Objective Establish if a Sub-Symptom Heart Rate Threshold (SSHeRT) exercise protocol affects recovery following Sports-Related Concussion (SRC).

Design Prospective cohort study.

Setting Loughborough University, UK.

Participants Control group (n=42) (July 2019-March 2020), intervention group (n=28) (July 2021-ongoing).

Interventions Both groups followed the Rugby Football Union (RFU) community pathway. The intervention group exercised daily on days 2–14 at 80% of SSHeRT determined by either, the Buffalo Concussion Bike Test (BCBT) for those with dysfunction on Vestibular-Oculo-Motor Screening (VOMS) or for those without, the Buffalo Treadmill Concussion Test (BCTT). The control group physically rested for the initial 14 days.

Outcome Measures Post-Concussion Symptom Scale (PCSS), Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), VOMS and academic attendance were completed at baseline and 2, 4, 8 and 14 days post-SRC and at Return To Play (RTP). Change from baseline was used in all analysis.

Main Results The exercise group reported a lower symptom severity at RTP (-3.00 (-5.00–1.00), -1.00 (-3.00–0.00), p=0.043), better performance on ImPACT’ verbal memory at 4 days (-0.50 (-2.00–12.00), -5.50 (-10.75–0.00), p=0.001) and 14 days (3.50 (-1.00–8.75), -2.00 (-10.00–3.00), p=0.001) and visual memory at RTP (7.00 (-1.75–16.00), -0.50 (-7.00–5.50), p=0.022). Performance on VOMS and Near Point Convergence (NPC) was better for the exercise group at 4 days (VOMS; 0.00 (0.00–4.50), 3.00 (0.00–12.25), p=0.004, NPC; 0.30 (-1.58–2.58), 1.30 (0.20–2.68), p=0.036)) and 8 days (VOMS; 0.00 (0.00–0.00), 0.00 (0.00–3.00), p=0.035, NPC; -0.15 (-2.75–1.30), 1.00 (0.00–1.88), p=0.007).

Conclusions University-aged student-athletes who follow the SSHeRT protocol may experience a quicker recovery of cognitive and VOM function.