Objective To conduct a systematic review and meta-analysis evaluating the role of exercise or rest in patients with concussion or mild traumatic brain injury.

Design Systematic review and meta-analysis.

Data sources Medline, PsychInfo, Scopus, Cochrane Controlled Trials Registers and Sport Discus, till March 2016 and hand search of some articles.

Study selection Randomised controlled trials (RCTS) and observational studies (OBS) comparing the effect of exercise or rest in patients with concussion, on different outcomes.

Participants Children and adults with concussion or mild traumatic brain injury.

Intervention Exercise or Rest.

Outcomes Post concussive symptoms (PCCS), balance error scoring system (BESS), immediate post concussion assessment and cognitive testing (ImPACT).

Main results Our search generated 921 studies. Of these, 5 RCTs and 12 OBS met our inclusion criteria. Methodological quality of most of the studies was poor. Meta-analysis of 6 studies involving more than 556 patients showed statistical significant decrease in PCCS with exercise compared to control, Mean Difference (MD) [95% Confidence Interval (CI)], −14.6 [−17.8, −11.3], p<0.001. There was some clinical, but no statistical heterogeneity among the studies (I2=32%). Exercise did not affect BESS, neuropsychological scale and ImPACT score.

There was not effect of rest on total symptoms in patients with concussion and number of patients with symptoms.

Conclusion Our systematic review and meta-analysis showed clear benefits of exercise in PCCS. However, the evidence was based on poor quality studies that vary in duration, frequency and intensity of exercise. A good quality RCT needs to be conducted to evaluate a clear effect of exercise and rest in patients with concussion.

Competing interests None.