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Physical Activity After Concussion: When and How Much?

In our last blog post, we discussed that rest following concussion, while commonly prescribed, may not be the best approach for maximizing recovery. Many patients immediately following a concussion are instructed to rest, including minimizing their physical and cognitive activity, and interactions with other people. But what do we know about strict rest following concussion?

If a concussion is caused during a sporting event, immediate removal from the game is crucial. So in that sense, “rest” is important immediately following an injury. This is important for several reasons, mostly to decrease the risk of an additional impact which could be fatal. The question remains, how long after a concussion is sustained should a person rest, and how quickly should they get back to activity?

A study published in 2015 (1) looked at 2 groups: one group that was instructed to follow strict rest guidelines for 5 days following concussion (“cocoon therapy”), and the second group who was instructed to follow 1-2 days of rest followed by gradual increase in activity and return to school. They found that the group prescribed 5 days of strict rest actually had more symptoms and a more prolonged recovery than the group who returned to activity sooner.

So the research is starting to show that earlier exercise and activity may lead to faster resolution of symptoms, but after an injury, how do you know the appropriate exercise intensity to perform? A group of researchers developed a test called the Buffalo Concussion Treadmill Test to assess how much activity an individual can tolerate following a concussion without making their symptoms worse (2). This is a graded exercise test that monitors a person’s heart rate and symptoms, while the workload gradually increases. If there is symptom exacerbation during testing, a sub-symptom exercise program is designed for that person to guide them safely back to physical activity. This program is designed based on the individual’s point of symptom exacerbation.

At Colorado Concussion Clinic, our clinicians are trained in the performance of the Buffalo Concussion Treadmill Test. We can help assess your current symptoms, exercise tolerance, and design an individualized program for safe return to exercise. Whether you have recently sustained a concussion, or have been struggling with persistent symptoms further out from your injury, a graded approach to exercise may help you in your recovery. Let us help you safely and efficiently get back to what you love to do!


1) 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.

2) Leddy JJ, Willer B. Use of graded exercise testing in concussion and return to activity management. Curr Sports Med Rep. 2013;12(6):370-376.