Aerobic Exercise for Sport-related Concussion: A Systematic Review and Meta-analysis.

INTRODUCTION Approximately 25% of people with sport-related concussion (SRC) experiences persistent symptoms. The 2016 Berlin consensus on SRC recommends symptom-limited aerobic exercise as a rehabilitation option for persistent symptoms after concussion. However, this recommendation is based on a limited body of knowledge as there is uncertainty about the effectiveness of such interventions. The objective of this systematic review is to assess the effects of symptom-limited aerobic exercise programs compared to control interventions on symptom intensity in individuals with SRC. METHODS A structured search was conducted in MEDLINE, EMBASE, CINHAL, EBM Reviews. Randomized clinical trials (RCTs) including aerobic exercise programs as an intervention for SRC were included. Following selection, the risk of bias and GRADE recommendations were applied to pooled studies for quantitative analysis. Standard mean differences (SMD 95% CI) were calculated. A descriptive analysis was also performed. RESULTS Seven RCTs (326 participants) in adolescent populations were included. Three out of seven RCTs had a high risk of bias. Symptom-limited aerobic exercise programs have a significant beneficial effect on the perception of symptoms (6 studies, 277 participants, low quality evidence, pooled SMD 95%CI: -0.44 [-0.68, -0.19]). When introduced in the acute phase, symptom-limited aerobic exercise programs have a significant beneficial effect on symptomatic recovery compared to control interventions (3 studies, 206 participants, moderate quality evidence, pooled SMD 95%CI: -0.43 [-0.71, -0.15]). CONCLUSION Symptom-limited aerobic exercise programs are beneficial in improving symptoms of adolescents following a SRC. Good quality studies are needed to determine effects on adults and on other outcomes.