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 because 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 with control interventions on symptom intensity in individuals with SRC.
Methods: A structured search was conducted in MEDLINE, EMBASE, CINHAL, and EBM reviews. Randomized clinical trials (RCT) including aerobic exercise programs as an intervention for SRC were included. After selection, the risk of bias and Grading of Recommendations, Assessment, Development and Evaluation recommendations were applied to pooled studies for quantitative analysis. Standard mean differences (SMD) and 95% confidence interval (CI) were calculated. A descriptive analysis was also performed.
Results: Seven RCT (326 participants) in adolescent populations were included. Three of seven RCT 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, -0.44; 95% CI, -0.68 to -0.19). When introduced in the acute phase, symptom-limited aerobic exercise programs have a significant beneficial effect on symptomatic recovery compared with control interventions (3 studies, 206 participants, moderate quality evidence, pooled SMD, -0.43; 95% CI, -0.71 to -0.15).
Conclusions: Symptom-limited aerobic exercise programs are beneficial in improving symptoms of adolescents after an SRC. Good-quality studies are needed to determine effects on adults and on other outcomes.