{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T06:30:26Z","timestamp":1791441026320,"version":"4.3.3"},"reference-count":30,"publisher":"Human Kinetics","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,1]]},"abstract":"Context<\/jats:bold>:<\/jats:italic> Early physical activity (PA) after concussion may promote symptom resolution. Prior studies have investigated exercise frequency\/duration, yet precise PA intensity or volume required for optimal recovery requires further investigation. moderate to vigorous physical activity (MVPA) is beneficial for physical health. We investigated whether sedentary time, light activity time, MVPA time, or activity frequency in the weeks following concussion are associated with time to symptom resolution among adolescents. Design<\/jats:bold>:<\/jats:italic> Prospective cohort study. Methods<\/jats:bold>:<\/jats:italic> Adolescents 10\u201318\u00a0years of age were tested \u226414\u00a0days of concussion and followed until symptom resolution. At the initial visit, participants rated symptom severity and were provided wrist-worn activity trackers to monitor PA for the following week. PA behavior was categorized each day based on heart rate: sedentary (resting), light PA (50%\u201369% age-predicted max heart rate), and MVPA (70%\u2013100% age-predicted max heart rate). Symptom resolution was defined as the date when participants reported cessation of concussion-like symptoms. Patients were not given specific PA instructions, though some may have received instructions from their physician. Results<\/jats:bold>:<\/jats:italic> Fifty-four participants were included in the study (54% female; mean age\u2009=\u200915.0 [1.8]\u00a0y; initially assessed 7.5 [3.2]\u00a0d after concussion). Female athletes recorded more sedentary time (900 [46] vs 738 [185]\u00a0min\/d; P<\/jats:italic>\u2009=\u2009.01; Cohen d<\/jats:italic>\u2009=\u20090.72), and less time in light PA (194.7 [64.5] vs 224 [55]\u00a0min\/d; P<\/jats:italic>\u2009=\u2009.08; Cohen d<\/jats:italic>\u2009=\u20090.48) and MVPA (23 [17] vs 38 [31]\u00a0min\/d; P<\/jats:italic>\u2009=\u2009.04; Cohen d<\/jats:italic>\u2009=\u20090.58) than male athletes. After adjusting for sedentary time, hours per day with >250 steps, sex, and initial symptom severity, more MVPA time was associated with faster symptom resolution time (hazard ratio\u2009=\u20091.016; 95% confidence interval, 1.001\u20131.032; P<\/jats:italic>\u2009=\u2009.04). Conclusion<\/jats:bold>:<\/jats:italic> Our findings offer preliminary insight into how varying PA intensities affect concussion recovery, as MVPA may be a higher intensity than what is typically prescribed in concussion care.<\/jats:p>","DOI":"10.1123\/jsr.2023-0022","type":"journal-article","created":{"date-parts":[[2023,6,9]],"date-time":"2023-06-09T09:01:55Z","timestamp":1686301315000},"page":"790-796","source":"Crossref","is-referenced-by-count":15,"title":["Early Moderate to Vigorous Physical Activity After Concussion Is Associated With Faster Symptom Resolution Time"],"prefix":"10.1123","volume":"32","author":[{"given":"Jacob G.","family":"Rademacher","sequence":"first","affiliation":[{"name":"Department of Biological Sciences, University of Denver, Denver, CO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathew J.","family":"Wingerson","sequence":"additional","affiliation":[{"name":"Sports Medicine Center, Children\u2019s Hospital Colorado, Aurora, CO, USA"},{"name":"Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine L.","family":"Smulligan","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Casey C.","family":"Little","sequence":"additional","affiliation":[{"name":"University of Virginia School of Medicine, Charlottesville, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie C.","family":"Wilson","sequence":"additional","affiliation":[{"name":"Sports Medicine Center, Children\u2019s Hospital Colorado, Aurora, CO, USA"},{"name":"Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA"},{"name":"Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2955-0191","authenticated-orcid":true,"given":"David R.","family":"Howell","sequence":"additional","affiliation":[{"name":"Sports Medicine Center, Children\u2019s Hospital Colorado, Aurora, CO, USA"},{"name":"Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"100","reference":[{"issue":"6","key":"r1","series-title":"Pediatrics","first-page":"999","article-title":"Duration and course of post-concussive symptoms","volume":"133","author":"Eisenberg MA","year":"2014","unstructured":"Eisenberg MA, Meehan WP, Mannix R. 