Table 1

An example of a graduated exertion protocol

StepsActivityObjective
1. Rest and recoveryRoutine daily activities as toleratedRecovery
2. Light aerobic exercise10–20 min on a stationary bike or treadmill with light to moderate resistance supervised by the team’s athletic trainer. No resistance training or weight training. Duration and intensity of the aerobic exercise can be gradually increased over time if no symptoms or signs return during or after the exerciseCardiovascular challenge to determine if there are recurrent concussion signs or symptoms
3. Continued aerobic exercise and introduction of strength trainingWith continued supervision by the athletic trainer, increase the duration and intensity of the aerobic exercise (eg, more intense or longer time on the bike or treadmill, introduction of running and sprinting) and introduction of non-contact sport-specific conditioning drills (eg, changing direction drills, cone drills). Introduction of strength training supervised by the athletic trainerProgress cardiovascular exercise, add strength training and more complex movements to determine if there are any recurrent concussion signs or symptoms
4. Football-specific activitiesParticipation in all non-contact activities for the typical duration of a full practiceIncreasing football-specific demands to determine if there are any recurrent concussion signs or symptoms. Add the cognitive load of playing football
5. Full football activity/clearanceFull participation in practice and contact without restrictionTolerance of all football activities without any recurrent concussion signs or symptoms
  • This table is adapted from McCrory et al 11 and serves as a guideline. Specifics will depend on each player’s situation. There is no set timeline for return to play or progression through the protocol.