Objective Determine if early aerobic exercise during day 2–14 of the RFU community pathway affects time to Return To Play (RTP).

Design Prospective cohort study.

Setting Loughborough University, UK, ongoing since July 2021.

Participants Rugby student-athletes, control group (n=42) (July 2019-March 2020), intervention group.

Interventions Both groups followed the RFU community pathway (RTP ≥ 19 days). Intervention group exercised daily on days 2–14 at 80% of their symptom-threshold as determined by either, the Buffalo Concussion Bike Test (BCBT) for those with Vestibular-Oculo-Motor Screening (VOMS) dysfunction or the Buffalo Treadmill Concussion Test (BCTT) for those without. Control group physically rested days 1–14.

Outcome Measures Post-Concussion Symptom Scale (PCSS), Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and VOMS were completed at baseline. This was repeated with the addition of the BCBT/BCTT at days 2, 4, 8 and 14 and academic attendance at 2, 4, 8 and 14 days and prior to RTP. Change from baseline was used for analysis.

Main Results Time to RTP was not significantly different between those who rested or exercised (22.0 (20.0–39.5) Vs 23.0 (20.5–32.25). Ability to be assessed on BCBT Vs BCTT at 2 or 4 days was not associated with a longer time to RTP (2 days; 23.0 (20.0–29.0) Vs 23 (20.8–37.0)) but was at 8 days (33.0 (29.0–42.0) Vs 23.0 (20.0–27.3), p=0.016).

Conclusions Early aerobic exercise does not delay RTP in concussed student-athletes following the RFU community pathway but VOMS dysfunction preventing student-athletes running at 8 days may delay RTP.