6.14 Early Exercise is Associated with Reduced Risk of Persisting Post-Concussion Symptoms among Collegiate Athletes: Findings from the NCAA-DOD Care Consortium

Objective To determine if the timing of light exercise initiation influences persisting post-concussion symptom (PPCS) prevalence in collegiate student-athletes with concussion. Design Prospective, longitudinal cohort. Setting National College Athletic Association institutions (n=30). Participants Collegiate student-athletes experiencing concussion (n=1228; age=18.4±0.9yrs; 56.5% male, 76.3% Division-I, 33.7% prior concussion history). Intervention Student-athletes were categorized by timing of light exercise prior to full symptom recovery and return-to-play protocol initiation. Exercise categories were early (≤2 days post-concussion), typical (3–7 days post-concussion), late (≥8 days post-concussion but prior to symptom recovery), and none (no exercise prior to symptom recovery). Outcome Measures Student-athletes completed the Sport Concussion Assessment Tool (SCAT) symptom inventory (22-items, total severity score: 0–132) throughout recovery. PPCS (yes/no) was defined as continuing symptoms on the SCAT symptom inventory ≥4 weeks post-concussion. A multivariable binomial regression with prevalence ratios (PR) and 95% confidence intervals (95%CI) compared PPCS between exercise groups while covarying for initial (<48hrs) SCAT symptom severity, sex, immediate removal from play, delayed symptom presentation, and sport contact classification. Main Results PPCS prevalence was low across all exercise groups (early=0.7%, typical=3.4%, late=20.6%, none=5.6%). Early exercise (PR=0.96, 95%CI:0.94–0.99; p=0.007) and typical exercise (PR=0.97, 95%CI:0.94–0.99; p=0.022) initiation had significantly reduced PPCS prevalence compared to the no exercise group, while the late exercise group had 11% increased prevalence (PR=1.11, 95%CI:1.04–1.18; p=0.001). Conclusions Light exercise initiation before the Concussion in Sport Group's current recommendations for 24–48hrs of physical rest was associated with reduced PPCS prevalence in collegiate student-athletes. Future studies should evaluate specific exercise prescriptions to optimize recovery outcomes.