Aerobic Exercise after Concussion

Ashley Contreras | 17 May, 2021

            Aerobic Exercise after Concussion

If you are reading this article I hope you have heard that REST IS OUT and EXERCISE IS IN! There are some guidelines though after concussion so here is the current information based on the clinical practice guidelines issued by the American Physical Therapy Association. It is best to figure out your exercise tolerance with a healthcare provider who has extra training in concussion care. If you are unable to access this assessment here are some tips to get started on your own. Be cautions and listen to your body as you begin. Symptoms tell a story that something in your brain or body is not functioning properly. Symptoms are not the problem but are a result of the problem and therefore can be used to guide you through treatment.


Rest should be implemented for 48 hours after a concussion. This refers to cognitive and physical rest.


You have to make sure that the activity you are starting does not put you at risk for another concussion. It is very important that you prevent a second concussion as this has been shown to increase healing time and significantly increase symptoms.


Be sure to hydrate with water before and during exercise. Dehydration can increase symptoms of dizziness, brain fog, lightheadedness, and imbalance. Drink your body weight in lbs divided by 2 = ounces you should drink daily. If you weight 140lbs then you should drink 70 ounces. 


Prevent falls: if you are having trouble with imbalance use a walking pole or hiking stick to allow yourself to feel safe going for walks outdoors. 


Moderate physical activity improves recovery outcomes when started as soon as the first week post-concussion. Physical activity follows the 2 point rule meaning that your symptoms do not increase more than 2 points on a 10 point scale due to the exercise.


Aerobic Exercises ranked from easiest to most difficult FOR THE BRAIN:

  • Walking in an open environment AKA nature
  • Biking (Stationary upright cycling or recumbent biking)
  • Swimming
  • Walking on a treadmill
  • Rowing
  • Elliptical
  • HIIT


The exercises are ranked in the above order due to their demand on the brain and the complexity of integrating the information through the brain. Walking and riding a stationary bike provide lower levels of stimuli to the visual, vestibular, somatosensory, and autonomic nervous system. They are tolerated well to begin. As overall exercise tolerance improves then you increase the workload of the brain as you would progressively add load to any type of workout.


Reasons for exercise intolerance:

  • Visual / vestibular mismatch
  • Autonomic dysregulation
  • Reduced cerebral bloodflow