{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T10:46:27Z","timestamp":1777891587525,"version":"3.51.4"},"reference-count":46,"publisher":"SAGE Publications","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["NRE"],"published-print":{"date-parts":[[2022,9,30]]},"abstract":"<jats:p>BACKGROUND: Recent research recommends physical exercise rather than rest following a mild traumatic brain injury (mTBI). OBJECTIVE: To determine the effect of physical exercise on persistent symptoms in people with mTBI. METHODS: A search of randomized controlled trials was conducted in CINAHL, Cochrane Library, EMBASE, MEDLINE, SportDiscus and Web of Science, from 2010 to January 2021. Studies were included if they described the effects of a physical exercise intervention in people with mTBI on persistent symptoms. Study quality, intervention reporting, and confidence in review findings were assessed with the CASP, TIDieR and GRADE respectively. RESULTS: 11 eligible studies were identified for inclusion. Study interventions broadly comprised of two categories of physical exercise, i.e., aerobic (n\u200a=\u200a8) and vestibular (n\u200a=\u200a3). A meta-analysis (n\u200a=\u200a3) revealed the aerobic exercise group improvement was significantly larger compared to the usual care group \u20130.39 (95% CI: \u20130.73 to \u20130.05, p\u200a=\u200a0.03). Only three studies using vestibular exercise reported on persistent symptoms and yielded mixed results. CONCLUSIONS: This study demonstrated that the use of aerobic exercise is supported by mixed quality evidence and moderate certainty of evidence, yet there is limited evidence for the use of vestibular exercise for improving persistent symptoms in people with mTBI.<\/jats:p>","DOI":"10.3233\/nre-220044","type":"journal-article","created":{"date-parts":[[2022,5,6]],"date-time":"2022-05-06T11:29:29Z","timestamp":1651836569000},"page":"185-200","source":"Crossref","is-referenced-by-count":6,"title":["Physical exercise for people with mild traumatic brain injury: A systematic review of randomized controlled trials"],"prefix":"10.1177","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0455-8389","authenticated-orcid":false,"given":"Sally","family":"Vuu","sequence":"first","affiliation":[{"name":"College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6266-6612","authenticated-orcid":false,"given":"Christopher J.","family":"Barr","sequence":"additional","affiliation":[{"name":"College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4482-8470","authenticated-orcid":false,"given":"Maggie","family":"Killington","sequence":"additional","affiliation":[{"name":"College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9552-0804","authenticated-orcid":false,"given":"Garner","family":"Jill","sequence":"additional","affiliation":[{"name":"College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5878-7649","authenticated-orcid":false,"given":"Maayken E.L.","family":"van den Berg","sequence":"additional","affiliation":[{"name":"College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","reference":[{"issue":"2","key":"10.3233\/NRE-220044_ref1","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1001\/jamapediatrics.2013.434","article-title":"Predicting postconcussion syndrome after mild traumatic brain injury in children and adolescents who present to the emergency department","volume":"167","author":"Babcock,","year":"2013","journal-title":"JAMA Pediatrics"},{"issue":"6","key":"10.3233\/NRE-220044_ref2","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1097\/HTR.0000000000000527","article-title":"Multidisciplinary concussion management: A model for outpatient concussion management in the acute and post-acute settings","volume":"34","author":"Bailey,","year":"2019","journal-title":"Journal of Head Trauma Rehabilitation"},{"issue":"3","key":"10.3233\/NRE-220044_ref3","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1123\/jsr.2019-0323","article-title":"Mode and intensity of physical activity during the postacute phase of sport-related concussion: A systematic review","volume":"30","author":"Baker,","year":"2021","journal-title":"Journal of Sport Rehabilitation"},{"issue":"2","key":"10.3233\/NRE-220044_ref5","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1016\/j.apmr.2017.09.108","article-title":"Safety of active rehabilitation for persistent symptoms after pediatric sport-related concussion: A randomized controlled trial","volume":"99","author":"Chan,","year":"2018","journal-title":"Archives of Physical Medicine and Rehabilitation"},{"issue":"4","key":"10.3233\/NRE-220044_ref8","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.3171\/2017.10.JNS17352","article-title":"Estimating