Research continues to show the benefits of incorporating supervised exercise during the early symptomatic period following a sport-related concussion.

Jeremiah Freeman, a certified athletic trainer with Michigan NeuroSport, worked alongside Dr. Michael Popvich, clinical assistant professor of Neurology at the University of Michigan, on a study looking to determine how well the introduction of dynamic supervised exercise challenges can guide in-clinic management decisions to help an athlete recover quicker.

Under standard clinical care, physicians and athletic trainers establish strict exercise parameters when first seeing a patient in the clinic following a concussion. Dynamic supervised exercises are clinically-supervised controlled movements and exercises designed to challenge a patient by inducing symptoms not normally present during supervised aerobic exercises. This way, a clinician can establish how the patient is progressing.

“We’re trying to exacerbate symptoms because we want to find the exercise points that we don’t want them hitting on their own. We’re addressing movements and things that will challenge their head in ways that give them symptoms in a supervised, controlled manner,” Freeman said. “This is what helps progress them.”

Freeman starts patients on a stationary exercise bike because it presents the least amount of stimulation. From there, the patient progresses to either an elliptical machine or jogging on their own to induce head motion and background stimulation. If the patient doesn’t show any symptoms, they begin running on a treadmill.

After the cardio exercises, the patient progresses to balance and spatial awareness exercises to work on their vestibular function. Freeman said that the head motion and eye movement associated with these exercises typically cause the patient to report symptoms.

“While you will feel symptoms while doing these head exercises, these help you get better and make it so you can check your blind spot while driving and not get dizzy or catch a pass or punt,” he added.

Finally, the patient progresses through agility exercises (quick stop and starts, change of direction, etc.) and sport-specific exercises before being fully cleared to return to play.

A zero to 10 scale (10 being the worst and 0 meaning no symptoms) is used to determine a symptom’s severity during exercise. A three-point increase on the scale determines when a patient needs to take a rest. If the symptom remains at a three-point increase following the rest period, the patient is told to stop.

The study’s outcome showed that adding in dynamic exercise challenges were safe and didn’t worsen a patient’s recovery. Patients who initiated the supervised exercise while still symptomatic returned to their sport earlier than those who waited until they were symptom-free to start exercising.

“We increase the intensity as they go along, and so this kind of knowledge, that helping them exercise more gets them better faster, encourages us as practitioners to push them,” Freeman explained. “We know what the limits are; we know what is good for them as long as we keep it within certain parameters. It helps us guide their treatment.”

Freeman added that further research into this area could help determine which exercises help patients recover faster from a concussion.