Blog

Concussion Rehabilitation: Combining Aerobic Exercise and Cognitive Training

| By Dr. Jennifer Hunnicutt

More research is emerging on the benefits of aerobic exercise and cognitive training for individuals diagnosed with concussion.

Treatment for concussion usually involves rest. But complete rest beyond 24-48 hours may actually prolong recovery. More and more research is emerging on the benefits of rehabilitation, such as aerobic exercise and cognitive training, for individuals diagnosed with concussion. However, most of this research has studied these two training modalities independently.

Because concussion is a complicated brain injury that affects multiple body systems, it is logical that combining aerobic exercise with cognitive training in an athlete’s rehabilitation would improve outcomes.

Today on the blog, we feature a research review recently published in the Journal of Athletic Training that offers current clinical concepts on the combined modalities of aerobic exercise and cognitive training in concussion rehabilitation. (1)

First, let’s discuss what is aerobic exercise and cognitive training in concussion rehabilitation.

What is aerobic exercise in concussion rehabilitation?

Aerobic exercise is cardiovascular exercise (also known as cardio) that gets the heart pumping and increases the heart rate and breathing rate. Review of the current research supports the use of aerobic exercise for both acute symptoms and persistent symptoms (presence of symptoms beyond 10-14 days for adults and four weeks for adolescents).

What is cognitive training in concussion rehabilitation?

Cognitive training is a type of rehabilitation that is aimed at improving a person’s ability to perform cognitive tasks. (2) Cognitive tasks involve memory, attention, and problem-solving. Review of the current research supports the use of post-concussion cognitive training in military, veteran, and athletic populations.

What are the benefits of combining aerobic exercise with cognitive training in concussion rehabilitation?

So far, there has been no research combining the two interventions in concussion rehabilitation. Therefore, authors of this article reviewed the studies that independently evaluated aerobic exercise and cognitive training. They also looked to other populations outside of concussed individuals (ie, older adults). In older adults, doing both aerobic exercise and cognitive training improves brain function and mood. In individuals with concussion, it is plausible that participating in both aerobic exercise and cognitive training would improve function and outcomes, as well as decrease time to recovery, beyond just participating in one intervention alone.

Current Clinical Concepts

The authors provide the following current clinical concepts for aerobic exercise and cognitive training specifically for athletes. These concepts can be implemented by athletic trainers or other healthcare providers specialized in concussion management.

  • Aerobic Exercise
    • Individualized aerobic exercise at an intensity of 80% of the heart rate achieved in baseline exercise tolerance assessment
    • Mode of aerobic exercise specific to concussed athlete (i.e., swimming exercise for a swimmer)
    • Amount of exercise should be 160 minutes per week (can be divided out over several days)
  • Cognitive Training
    • Cognitive tasks aimed at memory, attention, learning, and executive functioning
    • Training on stress management, problem solving, communication, and social skills
    • Cognitive training should occur 1-5 times per week (can be performed on same days of aerobic exercise)

It is unlikely that these concepts will be implemented in the first 48 hours after concussion. It should also be noted that each athlete with a concussion is totally different, so use of these concepts should be dictated by the state of the athlete and their recovery. Of course, with the use of aerobic exercise and cognitive training, concussion symptoms should be routinely monitored before, within, and after sessions, as well as over time.

References

  1. Callahan CE, Stoner L, Zieff GH, Register-Mihalik JK. The Additive Benefits of Aerobic Exercise and Cognitive Training Post-Concussion: Current Clinical Concepts. J Athl Train. 2022 Aug 22. doi: 10.4085/1062-6050-0186.22. Epub ahead of print. PMID: 35984726.
  2. Tsaousides T, Gordon WA. Cognitive rehabilitation following traumatic brain injury: assessment to treatment. Mt Sinai J Med. 2009 Apr;76(2):173-81. doi: 10.1002/msj.20099. PMID: 19306374.
Dr. Jennifer Hunnicutt
Latest posts by Dr. Jennifer Hunnicutt (see all)

Resources