Objective Examine the relationship between 5P risk score – predictor of persistent post-concussive symptoms (PPCS) – with physical activity (PA) and exercise characteristics among adolescents recovering from concussion.

Design Prospective cohort study.

Setting Sports medicine center.

Participants Adolescents evaluated ≤14 days of concussion (n=44, 50% female, 14.9±1.7 years).

Assessment of Risk Factors Participants were grouped by 5P score (high risk 9–12; medium/low risk 0–8) at initial evaluation and recorded PA and exercise sessions with an activity tracker.

Outcome Measures We compared demographic and injury variables, exercise characteristics [duration, frequency, intensity (maximum and average heart rates)] and PA (steps/day) between high- and medium/low-risk groups.

Main Results Seventeen participants (39%) had a high-risk score. The high-risk group had a significantly higher proportion of females (88% vs 26%, p<0.001) and those with depression history (41% vs 7%, p=0.02) than the medium/low-risk group. Those with a high-risk 5P score exercised less often (r=-0.31, p=0.04), for shorter duration (r=-0.41, p=0.007), and took fewer steps/day (r=-0.37, p=0.01), but there was a weak and non-significant correlation with exercise intensity. After adjusting for the effect of sex and depression history, a higher 5P risk score predicted lower maximum exercise intensity (β= -3.37; 95% CI= -6.43, -0.32; p=0.03) but no other PA/exercise characteristics.

Conclusions 5P risk score predicted exercise intensity in the 2 weeks after initial concussion assessment. Given the benefits of PA and exercise during concussion recovery, clinicians may use the 5P risk score to predict those at increased PPCS risk and promote exercise prescription in this population.

Trial registration NCT04199247