Objective To determine if light exercise initiation timing associated with symptom recovery and unrestricted return-to-play (RTP) time among collegiate student-athletes.

Design Prospective, longitudinal cohort.

Setting Thirty National College Athletic Association institutions.

Participants Student-athletes experiencing concussion (n=1228; age=18.4±0.9yrs; 56.5% male, 33.7%≥1 prior concussion).

Interventions (or Assessment of Risk Factors) Student-athletes were categorized by light exercise initiation timing prior to symptom resolution. Exercise categories included: early (≤2 days), typical (3–7 days), late (≥8 days), and none (no exercise).

Outcome Measures Days to symptom recovery and unrestricted RTP were determined by the clinician. We used multivariable Cox regressions (hazard ratios [HR], 95% confidence intervals [95%CI]) to compare symptom recovery and unrestricted RTP times between exercise groups (model covariates: <48 hour SCAT symptom severity, sex, immediate removal from play, delayed symptom presentation, sport contact classification).

Main Results Compared to no exercise, early exercise was 92% more likely to experience symptom recovery (HR=1.92; 95%CI: 1.57–2.36; p<0.001), 88% more likely to reach unrestricted RTP (HR=1.88; 95%CI: 1.55–2.28; p<0.001), and took 2.4 and 3.2 less median recovery days, respectively. Late exercise relative to no exercise was 57% less likely to reach symptom recovery (HR=0.43; 95%CI: 0.35–0.53; p<0.001), 46% less likely to achieve unrestricted RTP (HR=0.54; 95%CI: 0.45–0.66; p<0.001), and took 5.3 and 5.7 more median recovery days, respectively. Typical exercise did not differ from no exercise for symptom or unrestricted RTP (p≥0.329).

Conclusions Light exercise initiation, before the Concussion in Sport Group’s current 24–48-hour physical rest recommendation, associated with faster recovery metrics. Clinicians may consider using early exercise to improve student-athlete recovery.