A controlled early-exercise rehabilitation program commencing within 48 hours of a Sports-Related Concussion improves recovery in UK student-athletes: A prospective cohort study

OBJECTIVES: Explore if implementing an individualised Sub-Symptom Heart Rate Threshold (SSHeRT) rehabilitation program within 48 hours versus physical rest for 14 days affects recovery following SRC in university-aged student-athletes.

DESIGN: Prospective, observational cohort study.

METHODS: Two UK university-aged student-athlete rugby union cohorts were compared (Physical Rest Group (PRG), n = 140, July 2019-March 2020 and Controlled Early-Exercise Group (CEG), n = 167, July 2021-April 2023). Both groups completed the test battery (Post-Concussion Symptom Scale (PCSS), Immediate Post-Concussion and Cognitive Test (ImPACT), Vestibular-Ocular Motor Screening Tool (VOMS)) during pre-season to provide a baseline and within 48 hours, at 4, 8, 14-days post-SRC and at Return to Play (RTP). The PRG (n = 42) physically rested for 14 days as per the nationwide community guidelines. The CEG (n = 52) followed the SSHeRT rehabilitation program. Individual change to baseline was used in all analyses.

RESULTS: The CEG performed better on ImPACT's verbal memory at 4 (PRG; -5.5 (-10.8-0.0), CEG; 1.0 (-2.0-10.5), p = 0.05) and 14 days (PRG; -2.0 (-10.0-3.0), CEG; 4.0 (-1.0-11.0), p = 0.05) and on the VOMS at 4 (PRG; 3.0 (0.0-12.0), CEG; 0.0 (0.0-5.0), p = 0.03, OR; 2.910) and 14-days post-SRC (PRG; 0.0 (0.0-1.0), CEG; 0.0 (0.0-0.0), OR; 5.914). Near point convergence was better at all time points for the CEG. The CEG was 26.7 % more likely to have RTP within 30 days, and 6.7 and 5.1 times more likely to have resumed non-contact and contact academic activities by 4 days.

CONCLUSIONS: SSHeRT is safe, can be used within 48 hours of a SRC and may hasten university-aged student-athletes recovery following an SRC.