MANAGEMENT OF RETURN TO PHYSICAL ACTIVITY AFTER CONCUSSION: A SYSTEMATIC REVIEW

Agnieszka Burzej; Zofia Nowakowska; Wiktoria Dybizbańska; Mateusz Kacalak; Karolina Dziki; Aleksandra Marek; Julia Szklarska-Komenda; Katarzyna Garncarz; Maciej Komenda; Krzysztof Jamroch

doi:10.31435/ijitss.4(48).2025.4496

Authors

Agnieszka Burzej 5th Military Clinical Hospital with Polyclinic SPZOZ, Wrocławska 1-3, 30-901 Kraków, Poland https://orcid.org/0009-0003-0066-3197
Zofia Nowakowska Upper Silesian Medical Center of the Medical University of Silesia in Katowice, Ziołowa 45/47, 40-635 Katowice, Poland https://orcid.org/0009-0000-8030-7341
Wiktoria Dybizbańska Independent Public Healthcare Institution of the Ministry of the Interior and Administration in Kraków, Kronikarza Galla 25, 30-053 Kraków, Poland https://orcid.org/0009-0000-9899-7272
Mateusz Kacalak The Nicolaus Copernicus Provincial Multispecialty Center for Oncology and Traumatology in Łódź, ul. Pabianicka 62, 93-513 Łódź, Poland https://orcid.org/0009-0006-3386-0906
Karolina Dziki 5th Military Clinical Hospital with Polyclinic SPZOZ, Wrocławska 1-3, 30-901 Kraków, Poland https://orcid.org/0009-0005-1720-3810
Aleksandra Marek Central Teaching Hospital of the Medical University of Lodz, Pomorska 251, 92-213 Łódź, Poland https://orcid.org/0009-0002-3391-5082
Julia Szklarska-Komenda 105th Military Hospital SP ZOZ in Żary, ul. Domańskiego 2, 68-200 Żary, Poland https://orcid.org/0009-0000-9914-4917
Katarzyna Garncarz 5th Military Clinical Hospital with Polyclinic SPZOZ, Wrocławska 1-3, 30-901 Kraków, Poland https://orcid.org/0009-0001-7554-2715
Maciej Komenda 105th Military Hospital SP ZOZ in Żary, ul. Domańskiego 2, 68-200 Żary, Poland https://orcid.org/0009-0009-7327-417X
Krzysztof Jamroch 5th Military Clinical Hospital with Polyclinic SPZOZ, Wrocławska 1-3, 30-901 Kraków, Poland https://orcid.org/0009-0003-2562-1276

DOI:

https://doi.org/10.31435/ijitss.4(48).2025.4496

Keywords:

Sport-Related Concussion, Return to Activity, Aerobic Exercise, Active Rehabilitation, Progressive Exercise Protocol

Abstract

Sport-related concussion management has undergone significant evolution, shifting from prolonged rest to active rehabilitation approaches. This systematic review examines current evidence regarding optimal return to physical activity protocols following sport-related concussion. A comprehensive literature search was conducted using PubMed, CINAHL, SPORTDiscus, and Web of Science databases, focusing on studies published between 2018-2023. Inclusion criteria comprised randomized controlled trials, systematic reviews, and prospective cohort studies examining physical activity interventions during concussion recovery. Contemporary evidence strongly supports brief initial rest (24-48 hours) followed by progressive, sub-threshold aerobic exercise. Multiple randomized controlled trials demonstrate that early controlled exercise accelerates recovery without adverse effects, reducing median recovery time from 17 to 13 days. The Buffalo Concussion Treadmill Test enables individualized exercise prescription at 80-90% of symptom-threshold heart rate. Multimodal approaches targeting specific symptom clusters (vestibular, cervicogenic, autonomic) show superior outcomes compared to generic protocols. Implementation remains inconsistent, with only 45% of practitioners regularly prescribing structured exercise despite strong evidence. Active rehabilitation through controlled, progressive exercise represents the current evidence-based standard for concussion management. Early sub-threshold aerobic exercise, initiated within one week of injury, optimizes recovery while minimizing persistent symptoms. Future research should focus on precision medicine approaches and optimal protocols for special populations.

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