Exercises for Concussion

(TECHS Trial)

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: Northeastern University

Disqualifiers: Moderate-to-severe TBI, Neurological condition, Cardiac conditions, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 39

Duration: 12 weeks

24 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how different types of exercise can heal the brain and improve thinking skills after a mild traumatic brain injury (mTBI), such as a concussion. Participants will follow a 3-month exercise plan focusing on either balance exercises or aerobic exercises (also known as cardiovascular exercise or fitness training). The goal is to determine which type of exercise best aids recovery. Individuals who experienced a concussion within the past year and can exercise without pain or assistance might be suitable for this trial. As an unphased trial, this study provides a unique opportunity to contribute to understanding how exercise aids recovery from mTBI.

Do I have to stop taking my current medications for the trial?

The trial protocol does not specify if you need to stop taking your current medications. However, if you are being treated for certain cardiovascular conditions or have had recent cardiac events, you may be excluded from participating.

What prior data suggests that these exercise protocols are safe for individuals with mTBI?

Research shows that both aerobic and balance exercises are generally safe for people recovering from concussions. Aerobic exercise, such as walking or cycling, can reduce symptoms and speed up recovery for those with ongoing post-concussion issues. One study found that starting controlled aerobic exercise early safely shortens recovery time.

Balance exercises, or vestibular rehabilitation, are also safe and beneficial when started early. Research indicates they can reduce symptoms like dizziness and balance problems, enhancing overall recovery. In both children and adults recovering from concussions, this type of exercise therapy has decreased dizziness and improved balance.

Overall, past studies have shown both types of exercises to be well-tolerated, with no reports of serious side effects. This suggests they are likely safe options for those recovering from mild traumatic brain injuries. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about using exercise for concussion recovery because it offers a natural, non-pharmacological approach that could improve healing. Unlike standard treatments like rest and medication, aerobic exercise may enhance brain function by increasing blood flow and oxygen to the brain, possibly speeding up recovery. Balance exercises could also uniquely support recovery by improving coordination and stability, which are often affected by concussions. This approach not only targets physical symptoms but also encourages active rehabilitation, potentially leading to faster and more complete recovery.

What evidence suggests that this trial's exercise interventions could be effective for mTBI?

This trial will compare the effects of aerobic exercise and balance exercise on concussion recovery. Studies have shown that aerobic exercise, which participants in the Aerobic Exercise Group will perform, can improve symptoms after a concussion. Research indicates that starting aerobic exercise soon after the injury can significantly reduce the risk of long-lasting symptoms. For example, one study found that early aerobic activity led to a 48% lower chance of ongoing symptoms. Meanwhile, participants in the Balance Exercise Group will engage in balance exercises, like those used in vestibular rehabilitation, which may help reduce dizziness and balance problems. Although more research is needed, these exercises could be beneficial as part of a broader treatment plan for recovering from a concussion. ^{2 3 4 6 7}

Are You a Good Fit for This Trial?

This trial is for adults living in the community who have experienced a mild traumatic brain injury (mTBI) or concussion. The study seeks participants to test exercise interventions aimed at improving brain and cognitive recovery.

Inclusion Criteria

Signed Informed consent

Able to speak, read, and write English

MRI compatible

Exclusion Criteria

I have had a stroke or brain bleed in the past.

I have been diagnosed with a cognitive or physical disability.

I am not fluent in English.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

1 visit (in-person)

Baseline Assessment

Participants sign informed consent and undergo baseline assessments including MRI, EEG, cognition tests, and lifestyle questionnaires

1 day

1 visit (in-person)

Treatment

Participants engage in a 12-week exercise intervention focusing on either aerobic or balance exercises, with remote sessions conducted via Zoom

12 weeks

36 remote sessions (via Zoom)

Follow-up

Participants are monitored for safety and effectiveness after treatment, with endpoint assessments including MRI, EEG, and cognitive tests

1 day

1 visit (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Aerobic Exercise
• Balance Exercise

Trial Overview The study is testing two types of physical exercises: balance and aerobic exercises. Participants will follow a 3-month exercise protocol to see which type better aids recovery after mTBI.

How Is the Trial Designed?

Group I: Aerobic Exercise Group Experimental Treatment 1 Intervention

Group II: Balance Exercise Group Active Control 1 Intervention

Who Is Running the Clinical Trial?

Northeastern University

Lead Sponsor

Trials

103

Recruited

72,600+

Published Research Related to This Trial

In a study involving 75 amateur athletes (45 females and 30 males), light aerobic exercise after a concussion led to increased reports of balance problems and somatic symptoms for both genders, indicating that some symptoms may temporarily worsen post-exercise.

