Physical Activity After Concussion: When and How Much?
After a concussion, one of the most common questions is:
"How much activity should I be doing?"
For years, people with concussion were often told to rest in a dark, quiet room until their symptoms completely disappeared. While a period of relative rest is important immediately after an injury, prolonged inactivity is generally not the goal of concussion recovery.
Current approaches to concussion management emphasize a gradual return to everyday activities and physical activity, guided by symptoms and individual tolerance.
The right amount of activity can look different for every person.
Why Is Rest Important Immediately After a Concussion?
If a concussion occurs during sports or another physical activity, the athlete should be removed from play and evaluated appropriately.
Immediate removal is important because continuing to participate while experiencing a suspected concussion can expose someone to another injury before they have recovered.
During the initial period after a concussion, your healthcare provider may recommend a short period of relative rest. This generally means reducing activities that significantly worsen symptoms while still allowing gentle, everyday activities as tolerated.
The goal is not necessarily complete physical and cognitive inactivity.
Is Too Much Rest Bad for Concussion Recovery?
Research has changed how healthcare professionals think about rest after concussion.
Earlier approaches often emphasized prolonged, strict rest. However, studies have found that extended periods of strict rest may not improve recovery and can sometimes contribute to increased symptoms and difficulty returning to normal activities.
Instead, current concussion management generally favors a brief period of relative rest followed by a gradual return to activity as tolerated.
This does not mean that someone should immediately return to intense exercise.
It means finding the appropriate level of activity for the individual and gradually increasing it as recovery allows.
Why Can Exercise Be Helpful After a Concussion?
Physical activity affects many systems involved in concussion recovery, including cardiovascular function, the autonomic nervous system, and the brain's ability to regulate activity.
For some people, appropriately prescribed aerobic exercise can be an important part of rehabilitation.
Exercise may help patients gradually improve their tolerance for physical activity while providing the body with an opportunity to adapt to increasing levels of exertion.
However, more exercise is not necessarily better.
If activity consistently causes a significant increase in symptoms, the intensity or duration may need to be adjusted.
How Do I Know How Much Exercise Is Appropriate?
This is where concussion recovery becomes individualized.
Two people with the same type of injury may have very different exercise tolerance.
One person may be able to walk or exercise at a moderate intensity without significant symptoms. Another may experience headache, dizziness, nausea, fatigue, or other symptoms with relatively low levels of exertion.
Your healthcare provider or rehabilitation professional can help determine an appropriate starting point based on your symptoms, current activity level, and stage of recovery.
What Is Exercise Intolerance After Concussion?
Exercise intolerance occurs when physical activity produces symptoms that are disproportionate to the level of exertion or prevents someone from returning to their normal activities.
Symptoms during or after exercise may include:
Headache
Dizziness
Nausea
Fatigue
Lightheadedness
Visual symptoms
Difficulty regulating heart rate
Feeling unusually unwell with exertion
Exercise intolerance can be one component of a broader concussion presentation and may be related to changes in the body's ability to regulate physiological responses to exercise.
Identifying this problem can help your rehabilitation team determine how exercise should be incorporated into your recovery.
What Is the Buffalo Concussion Treadmill Test?
The Buffalo Concussion Treadmill Test (BCTT) is a graded exercise assessment that can be used to evaluate exercise tolerance in people recovering from concussion.
During the test, a clinician gradually increases the workload while monitoring the individual's symptoms and physiological response.
The assessment can provide information about:
Exercise tolerance
Symptom response to increasing exertion
Heart rate response
The level of activity that can be tolerated
If symptoms increase at a particular level of exertion, that information can help the clinician develop an individualized sub-symptom aerobic exercise program.
The goal is to identify an appropriate level of exercise rather than simply pushing through symptoms.
What Does a Graded Exercise Program Look Like?
A graded exercise program is individualized, but it generally involves starting at a level the person can tolerate and gradually increasing the duration or intensity of activity over time.
Depending on the individual, exercise might include:
Walking
Stationary cycling
Light aerobic exercise
Other forms of cardiovascular activity
The appropriate starting point depends on the person's symptoms, fitness level, medical history, and clinical evaluation.
As tolerance improves, activity can be gradually progressed.
If symptoms increase significantly, the program may need to be modified.
What About Daily Activities?
Physical activity isn't limited to formal exercise.
Concussion recovery also involves gradually returning to everyday activities such as:
Walking
Household tasks
Work
School
Social activities
Shopping
Driving, when medically appropriate
Recreation
Your recovery plan should consider the whole picture, not just how much you can exercise.
For some people, symptoms may be more affected by cognitive or visual demands than physical exertion. Others may tolerate mental activity but struggle with exercise.
This is why concussion rehabilitation should be individualized.
What If Exercise Makes My Symptoms Worse?
A temporary increase in symptoms does not necessarily mean you have harmed your brain or set your recovery back permanently.
However, consistently pushing through significant symptoms is not an appropriate recovery strategy.
If exercise repeatedly causes a substantial increase in symptoms, talk with your healthcare provider or rehabilitation team.
Your clinician can help determine whether:
The intensity is too high
The duration needs to be reduced
Another system is contributing to your symptoms
Your exercise program needs to be modified
Additional evaluation or rehabilitation is appropriate
What About Athletes?
Athletes should follow a gradual return-to-sport progression rather than immediately returning to full practice or competition.
Return to sport generally involves progressively increasing physical and sport-specific demands while monitoring symptoms and overall function.
An athlete may need to demonstrate tolerance of increasingly demanding activity before returning to unrestricted competition.
Athletic trainers, physical therapists, physicians, coaches, and families can all play important roles in supporting this process.
You Don't Have to Wait Until Every Symptom Is Gone to Start Moving
One of the biggest changes in concussion care is the recognition that recovery does not necessarily require complete inactivity until every symptom disappears.
For many people, appropriately dosed physical activity can be part of the treatment plan.
The key is finding the right amount for your individual stage of recovery.
If you've recently sustained a concussion—or if you've been struggling with persistent symptoms and exercise intolerance—an individualized assessment can help determine where to begin.
Ready to Get Back to What You Love?
At Colorado Concussion Clinic, our clinicians can evaluate symptoms and exercise tolerance and develop an individualized rehabilitation plan based on your needs.
A graded approach to physical activity may be an important part of your recovery.
References
Thomas DG, Apps JN, Hoffman RG, et al. Benefits of strict rest after acute concussion: a randomized controlled trial. Pediatrics. 2015;135(2):213-223.
Leddy JJ, Willer B. Use of graded exercise testing in concussion and return to activity management. Current Sports Medicine Reports. 2013;12(6):370-376.