{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T02:33:35Z","timestamp":1789266815566,"version":"build-2803163510"},"reference-count":45,"publisher":"BMJ","issue":"5","funder":[{"name":"OSSU IMPACT Award","award":["No numbers"],"award-info":[{"award-number":["No numbers"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Sports Med"],"accepted":{"date-parts":[[2021,11,8]]},"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Investigate whether resuming physical activity (PA) at 72 hours post concussion is safe and reduces symptoms at 2\u2009weeks, compared with resting until asymptomatic.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Real-life conditions, multicentre, single-blinded randomised clinical trial, conducted in three Canadian paediatric emergency departments (ED). Children\/youth aged 10\u2013&lt;18 years with acute concussion were recruited between March 2017 and December 2019, and randomly assigned to a 4-week stepwise return-to-PA protocol at 72 hours post concussion even if symptomatic (experimental group (EG)) or to a return-to-PA once asymptomatic protocol (control group (CG)). The primary outcome was self-reported symptoms at 2\u2009weeks using the Health and Behaviour Inventory. Adherence was measured using accelerometers worn 24\u2009hours\/day for 14 days post injury. Adverse events (AE) (worsening of symptoms requiring unscheduled ED or primary care visit) were monitored. Multivariable intention-to-treat (ITT) and per-protocol analyses adjusting for prognostically important covariates were examined. Missing data were imputed for the ITT analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>456 randomised participants (EG: N=227; mean (SD) age=13.3 (2.1) years; 44.5% women; CG: N=229; mean (SD) age=13.3 (2.2) years; 43.7% women) were analysed. No AE were identified. ITT analysis showed no strong evidence of a group difference at 2\u2009weeks (adjusted mean difference=\u22121.3 (95% CI:\u22123.6 to 1.1)). In adherent participants, initiating PA 72 hours post injury significantly reduced symptoms 2\u2009weeks post injury, compared with rest (adjusted mean difference=\u22124.3 (95% CI:\u22128.4 to \u20130.2)).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Symptoms at 2\u2009weeks did not differ significantly between children\/youth randomised to initiate PA 72 hours post injury versus resting until asymptomatic; however, many were non-adherent to the intervention. Among adherent participants, early PA was associated with reduced symptoms at 2\u2009weeks. Resumption of PA is safe and may be associated with milder symptoms at 2\u2009weeks.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>1b.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial registration number<\/jats:title><jats:p><jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT02893969\">NCT02893969<\/jats:ext-link>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Registry name<\/jats:title><jats:p>Pediatric Concussion Assessment of Rest and Exertion (PedCARE).<\/jats:p><\/jats:sec>","DOI":"10.1136\/bjsports-2021-105030","type":"journal-article","created":{"date-parts":[[2021,11,26]],"date-time":"2021-11-26T18:25:11Z","timestamp":1637951111000},"page":"271-278","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":51,"title":["Is early activity resumption after paediatric concussion safe and does it reduce symptom burden at 2 weeks post injury? 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