BUFFALO, N.Y. -- University at Buffalo researchers are the first
to show that a controlled individualized exercise training program
can bring athletes and others suffering with post-concussion
syndrome (PCS) back to the playing field or to their daily
In a paper published in the January issue of the Clinical
Journal of Sport Medicine, the researchers report that a program of
progressive exercise developed individually for each participant
and performed at levels just below the onset of symptoms is safe
and can relieve nearly all PCS symptoms.
Their results counter the accepted wisdom that PCS should be
treated with rest, reassurance and antidepressants, and that
physical activity should be avoided.
"Perhaps the most exciting aspect of this study is that all of
the subjects that participated, both athletes and non-athletes, got
better eventually, although the athletes certainly improved the
fastest," says Barry Willer, PhD, UB professor of psychiatry and
rehabilitation sciences and senior author on the study.
"It also was reassuring to discover that the use of exercise was
safe and did not prolong symptoms, a worry expressed by other
John J. Leddy, MD, associate professor of orthopaedics and
co-director of UB's Sports Medicine Institute, where the study was
conducted, is first author on the study. Willer, Leddy and Karl
Kozlowski, PhD, UB clinical instructor of exercise and nutrition
sciences, developed the exercise protocol. (To view a slide show
about a patient who participated in the UB program, go to http://www.youtube.com/watch?v=pUEmfnIIhwM.)
For unknown reasons, 5-10 percent of people who experience a
concussion have symptoms that persist beyond six weeks. These
persons are diagnosed with PCS. Previously there was no treatment
for the condition with proven success.
The UB regimen is based on the hypothesis that the regulatory
system responsible for maintaining cerebral blood flow, which may
be dysfunctional in people with a concussion, can be restored to
normal by controlled, graded, symptom-free exercise.
The researchers developed their program in 2004. "We were
testing athletes for return to sport using an exercise test," says
Willer, "and we decided that if an athlete becomes symptomatic at a
heart rate of, say, 140, maybe they could exercise at a heart rate
of 125, without complications. We soon discovered that the athletes
got better much quicker if they exercised."
Physicians in UB's Sports Medicine Concussion Clinic initially
used their approach only with athletes from UB teams, but word
spread, and they now have assessed and treated many professional
athletes, especially those from the National Hockey League.
"One of the advantages we offer to professional teams is a more
precise test of post-concussion syndrome," says Leddy. "If the
patient does not develop symptoms during the exercise test, then
the cause of their difficulties is likely to be another source.
Most commonly it is neck strain, which tends to cause headaches
that mimic post-concussion headache."
For the preliminary study just published, the researchers
enrolled six non-athletes who suffered concussions in auto
accidents or falls, along with six athletes, five who were injured
in their sport and one in a car accident.
Participants were tested initially on a treadmill to determine
the exercise intensity that triggered symptoms. With individual
baselines established, each participant exercised at 80 percent of
that intensity every day for three weeks and then returned for a
repeat test. In most instances, retesting demonstrated that
participants could work at a higher intensity and the exercise
protocol then was increased. This pattern continued until
participants could exercise completely without experiencing PCS
As might be expected, the athletes recovered more quickly than
the non-athletes, results showed. They returned to normal within 11
to 36 days, while the non-athletes required 41 to 112 days of
intervention. All participants had returned to work, school or
athletic activities at a three month post-program follow-up.
Ten of the 12 participants were completely free of symptoms at
follow-up. One participant still experienced cognitive and visual
symptoms, and another, who had a history of migraines, continued to
"The data suggest that some PCS symptoms are related to
disturbed cerebral autoregulation, and that after this treatment,
the brain was able to regulate blood flow when the blood pressure
rose during exercise," says Leddy. "We think progressive stepwise
aerobic training may improve cerebral autoregulation by
conditioning the brain to gradually adapt to repetitive mild
elevations of systolic blood pressure."
Kozlowski adds that although each concussion should be
considered a "unique injury," a randomized trial that included a
PCS control group should be conducted to address the possibility
that PCS symptoms would have resolved spontaneously without
"All of our subjects had been symptomatic for months before
treatment and were not getting better on their own," says
Kozlowski, "so we are pretty convinced that the regulated exercise
program did the trick." A grant application to NIH to conduct such
a randomized trial currently is under review.
James P. Donnelly, PhD, from the UB Department of Counseling,
School and Educational Psychology; David R. Pendergast, EdD, UB
professor of physiology and biophysics; and Leonard H. Epstein,
PhD, UB professor of pediatrics, also contributed to the study.
The study received financial support from the Buffalo Sabres
Foundation and the Robert Rich Family Foundation.
The University at Buffalo is a premier research-intensive public
university, a flagship institution in the State University of New
York system and its largest and most comprehensive campus. UB's
more than 28,000 students pursue their academic interests through
more than 300 undergraduate, graduate and professional degree
programs. Founded in 1846, the University at Buffalo is a member of
the Association of American Universities.