The phrase ‘when in doubt, sit it out’ is the pervasive idea that instructs concussion patients to not exercise while having symptoms. The recommendation, widely adopted by sport concussion protocols, is based on expert consensus and formed on limited, low quality evidence.

A team led by Drs. Catherine Varner, Bjug Borgundvaag and Shelley McLeod, researchers at the Schwartz/Reisman Emergency Medicine Institute (SREMI), based at Mount Sinai Hospital conducted the first randomized trial of prescribed early light exercise for adults with concussion. Results were published in this month’s Academic Emergency Medicine and received the 2020 Canadian Association of Emergency Physicians’ award for research abstract of the year.

The randomized control trial compared prescribing light exercise to standard discharge instructions for adults with concussion. The study prospectively enrolled the largest cohort (367 participants) of this patient population to date in three Canadian emergency departments.

“We found there were no differences in recovery or health care utilization outcomes despite exercise group participants completing more physical activity than the control group participants, an outcome that persisted for the duration of the 30 day follow-up period,” said Dr. Catherine Varner, lead author and physician at SREMI.

The results suggest early light exercise may be encouraged as tolerated at ED discharge following concussion, but this guidance is not sufficient to prevent prolonged symptoms.