Comparison of Rest to Aerobic Exercise and Placebo-Like Treatment of Acute Sport-Related Concussion in Male and Female Adolescents

Abstract Objective To compare a sample of adolescents with SRC who were prescribed rest with two arms of a RCT comparing aerobic exercise to placebo-like stretching. We also compared sex differences across the three approaches to treatment. Design Quasi-experimental trial Setting University concussion management clinics Participants Adolescent athletes (aged 13-18 years) presenting within 10 days of SRC (mean 5 days after injury) received a recommendation for rest (Rest Group [RG], n=48, 15.4±1 years, 25% female). Their outcomes were compared with matched samples of adolescents assigned to aerobic exercise (Exercise Group [EG], n=52, 15.3±2 years, 46% female) or placebo-like stretching (Placebo Group [PG], n=51, 15.4±2 years, 47% female). Main Outcome Measures The primary outcome was median days from injury to recovery. The secondary outcome was proportion classified as normal recovery ( Results RG recovered in 16 days (IQR 9.25, 23.25), which was significantly delayed (p=0.020) compared with EG (13 days interquartile [IQR] 10, 18.5). The PG recovered in 17 days (IQR 13, 23). Four percent of EG, 14% of PG and 13% of RG had delayed recovery (p=0.190). There was no difference in recovery time or delayed recovery between males and females across groups. Females prescribed rest experienced an increase in symptoms versus the other groups (p=0.013). Conclusion Relative rest and a placebo-like stretching program were very similar in days to recovery and symptom improvement pattern after SRC. Both conditions were less effective than sub-symptom threshold aerobic exercise. Females appear to be susceptible to symptom increase when prescribed rest.