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Relationship of early participation in physical activities to persistent post-concussive symptoms following acute paediatricpediatric concussion
  1. Roger Zemek1,2,
  2. Anne M Grool3,
  3. Mary Aglipay3,
  4. Franco Momoli3,
  5. William P Meehan III4,
  6. Stephen B Freedman5,
  7. Keith Owen Yeates6,
  8. Jocelyn Gravel7,
  9. Isabelle Gagnon8,
  10. Kathy Boutis9,
  11. Willem Meeuwisse10,
  12. Nick Barrowman3,
  13. Martin H Osmondon11,
  14. on behalf of the Pediatric Emergency Research Canada (PERC) Concussion Team
  1. 1Department of Paediatrics and Emergency Medicine, Clinical Research Chair in Paediatric Concussion, University of Ottawa
  2. 2Clinical Research Unit, Children’s Hospital of Eastern Ontario, Canada
  3. 3Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
  4. 4Sports Concussion Clinic, Boston Children’s Hospital, Boston, Massachusetts, USA
  5. 5Department of Paediatrics, Alberta Children’s Hospital, Alberta Children’s Hospital Research Institute, University of Calgary, Alberta, Canada
  6. 6Department of Psychology, Alberta Children’s Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
  7. 7Department of Paediatrics, Hospital Ste. Justine, University of Montreal, Montreal, Quebec, Canada
  8. 8Department of Paediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
  9. 9Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
  10. 10Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
  11. 11Department of Paediatrics, Children’s Hospital of Eastern Ontario,University of Ottawa, Ottawa, Ontario, Canada


Trial Registration Indentifier: NCT01873287.

Objective To investigate if early physical activity (7-days post-injury) was associated with lower risk of persistent post-concussive symptoms (PPCS) compared to guideline-recommended conservative rest.

Design Prospective, multicenter, cohort study.

Setting Nine tertiary Canadian Paediatric EDs.

Participants 2413 children (61% male) aged 5-18 years with acute concussion (<48 hours) with inclusion/exclusion criteria per Predicting Persistent Post-concussive Problems in Paediatrics (5P) study.

Assessment of risk factors Participation in physical activities, post-concussive symptoms, and concussion modifiers were assessed using standardised questionnaires at baseline, 7- and 28-days post-injury.

Outcome measures PPCS (primary outcome) was defined as ≥3 new or worsening symptoms on Post-Concussion Symptom Inventory at 28-days post-enrolment. The relationship between early physical activity and PPCS was examined using regression, 1:1 propensity-matched, and inverse probability of treatment weighting (IPTW) analyses.

Results PPCS occurred in 678/2413 (30.1%) participants. Most children (n=1677, 70%) participated in physical activity at one-week of which only n=528 (31%) were symptom-free. Early physical activity was associated with reduced likelihood of PPCS [regression: OR=0.42, (95% CI: 0.35–0.51)]. Early activity remained associated with reduced PPCS risk when matched 1:1 for propensity score [n=1290, OR=0.56, (95% CI: 0.44–0.71)], and using IPTW [n=2235, OR=0.62, (95% CI: 0.51–0.76)]. Sensitivity analyses (replacement of baseline symptoms with one-week symptoms) maintained significant associations [regression: OR=0.42, (95% CI: 0.35–0.51); propensity matching: OR=0.75, (95% CI: 0.60–0.94); and IPTW: OR=0.69, (95% CI: 0.57–0.85)].

Conclusions Physical activity within 7-days post-injury was associated with lower risk for PPCS in youth recovering from acute concussion. RCTs are urgently needed to confirm these findings and to determine the optimal timing of the initiation of physical activity.

Competing interests No competing interests to disclose. This study was supported by Canadian Institutes of Health Research (CIHR) Operating Grant MOP:#126197; CIHR-Ontario Neurotrauma Foundation Mild Traumatic Brain Injury Team Grant TM1:#127047; and CIHR planning grant MRP: #119829.


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