TY  - JOUR
PY  - 2016//
TI  - Association between early participation in physical activity following acute concussion and persistent postconcussive symptoms in children and adolescents
JO  - JAMA journal of the American Medical Association
A1  - Grool, Anne M.
A1  - Aglipay, Mary
A1  - Momoli, Franco
A1  - Meehan, William P.
A1  - Freedman, Stephen B.
A1  - Yeates, Keith Owen
A1  - Gravel, Jocelyn
A1  - Gagnon, Isabelle
A1  - Boutis, Kathy
A1  - Meeuwisse, Willem
A1  - Barrowman, Nick
A1  - Ledoux, Andrée-Anne
A1  - Osmond, Martin H.
A1  - Zemek, Roger
SP  - 2504
EP  - 2514
VL  - 316
IS  - 23
N2  - IMPORTANCE: Although concussion treatment guidelines advocate rest in the immediate postinjury period until symptoms resolve, no clear evidence has determined that avoiding physical activity expedites recovery. <br><br>OBJECTIVE: To investigate the association between participation in physical activity within 7 days postinjury and incidence of persistent postconcussive symptoms (PPCS). DESIGN, SETTING, AND PARTICIPANTS: Prospective, multicenter cohort study (August 2013-June 2015) of 3063 children and adolescents aged 5.00-17.99 years with acute concussion from 9 Pediatric Emergency Research Canada network emergency departments (EDs). EXPOSURES: Early physical activity participation within 7 days postinjury. MAIN OUTCOMES AND MEASURES: Physical activity participation and postconcussive symptom severity were rated using standardized questionnaires in the ED and at days 7 and 28 postinjury. PPCS ( MAIN OUTCOMES AND MEASURES: ≥3 new or worsening symptoms on the Post-Concussion Symptom Inventory) was assessed at 28 days postenrollment. Early physical activity and PPCS relationships were examined by unadjusted analysis, 1:1 propensity score matching, and inverse probability of treatment weighting (IPTW). Sensitivity anal MAIN OUTCOMES AND MEASURES: yses examined patients (≥3 symptoms) at day 7. <br><br>RESULTS: Among 2413 participants who completed the primary outcome and exposure, (mean [SD] age, 11.77 [3.35] years; 1205 [39.3%] females), PPCS at 28 days occurred in 733 (30.4%); 1677 (69.5%) participated in early physical activity including light aerobic exercise (n RESULTS:  = 795 [32.9%]), sport-specific exercise (n = 214 [8.9%]), noncontact drills (n = 143 [5.9%]), full-contact practice (n = 106 [4.4%]), or full competition (n = 419 [17.4%]), whereas 736 (30.5%) had no physical activity. On unadjusted analysis, early physical activity participants RESULTS:  had lower risk of PPCS than those with no physical activity (24.6% vs 43.5%; Absolute risk difference [ARD], 18.9% [95% CI,14.7%-23.0%]). Early physical activity was associated with lower PPCS risk on propensity score matching (n = 1108 [28.7% for early physical activity vs 40.1% for no physica RESULTS: l activity]; ARD, 11.4% [95% CI, 5.8%-16.9%]) and on inverse probability of treatment weighting analysis (n = 2099; relative risk [RR], 0.74 [95% CI, 0.65-0.84]; ARD, 9.7% [95% CI, 5.7%-13.7%]). Among only patients symptomatic at day 7 (n = 803) compared with those who reported no physical a RESULTS: ctivity (n = 584; PPCS, 52.9%), PPCS rates were lower for participants of light aerobic activity (n = 494 [46.4%]; ARD, 6.5% [95% CI, 5.7%-12.5%]), moderate activity (n = 176 [38.6%]; ARD, 14.3% [95% CI, 5.9%-22.2%]), and full-contact activity (n = 133 [36.1%]; ARD, 16.8% [95% CI, 7. <br><br>RESULTS: 5%-25.5%]). No significant group difference was observed on propensity-matched analysis of this subgroup (n = 776 [47.2% vs 51.5%]; ARD, 4.4% [95% CI, -2.6% to 11.3%]). <br><br>CONCLUSIONS AND RELEVANCE: Among participants aged 5 to 18 years with acute concussion, physical activity within 7 days of acute injury compared with no physical activity was associated with reduced risk of PPCS at 28 days. A well-designed randomized clinical trial is needed to determine the benefits of early physical activity following concussion.<p />  <p>Language: en</p>
LA  - en
SN  - 0098-7484
UR  - http://dx.doi.org/10.1001/jama.2016.17396
ID  - ref1
ER  -