Early return to social and physical activity after a concussion in youth can improve concussion symptoms when compared with rest, according to a systematic review and meta-analysis published in Pediatrics.

Concussions are highly prevalent in youth and the younger population has a slower recovery rate compared with adults. While rest was previously preferred for concussions, more recent guidelines have preferred an early return to social and physical activity. Researchers conducted a systematic review and meta-analysis to assess the efficacy of early return to social and physical activity, following a concussion compared with rest. 

The databases included in this study were Medline Ovid, Embase Ovid, CINAHL EBSCO, and PsychINFO. The researchers included studies composed of youth participants aged 0 to 18 years with at least 1 concussion. Studies with both youth and adult populations were included in the analysis if there were more youth than adults (>50%). Only peer-reviewed journals published in English were included in the analysis. 

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Physical activity included both aerobic and anaerobic activities. Social activities were defined as activities that engaged a participant based on their interactions with peers, social settings, and interests. 

The primary outcome was recovery following concussion and studies reporting symptom relief, quality of life, and days until return to preinjury activity were included in the analysis. 

There were 5,642 studies identified using the search strategy and a total of 5,618 studies were excluded from the analysis. Of these studies, 24 were included in the final analysis, 10 of these studies were randomized control trials, and the sample sizes ranged from 6 to 677 participants. There were 4 studies with adult populations. All studies included physical activity, with aerobic exercise included in 17 studies.

A meta-analysis was conducted using data from 7 randomized control trials reporting symptom resolution. Engagement in physical and social activities significantly affected symptom resolution (standardized mean difference [MD], 0.39; 95% CI, 0.15-0.63; I2, 0%; P = .002).

There were 2 studies that reported the Pediatric Quality of Life Inventory (PedsQL), which assessed both child and patient quality of life. A meta-analysis was conducted for these studies, showing that engagement in physical and social activities had no significant effects on QoL (MD, -0.91; 95% CI, -7.76 to 5.94; I2, 0%; P = .79).

A meta-analysis was not conducted for studies reporting the effect of physical activity on days to preinjury activity levels because only 1 study was identified. This study did not show significant results between rest vs exercise in returning to full activity. 

“Notably, return to activity guidelines after concussion presents a clear path for a safe return to activity,” the researchers noted. “When following guidelines, individuals slowly progress the level of activity participation depending on the prevalence of worsening or new emerging symptoms.”

Study limitations included the exclusion of 1 outcome from analysis, variation in intervention initiation, a high risk of bias in some studies, and lack of social activity interventions. 


Chauhan R, Cheng A, Tsow R, Sakakibara BM, Babul S, Schmidt J. Activity and recovery among youth with concussion: a meta-analysisPediatrics. Published online April 19, 2023. doi:10.1542/peds.2022-059592

This article originally appeared on Neurology Advisor