Background

Sport-related concussion is a public health problem, particularly in adolescents. Quality of life is reduced in adolescents with persistent post-concussive symptoms (symptoms >28 days). We replicated a previous randomised controlled trial to validate the safety, efficacy, and generalisability of, and objective adherence to, prescribed early targeted heart rate subsymptom threshold aerobic exercise compared with placebo-like stretching exercise for adolescent recovery from sport-related concussion and for reducing the risk of persistent post-concussive symptoms.

Methods

This randomised controlled trial was done at three community and hospital-affiliated sports medicine concussion centres in the USA. Male and female adolescent athletes (aged 13–18 years) presenting within 10 days of sport-related concussion were randomly assigned to individualised subsymptom threshold aerobic or stretching exercise at least 20 min daily, for up to 4 weeks after injury. Exercise adherence and intensity were measured by heart rate monitors. The primary outcome was clinical recovery (ie, return to baseline symptoms, normal exercise tolerance, and a normal physical examination) within the 4-week intervention period, and development of persistent post-concussive symptoms beyond 28 days after injury. This study is registered with ClinicalTrials.gov, NCT02959216.

Findings

Between Aug 1, 2018, and March 31, 2020, 118 adolescents were recruited (61 were randomly assigned to the aerobic exercise group and 57 to the stretching exercise group) and included in the intention-to-treat analysis. On survival analysis, controlling for sex, site, and mean daily exercise time, patients assigned to aerobic exercise were more likely to recover within 4 weeks after injury compared with those assigned to stretching exercise, with a 48% reduced risk of persistent post-concussive symptoms (hazard ratio for stretching vs aerobic exercise of 0·52 [95% CI 0·28–0·97], p=0·039). No adverse events were reported.

Interpretation

This multicentre study found that early treatment with subsymptom threshold aerobic exercise safely speeds recovery from sport-related concussion and reduces the risk for persistent post-concussive symptoms, an important result given the impact of delayed recovery on adolescent quality of life. Adherence was good and there were no adverse events from this non-pharmacological treatment. These results suggest that physicians should not only permit, but consider prescribing, early subsymptom threshold physical activity to adolescents as treatment for sport-related concussion and to reduce the risk of persistent post-concussive symptoms.

Funding

American Medical Society for Sports Medicine.

中文翻译：

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青少年运动相关脑震荡的早期目标心率有氧运动与安慰剂拉伸对比：一项随机对照试验

背景

与运动有关的脑震荡是一个公共卫生问题，尤其是在青少年中。有持续性脑震荡后症状（症状 > 28 天）的青少年的生活质量下降。我们复制了之前的随机对照试验，以验证规定的早期目标心率亚症状阈值有氧运动的安全性、有效性和普遍性以及客观遵守，与安慰剂样伸展运动相比，对于青少年从运动相关脑震荡中恢复和减少脑震荡后症状持续存在的风险。

方法

这项随机对照试验是在美国的三个社区和医院附属运动医学脑震荡中心进行的。在运动相关脑震荡后 10 天内出现的男性和女性青少年运动员（13-18 岁）被随机分配到个体化的亚症状阈值有氧运动或伸展运动中，每天至少 20 分钟，持续时间最长为受伤后 4 周。通过心率监测器测量运动依从性和强度。主要结局是在 4 周干预期内的临床恢复（即恢复到基线症状、正常运动耐量和正常体检），以及损伤后 28 天后持续性脑震荡后症状的发展。本研究已在 ClinicalTrials.gov 注册，NCT02959216。

发现

2018 年 8 月 1 日至 2020 年 3 月 31 日期间，招募了 118 名青少年（61 名随机分配到有氧运动组，57 名随机分配到伸展运动组）并纳入意向治疗分析。在生存分析中，控制性别、部位和平均每日运动时间后，与接受拉伸运动的患者相比，接受有氧运动的患者在受伤后 4 周内更有可能恢复，持续性脑震荡后遗症的风险降低 48%症状（拉伸与有氧运动的风险比为0·52 [95% CI 0·28–0·97]，p=0·039）。没有报告不良事件。

解释

这项多中心研究发现，使用亚症状阈值有氧运动进行早期治疗可以安全地加速运动相关脑震荡的恢复，并降低持续性脑震荡后症状的风险，鉴于延迟恢复对青少年生活质量的影响，这是一个重要的结果。依从性良好，这种非药物治疗没有出现不良事件。这些结果表明，医生不仅应该允许，而且应该考虑为青少年开具早期亚症状阈值的体力活动，作为与运动相关的脑震荡的治疗方法，并降低持续性脑震荡后症状的风险。

资金

美国运动医学会。