Early Exercise is Associated with Faster Concussion Recovery Among Collegiate Athletes: Findings from the NCAA-DoD CARE Consortium,Sports Medicine

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Early Exercise is Associated with Faster Concussion Recovery Among Collegiate Athletes: Findings from the NCAA-DoD CARE Consortium
Sports Medicine ( IF 9.3 ) Pub Date : 2023-05-20 , DOI: 10.1007/s40279-023-01861-w
Landon B Lempke ₁ , Elizabeth F Teel ₂ , Robert C Lynall ₃ , Nicole L Hoffman ₄ , Thomas A Buckley ₅ , James T Eckner ₆ , Michael A McCrea ₇ , Thomas W McAllister ₈ , Steven P Broglio ₁ , Julianne D Schmidt ₂ ,

Affiliation

Background

Growing evidence indicates early exercise may improve symptoms and reduce clinical recovery time after concussion, but research examining collegiate student-athletes is scarce.

Objective

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.

Methods

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.

Results

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.

Conclusion

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.

中文翻译：

早期锻炼与大学运动员脑震荡恢复更快有关：NCAA-DoD CARE 联盟的调查结果

背景

越来越多的证据表明，早期锻炼可以改善症状并缩短脑震荡后的临床恢复时间，但针对大学生运动员的研究却很少。

客观的

本研究的目的是通过在脑震荡患者中分级恢复比赛 (RTP) 方案之前开始轻度运动的时间来比较症状恢复时间、临床恢复时间和持续性脑震荡后症状（即症状≥ 28 天）的患病率参与者。

方法

参加 CARE 联盟的 30 个机构的大学生运动员（n = 1228；年龄 18.4 ± 0.9 岁；56.5% 为男性，76.3% I 级；33.7% ≥ 1 次既往脑震荡）完成了脑震荡后评估，并进行了长期监测。症状恢复（从受伤到症状消失的天数）和临床恢复（从受伤到返回比赛方案完成的天数）由学生运动员的临床医生确定。学生运动员根据开始轻度运动的时间进行分类。将早期（脑震荡后 < 2 天；n = 161）、典型（脑震荡后 3-7 天；n = 281）和晚期运动（脑震荡后 ≥ 8 天；n = 169）组与无运动组进行比较。 -所有分析的运动组（n = 617；即，在开始 RTP 方案之前没有运动）。具有风险比 (HR) 和生存曲线的多变量 Cox 回归模型以及具有患病率 (PR) 的多变量二项式回归模型比较了运动组之间的恢复结果，同时考虑了协变量。

结果

与不运动组相比，早期运动组症状恢复的可能性高出 92%（HR 1.92；95% CI 1.57–2.36），达到临床康复的可能性高出 88%（HR 1.88；95% CI 1.55– 2.28），恢复时间中位数分别减少了 2.4 天和 3.2 天。与不运动组相比，晚期运动组达到症状恢复的可能性降低 57%（HR 0.43；95% CI 0.35–0.53），实现临床恢复的可能性降低 46%（HR 0.54；95% CI 0.45–0.66）），分别需要 5.3 天和 5.7 天才能恢复。与不运动组相比，典型运动组在症状或临床恢复方面没有差异（p≥0.329 ）。合并样本中持续性脑震荡后症状的患病率为 6.6%。早期锻炼组的持续性脑震荡后症状患病率降低了 4%（PR 0.96，95% CI 0.94–0.99），典型锻炼组的持续性脑震荡后症状患病率降低了 3%（PR 0.97，95% CI 0.94–0.99），而晚期锻炼组则降低了 3% 的患病率（PR 0.97，95% CI 0.94–0.99）。与不运动组相比，患病率升高（PR 1.11，95% CI 1.04-1.18）。