by Sean Phillips, PT, DPT, OCS

Sports-related concussion (SRC) is a very common sports injury in America and can affect people of all ages. Concussions are a physiological event in which the brain and head are rapidly moved, typically as a result of a hit or sudden loss of momentum. Although the CDC classifies concussions as a mild traumatic brain injury (TBI), the symptoms can be severely limiting and long-lasting. In the article, “Exercise is Medicine for Concussions” by Leddy et al., researchers reviewed the treatment approaches for athletes with concussions utilizing low-threshold exercise intensity for rehabilitation. 

Concussions can produce many symptoms in an athlete, but one of the most common is exercise intolerance. Current research suggests that this is caused by a concussion’s effects on an individual’s autonomic nervous system (ANS), which plays a large role in respiration. When the ANS is damaged, ventilation can be limited in proportion to activity or exercise intensity leading to an accumulation of CO2 in the arterial blood (PaCO2). Once this occurs the cerebral blood flow will also be out of proportion to exercise and produce the intolerance that many people display. 

Through a variety of experimental and observational data, researchers have identified that sub-threshold aerobic exercise can help normalize these levels and reduce a person’s symptoms. Therefore, exercise is essentially “medicine” for athletes or individuals recovering from a concussion. 

This article reviewed two different techniques of finding the proper heart rate dosing for the correct level of sub-threshold exercises. These included the Buffalo Concussion Treadmill Test (BCTT) and Buffalo Concussion Bike Test (BCBT). Once the target heart rate is determined, an individual may be able to safely speed recovery from a concussion. This is most effectively accomplished with consistent supervision from an experienced healthcare professional such as a physical therapist in order to ensure the athlete stays within his or her target levels. 

In conclusion, this article provided evidence for safe and effective ways to reduce or prevent prolonged symptoms from SRC utilizing individualized exercise dosing and monitoring. If you are experiencing any lingering exercise intolerance following a concussion, consult your doctor or contact a physical therapist near you to help return to your normal levels. 


Article: Exercise is Medicine for Concussions; Leddy JJ, Haider MN, Ellis M, Willer BS; Curr Sports Med Rep. 2018 August ; 17(8): 262–270. doi:10.1249/JSR.0000000000000505