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Consensus statement on concussion in sport\u2014the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017;51(11):838\u2013847. doi:10.1136\/bjsports-2017-097699"},{"issue":"11","key":"r4","series-title":"JAMA Pediatr","article-title":"Centers for disease control and prevention guideline on the diagnosis and management of mild traumatic brain injury among children","volume":"172","author":"Lumba-Brown A","year":"2018","unstructured":"Lumba-Brown A, Yeates KO, Sarmiento K, et\u00a0al. Centers for disease control and prevention guideline on the diagnosis and management of mild traumatic brain injury among children. JAMA Pediatr. 2018;172(11):e182853. doi:10.1001\/jamapediatrics.2018.2853"},{"issue":"4","key":"r5","series-title":"JAMA Pediatr","first-page":"319","article-title":"Early subthreshold aerobic exercise for sport-related concussion: a randomized clinical trial","volume":"173","author":"Leddy JJ","year":"2019","unstructured":"Leddy JJ, Haider MN, Ellis MJ, et\u00a0al. Early subthreshold aerobic exercise for sport-related concussion: a randomized clinical trial. JAMA Pediatr. 2019;173(4):319\u2013325. doi:10.1001\/jamapediatrics.2018.4397"},{"issue":"11","key":"r6","series-title":"Lancet Child Adolesc Health","first-page":"792","article-title":"Early targeted heart rate aerobic exercise versus placebo stretching for sport-related concussion in adolescents: a randomised controlled trial","volume":"5","author":"Leddy JJ","year":"2021","unstructured":"Leddy JJ, Master CL, Mannix R, et\u00a0al. Early targeted heart rate aerobic exercise versus placebo stretching for sport-related concussion in adolescents: a randomised controlled trial. Lancet Child Adolesc Health. 2021;5(11):792\u2013799. doi:10.1016\/S2352-4642(21)00267-4"},{"key":"r7","series-title":"Phys Ther Sport","first-page":"196","article-title":"Early aerobic exercise among adolescents at moderate\/high risk for persistent post-concussion symptoms: a pilot randomized clinical trial","volume":"55","author":"Howell DR","year":"2022","unstructured":"Howell DR, Wingerson MJ, Kirkwood MW, Grubenhoff JA, Wilson JC. Early aerobic exercise among adolescents at moderate\/high risk for persistent post-concussion symptoms: a pilot randomized clinical trial. Phys Ther Sport. 2022;55:196\u2013204. doi:10.1016\/j.ptsp.2022.04.010"},{"issue":"5","key":"r8","series-title":"Acad Emerg Med","first-page":"493","article-title":"A randomized trial comparing prescribed light exercise to standard management for emergency department patients with acute mild traumatic brain injury","volume":"28","author":"Varner CE","year":"2021","unstructured":"Varner CE, Thompson C, de Wit K, Borgundvaag B, Houston R, McLeod S. A randomized trial comparing prescribed light exercise to standard management for emergency department patients with acute mild traumatic brain injury. Acad Emerg Med. 2021;28(5):493\u2013501. doi:10.1111\/acem.14215"},{"issue":"7","key":"r9","series-title":"Am J Sports Med","first-page":"1912","article-title":"Influence of aerobic exercise volume on postconcussion symptoms","volume":"49","author":"Howell DR","year":"2021","unstructured":"Howell DR, Hunt DL, Aaron SE, Meehan WP, Tan CO. 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Int J Environ Res Public Health. 2021;18(14):7373. doi:10.3390\/ijerph18147373"},{"issue":"4","key":"r11","series-title":"J Head Trauma Rehabil","first-page":"249","article-title":"Postconcussion exercise volume associations with depression, anxiety, and dizziness symptoms, and postural stability: preliminary findings","volume":"37","author":"Howell DR","year":"2022","unstructured":"Howell DR, Hunt DL, Oldham JR, Aaron SE, Meehan WP, Tan CO. Postconcussion exercise volume associations with depression, anxiety, and dizziness symptoms, and postural stability: preliminary findings. J Head Trauma Rehabil. 2022;37(4):249\u2013257. doi:10.1097\/HTR.0000000000000718"},{"issue":"8","key":"r12","series-title":"Curr Allergy Asthma Rep","article-title":"Wearable technology and how this can be implemented into clinical practice","volume":"20","author":"Greiwe J","year":"2020","unstructured":"Greiwe J, Nyenhuis SM. Wearable technology and how this can be implemented into clinical practice. 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