Physical activity following sport-related concussion in adolescents: a systematic review.

When a teenager suffers a concussion playing sports, one practical question is how soon and how much movement is safe, since both too much and too little activity could slow recovery. This review pulled together 22 studies looking at daily physical activity, structured active rehabilitation programs, and single bouts of exertion testing in adolescents recovering from sport-related concussion. Across this evidence, daily physical activity or active rehabilitation programs involving light exercise below the threshold that triggers symptoms were associated with fewer symptoms and a shorter time to medical clearance, and brief exertion testing appeared feasible. The finding is interesting because it challenges strict rest-based recovery approaches, but the underlying studies were mostly non-randomized, methodological quality varied considerably, and only two randomized controlled trials were included, so confidence in these associations remains limited.

If your teenager has had a sports-related concussion, you may wonder how much activity is okay during recovery. This review gathered 22 studies looking at exactly that question, comparing daily light physical activity, structured exercise programs, and brief tests of exertion in young athletes recovering from concussion. The overall pattern across these studies suggested that gentle daily activity, kept below the level that brings on symptoms, was linked with fewer symptoms and a shorter time until doctors cleared the athlete to return.

Brief exercise testing also seemed feasible in this research. However, most of the underlying studies were not strong randomized trials, and the quality of the research varied a lot, so these findings should be seen as encouraging associations rather than proven cause-and-effect.

This research doesn't tell you exactly when or how much activity is right for any individual, since that depends on each young person's own symptoms and recovery.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This review addresses a recurring clinical question in pediatric concussion management: whether early, graded physical activity helps or hinders recovery compared with strict rest. It synthesises 22 studies across three categories, daily physical activity, active rehabilitation/exercise programs (typically 20 minutes of daily aerobic activity below symptom threshold), and single-bout exertion testing, in adolescents under 18 assessed within one to two weeks (acute) or four weeks (prolonged recovery) of sport-related concussion. The body of evidence suggests that daily physical activity and structured sub-symptom-threshold exercise programs are associated with reduced symptom burden and fewer days to medical clearance, and that single bouts of exertion testing were reported as feasible, informing a shift away from prolonged rest-based protocols.

However, risk-of-bias scores ranged widely (7 to 24) and only two randomized controlled trials were included, meaning most findings come from observational or lower-quality designs and should be interpreted as associations rather than established treatment effects. The review does not establish optimal timing, intensity, duration, or modality of activity, nor does it differentiate outcomes by concussion subtype, so it cannot yet inform a specific return-to-activity protocol.