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Evidence grows showing benefits of post-concussion exercise but causation yet to be proven, UB expert says

By ELLEN GOLDBAUM

Published December 22, 2016

“The study published this week tells us that strict rest after a concussion is not the way to go. What it doesn’t tell us is whether exercise is definitely better.”
John Leddy, medical director
UB Concussion Management Clinic

UB researchers say an observational study published this week in the Journal of the American Medical Association is part of a growing body of evidence suggesting that long periods of rest may not help concussion patients recover. The research shows an association between fewer post-concussion symptoms and early post-concussion physical activity.

The UB researchers first reported in 2010 that sub-threshold physical activity was therapeutic in athletes and non-athletes who had a concussion, but they note the new study by Canadian researchers still doesn’t prove causation.

“The study published this week tells us that strict rest after a concussion is not the way to go,” says John J. Leddy, medical director of the UB Concussion Management Clinic, a physician with UBMD Orthopaedics & Sports Medicine, and clinical professor in the Department of Orthopaedics in the Jacobs School of Medicine and Biomedical Sciences. “What it doesn’t tell us is whether exercise is definitely better.”

Because the new study is observational, it doesn’t control for possible confounding factors, as would be the case in a randomized, controlled clinical trial in which participants are randomly assigned to an intervention or a control group, he adds.

That’s the goal of a study Leddy is currently conducting; it is the first randomized, controlled clinical trial of individualized exercise for the treatment of sport-related concussions in adolescents within the first week after injury. Leddy is conducting it with co-investigator Barry S. Willer, director of research for the UB Concussion Management Clinic and professor in the Department of Psychiatry.

“Our study hypothesis is that early, controlled exercise below the threshold where symptoms are exacerbated will speed recovery from concussion,” Leddy says. “We’ve always maintained that the level of physical activity after a concussion should be individualized and should always stay below the level where it would exacerbate symptoms.”

Funded by the Ralph C. Wilson Foundation and the Program for Understanding Childhood Concussion and Stroke, it is being conducted by physicians at UBMD Orthopaedics & Sports Medicine,  part of the practice plan of the Jacobs School of Medicine and Biomedical Sciences, and through the University of Manitoba in Canada.

Results of the study, to be completed on approximately 100 adolescents who have experienced a concussion while playing a sport, are expected toward the end of 2017.

Earlier this year, the National Institutes of Health also funded Leddy and Willer to investigate the physiological mechanisms involved in adolescents who experience a concussion in order to better understand and treat the condition.