Objective To evaluate the combined effect of early concurrent sleep and exercise on time-to-symptom-resolution among adolescents with concussion.

Design Retrospective study.

Setting Pediatric sports medicine center.

Participants Patients aged 6–18 years presenting for care within 21 days post-concussion.

Outcome Measures Patients indicated if they had begun exercising or were experiencing sleep problems in the time between injury and clinical evaluation. Patients were grouped as: Exercising/No Sleep Problems (+Ex/+Sleep); No Exercise/Sleep Problems (-Ex/-Sleep); Exercising/Sleep Problems (+Ex/-Sleep); No Exercise/No Sleep Problems (-Ex/+Sleep). Patients were followed until symptom resolution.

Main Results 212 patients with concussion (14.4±2.5 years; 47% female; 9.7±5.6 days post-injury) were included: 12% (n=25) +Ex/+Sleep; 40% (n=85) -Ex/-Sleep; 5% (n=11) +Ex/-Sleep; and 43% (n=91) -Ex/+Sleep. There were no between-group age (p=0.46) or sex (p=0.60) differences. After adjusting for pre-injury sleep problems and time-to-clinical-evaluation the +Ex/+Sleep group had significantly shorter symptom durations than the other groups: an estimated 4.2x shorter than the -Ex/-Sleep group (hazard ratio=0.24; 95% CI=0.14–0.41), 2.7x shorter than the +Ex/-Sleep group (hazard ratio=0.37; 95% CI=0.14–0.98), and 3.1x shorter for than -Ex/+Sleep group (hazard ratio=0.32; 95% CI=0.19–0.54).

Conclusions The combined effect of early exercise and sleep post-concussion is associated with faster symptom resolution relative to those who did not exercise or report good sleep, singularly or combined.