the global incidence of traumatic brain injury","volume":"130","author":"Dewan,","year":"2018","journal-title":"Journal of Neurosurgery"},{"issue":"6","key":"10.3233\/NRE-220044_ref9","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1097\/JSM.0000000000000671","article-title":"Feasibility of early active rehabilitation for concussion recovery in youth: A randomized controlled trial","volume":"30","author":"Dobney,","year":"2020","journal-title":"Clinical Journal of Sport Medicine"},{"key":"10.3233\/NRE-220044_ref10","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/B978-0-444-63954-7.00017-3","article-title":"Chapter - Postconcussion syndrome","volume":"158","author":"Dwyer,","year":"2018","journal-title":"Handbook of Clinical Neurology"},{"issue":"7","key":"10.3233\/NRE-220044_ref11","first-page":"1","article-title":"Multi-disciplinary management of athletes with post-concussion syndrome: An evolving pathophysiological approach","volume":"136","author":"Ellis,","year":"2016","journal-title":"Frontiers in Neurology"},{"issue":"2","key":"10.3233\/NRE-220044_ref12","doi-asserted-by":"crossref","first-page":"238","DOI":"10.3109\/02699052.2014.965207","article-title":"Physiological, vestibulo-ocular and cervicogenic post-concussion disorders: An evidence-based classification system with directions for treatment","volume":"29","author":"Ellis,","year":"2015","journal-title":"Brain Injury"},{"issue":"7","key":"10.3233\/NRE-220044_ref13","first-page":"1334","article-title":"American College of Sports Medicine position stand. Quantity and quality of exercise for developing and main taining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: Guidance for prescrib ing exercise","volume":"43","author":"Garber,","year":"2011","journal-title":"Medicine&Science in Sports&Exercise"},{"issue":"3","key":"10.3233\/NRE-220044_ref14","doi-asserted-by":"crossref","first-page":"519","DOI":"10.3233\/NRE-130874","article-title":"Vestibular rehabilitation following mild traumatic brain injury","volume":"32","author":"Gurley,","year":"2013","journal-title":"NeuroRehabilitation"},{"issue":"2","key":"10.3233\/NRE-220044_ref15","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1123\/jsr.2019-0070","article-title":"Does early low-intensity aerobic exercise hasten recovery in adolescents with sport-related concussion?","volume":"29","author":"Henke,","year":"2020","journal-title":"Journal of Sport Rehabilitation"},{"key":"10.3233\/NRE-220044_ref16","unstructured":"Herdman, S. , Clendaniel R. (2014).Vestibular rehabilitation (4th ed.).F.A. Davis Company."},{"issue":"g1687","key":"10.3233\/NRE-220044_ref17","first-page":"1","article-title":"Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide","volume":"348","author":"Hoffmann,","year":"2014","journal-title":"BMJ"},{"key":"10.3233\/NRE-220044_ref18","unstructured":"GRADEpro GDT..(2020) GRADEpro GDT. [Computer software], \u2013Ontario: Canada."},{"issue":"4","key":"10.3233\/NRE-220044_ref19","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1542\/peds.2005-0994","article-title":"Pediatric sport-related concussion: A review of the clinical management of an oft-neglected population","volume":"117","author":"Kirkwood,","year":"2006","journal-title":"Pediatrics"},{"issue":"6","key":"10.3233\/NRE-220044_ref20","first-page":"519","article-title":"The effects of vestibular rehabilitation on dizziness and balance problems in patients after traumatic brain injury: A randomized controlled trial","volume":"30","author":"Kleffelgaard,","year":"2019","journal-title":"Clinical Journal of Sport Medicine"},{"issue":"2","key":"10.3233\/NRE-220044_ref21","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1097\/HTR.0000000000000238","article-title":"Aero-bic exercise for adolescents with prolonged symptoms after mild traumatic brain injury: An exploratory randomized clini-cal trial","volume":"32","author":"Kurowski,","year":"2017","journal-title":"Journal of Head Trauma Rehabilitation"},{"issue":"3","key":"10.3233\/NRE-220044_ref22","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1177\/0363546517706137","article-title":"The effect of physical exercise after a concussion: a sys-tematic review and meta-analysis","volume":"46","author":"Lal,","year":"2018","journal-title":"American Journal of Sports Medicine"},{"issue":"12","key":"10.3233\/NRE-220044_ref23","doi-asserted-by":"crossref","first-page":"2491","DOI":"10.1249\/MSS.0000000000002402","article-title":"Aerobic exercise for sport-related con-cussion: A systematic review and meta-analysis","volume":"52","author":"Langevin","year":"2020","journal-title":"Medicine & Science in Sports & Exercise"},{"issue":"6","key":"10.3233\/NRE-220044_ref24","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1249\/JSR.0000000000000008","article-title":"Use of graded exercise testing in concussion and return-to-activity management","volume":"12","author":"Leddy,","year":"2013","journal-title":"Current Sports Medicine Reports"},{"issue":"4","key":"10.3233\/NRE-220044_ref25","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1001\/jamapediatrics.2018.4397","article-title":"Early subthreshold aerobic exer-cise for sport-related concussion: A randomized clinical trial","volume":"173","author":"Leddy,","year":"2019","journal-title":"JAMA Pediatrics"},{"issue":"2","key":"10.3233\/NRE-220044_ref26","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1177\/1941738111433673","article-title":"Rehabilitation of concussion and post-concussion syn-drome","volume":"4","author":"Leddy,","year":"2012","journal-title":"Sports Health"},{"issue":"5","key":"10.3233\/NRE-220044_ref27","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1016\/S1474-4422(15)00002-2","article-title":"Diagnosis, prognosis, and clinical management of mild traumatic brain injury","volume":"14","author":"Levin","year":"2015","journal-title":"Lancet Neurology"},{"issue":"588","key":"10.3233\/NRE-220044_ref28","first-page":"1","article-title":"The association between moderate and vigorous physical activity and time to medical clearance to return to play following sport-related concussion in youth ice hockey players","volume":"10","author":"Lishchynsky","year":"2019","journal-title":"Frontiers in Neurology"},{"issue":"12","key":"10.3233\/NRE-220044_ref29","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1016\/S1474-4422(17)30371-X","article-title":"Traumatic brain injury: Integrated approaches to improve prevention, clinical care, and research","volume":"16","author":"Maas,","year":"2017","journal-title":"Lancet Neurology"},{"issue":"5","key":"10.3233\/NRE-220044_ref30","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1080\/87565641.2015.1067706","article-title":"Programmed physical exertion in recovery from sports-related concussion: A randomized pilot study","volume":"40","author":"Maerlender,","year":"2015","journal-title":"Developmental Neuropsychology"},{"issue":"3","key":"10.3233\/NRE-220044_ref31","doi-asserted-by":"crossref","first-page":"265","DOI":"10.4085\/1062-6050-43.3.265","article-title":"Concussion in sports: Postconcussive activity levels, symptoms, and neu rocognitive performance","volume":"43","author":"Majerske,","year":"2008","journal-title":"Journal of Athletic Training"},{"issue":"5","key":"10.3233\/NRE-220044_ref32","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1136\/bjsports-2013-092255","article-title":"The difficult patinet: What is the best approach to investigation and management of persistent (>\u200a 10 days) postconcussive symptoms?","volume":"47","author":"Makdissi,","year":"2013","journal-title":"British Journal of Sports Medicine"},{"issue":"6","key":"10.3233\/NRE-220044_ref33","doi-asserted-by":"crossref","first-page":"688","DOI":"10.3109\/02699052.2015.1004755","article-title":"Updated clinical practice guidelines for concussion\/mild traumatic brain injury and persistent symptoms","volume":"29","author":"Marshall,","year":"2015","journal-title":"Brain Injury"},{"key":"10.3233\/NRE-220044_ref34","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.neubiorev.2014.11.016","article-title":"Functional magnetic resonance imaging of mild traumatic brain injury","volume":"49","author":"Mayer,","year":"2015","journal-title":"Neuroscience & Biobehavioral Reviews"},{"key":"10.3233\/NRE-220044_ref35","unstructured":"McArdle, W. , Katch, F. , Katch, V. (2014).Exercise physiology: Nutrition, energy, and human development (8th ed.). Lippincot Williams&Wilkins."},{"issue":"11","key":"10.3233\/NRE-220044_ref36","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1136\/bjsports-2017-097699","article-title":"Consensus statement on concussion in sport - The 5th international conference on concussion in sport held in Berlin, October 2016","volume":"51","author":"McCrory,","year":"2017","journal-title":"British Journal of Sports Medicine"},{"issue":"5","key":"10.3233\/NRE-220044_ref37","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1136\/bjsports-2013-092313","article-title":"Consensus statement on concussion in sport: The 4th International Conference on Concussion in Sport held in Zurich, November 2012","volume":"47","author":"McCrory,","year":"2013","journal-title":"British Journal of Sports Medicine"},{"issue":"3","key":"10.3233\/NRE-220044_ref38","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1097\/PHM.0000000000001340","article-title":"The