的恢复时间。与不运动组相比，典型运动组在症状或临床康复方面的风险无显著差异（p≥0.329）。在合并样本中，持续性脑震荡后症状的发生率为 6.6%。早期运动组的发生率低 4%（PR 0.96，95%置信区间 0.94-0.99），典型运动组的发生率低 3%（PR 0.97，95%置信区间 0.94-0.99），而晚期运动组的发生率高 11%（PR 1.11，95%置信区间 1.04-1.18）。
脑震荡后<2 天开始运动与更有可能更快地恢复症状和临床症状，以及更低的持续性脑震荡后症状发生率有关。在考虑到我们的发现和现有文献后，合格的临床医生可能会将早期运动纳入其临床实践中，以提供治疗和改善运动员的康复。