role of subsymptom theshold aerobic exercise and persistent concussion symptoms in patients with postconcussion syndrome: A systematic review","volume":"99","author":"McIntyre,","year":"2020","journal-title":"American Journal of Physical Medicine & Rehabilitation"},{"issue":"1","key":"10.3233\/NRE-220044_ref39","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1136\/bmjsem-2018-000404","article-title":"Feasibility of a postacute structured aerobic exercise intervention following sport concussion in symptomatic adolescents: A randomised controlled study","volume":"4","author":"Micay,","year":"2018","journal-title":"BMJ Open Sport & Exercise Medicine"},{"issue":"n71","key":"10.3233\/NRE-220044_ref41","first-page":"1","article-title":"The PRISMA 2020 statement: an updated guideline for reporting system atic reviews","volume":"372","author":"Page,","year":"2021","journal-title":"British Medical Journal"},{"issue":"5","key":"10.3233\/NRE-220044_ref42","doi-asserted-by":"crossref","first-page":"650","DOI":"10.26603\/ijspt20200650","article-title":"The effect of aerobic exercise on adolescent athletes post-concussion: A systematic review and meta-analysis","volume":"15","author":"Powell,","year":"2020","journal-title":"International Journal of Sports Physical Therapy"},{"key":"10.3233\/NRE-220044_ref43","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1146\/annurev-psych-010213-115103","article-title":"Sport and nonsport etiologies of mild traumatic brain injury: Similarities and dif-ferences","volume":"65","author":"Rabinowitz,","year":"2014","journal-title":"Annual Review of Psychology"},{"issue":"12","key":"10.3233\/NRE-220044_ref44","doi-asserted-by":"crossref","first-page":"2009","DOI":"10.1111\/sms.12827","article-title":"Feasibility of early physical therapy for dizziness after a sports-related concus-sion: A randomized clinical trial","volume":"27","author":"Reneker,","year":"2017","journal-title":"Scandinavian Journal of Medicine & Science in Sports"},{"issue":"3","key":"10.3233\/NRE-220044_ref45","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1080\/02699052.2018.1552022","article-title":"Specialized interdisciplinary rehabilitation reduces persistent post-concussive symptoms: A randomized clinical trial","volume":"33","author":"Rytter,","year":"2019","journal-title":"Brain Injury"},{"issue":"12","key":"10.3233\/NRE-220044_ref46","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1136\/bjsports-2016-097475","article-title":"Rest and treatment\/rehabilitation following sport-related concussion: A systematic review","volume":"51","author":"Schneider,","year":"2017","journal-title":"British Journal of Sports Medicine"},{"issue":"17","key":"10.3233\/NRE-220044_ref47","doi-asserted-by":"crossref","first-page":"1294","DOI":"10.1136\/bjsports-2013-093267","article-title":"Cervicovestibu-lar rehabilitation in sport-related concussion: A randomised controlled trial","volume":"48","author":"Schneider,","year":"2014","journal-title":"British Journal of Sports Medicine"},{"issue":"j4008","key":"10.3233\/NRE-220044_ref48","first-page":"1","article-title":"AMSTAR 2: a critical appraisal tool for sys-tematic reviews that include randomised or non-randomised studies of healthcare interventions, or both","volume":"358","author":"Shea,","year":"2017","journal-title":"British Medical Journal"},{"key":"10.3233\/NRE-220044_ref49","first-page":"29","article-title":"Therapeutic effect of aerobic exercise for adolescents after mild traumatic brain injury and sport-related concussion: A meta-analysis from randomized controlled tri-als","volume":"146","author":"Shen,","year":"2021","journal-title":"World Neurology"},{"issue":"18","key":"10.3233\/NRE-220044_ref50","doi-asserted-by":"crossref","first-page":"1665","DOI":"10.1212\/WNL.0000000000000944","article-title":"Cerebrovascular regulation, exercise, and mild trau-matic brain injury","volume":"83","author":"Tan","year":"2014","journal-title":"Neurology"}],"container-title":["NeuroRehabilitation"],"original-title":[],"link":[{"URL":"https:\/\/content.iospress.com\/download?id=10.3233\/NRE-220044","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T06:07:06Z","timestamp":1777615626000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/full\/10.3233\/NRE-220044"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,30]]},"references-count":46,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3233\/nre-220044","relation":{},"ISSN":["1053-8135","1878-6448"],"issn-type":[{"value":"1053-8135","type":"print"},{"value":"1878-6448","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,30]]}}}