Women experienced significant reductions in emotional symptoms like irritability and sadness after aerobic exercise, while men did not show significant changes in headache or emotional symptoms, highlighting important sex differences in symptom response post-concussion.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Sex differences in self-reported symptoms after aerobic exercise in non-injured athletes: implications for concussion management programmes. Gaetz, MB., Iverson, GL.[2009]

In a study of 65 adolescent athletes with sport-related concussions, a dynamic supervised exercise challenge (DSEC) was more effective at uncovering concussion symptoms than a basic aerobic supervised exercise challenge (ASEC), with 37% of previously asymptomatic patients developing symptoms during the DSEC.

The findings suggest that incorporating dynamic exercises into concussion assessments can enhance symptom detection, which is crucial for guiding safe return-to-play decisions in young athletes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Symptom Provocation During Aerobic and Dynamic Supervised Exercise Challenges in Adolescents With Sport-Related Concussion. Popovich, M., Sas, A., Almeida, AA., et al.[2022]

Aerobic exercise at subsymptom and submaximal intensities is safe for individuals with sports-related concussions, as shown in four randomized controlled trials that included supervised exercise starting within one week of injury.

Controlled exercise may benefit adolescents with persistent concussion symptoms, and while symptom changes can occur, they do not negatively impact long-term recovery, supporting a shift from traditional rest to active rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Rehabilitation Utilizing Controlled Aerobic Activity in Patients With a Concussion: A Critically Appraised Topic. Prince, J., Schussler, E., McCann, R.[2021]

A 3-month community-based aerobic exercise training program showed a trend toward improved cardiorespiratory fitness (CRF) in individuals with traumatic brain injury (TBI), with an 8% increase in VO2peak compared to a 4% decrease in a stretching and toning group, indicating potential efficacy of aerobic exercise for this population.

The study demonstrated that while it is feasible to conduct exercise training in community settings for TBI patients, only 50% of participants adhered to the program, highlighting the need for strategies to improve adherence in future trials.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A proof-of-concept trial of a community-based aerobic exercise program for individuals with traumatic brain injury. Ding, K., Tarumi, T., Tomoto, T., et al.[2021]

In a study of 14 adults with persistent concussion symptoms, a 6-month supervised home exercise program combining vestibular rehabilitation and aerobic training led to significant improvements in concussion-related symptoms and functional abilities, as measured by various clinical assessments.

Participants showed notable progress in returning to work and engaging in meaningful activities, with statistical significance in measures related to symptom reduction and balance confidence, indicating the effectiveness of this rehabilitation approach.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Outcomes Following a Vestibular Rehabilitation and Aerobic Training Program to Address Persistent Post-Concussion Symptoms. Moore, BM., Adams, JT., Barakatt, E.[2018]

Early aerobic exercise prescribed within 10 days of a sport-related concussion (SRC) significantly reduces recovery times, even for adolescents with more severe symptoms, as indicated by a hazard ratio of 0.621.

Adolescents with more than three abnormal oculomotor and vestibular signs had a higher incidence of persistent post-concussive symptoms (38%) when assigned to a placebo-like stretching group, compared to only 21% in the aerobic exercise group, suggesting that aerobic exercise may help mitigate long-term symptoms.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adolescents With More Oculomotor and Vestibular Signs of Sport-Related Concussion Benefit from Aerobic Exercise: An Exploratory Analysis. Corrado, C., Willer, BS., McPherson, JI., et al.[2023]

In a pilot study of 91 patients with postconcussion syndrome (PCS), those who participated in a progressive exercise rehabilitation program showed a high return to full daily functioning, with 72% overall success, including 77% from the physiologic PCS group.

Only 1 out of 6 patients who declined exercise rehabilitation returned to full functioning, suggesting that engaging in exercise may be crucial for recovery from PCS.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Return to full functioning after graded exercise assessment and progressive exercise treatment of postconcussion syndrome. Baker, JG., Freitas, MS., Leddy, JJ., et al.[2022]

A review of 20 studies on non-aerobic exercise interventions for improving balance and gait in individuals with mild-to-moderate traumatic brain injury (TBI) found limited evidence of effectiveness, highlighting the need for better quality research.

The studies reviewed often had small sample sizes and varied methodologies, indicating that future research should focus on standardizing interventions and outcome measures to provide clearer insights into their efficacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of physical therapy for improving gait and balance in individuals with traumatic brain injury: a systematic review. Bland, DC., Zampieri, C., Damiano, DL.[2021]

A brief aerobic exercise intervention improved total symptom scores in healthy participants, indicating some positive effects on concussion-related symptoms after training, with scores decreasing from 5.1 to 1.9 over two sessions.

Despite some improvements in symptoms and cognitive flexibility, the overall changes were small and did not significantly affect clinical concussion assessment tools, suggesting that these tools remain stable regardless of aerobic exercise training.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Randomized Controlled Trial Evaluating Aerobic Training and Common Sport-Related Concussion Outcomes in Healthy Participants. Teel, EF., Register-Mihalik, JK., Appelbaum, LG., et al.[2020]

An 8-week progressive aerobic exercise program was found to be feasible and well tolerated by five individuals recovering from moderate to severe traumatic brain injury (TBI), indicating that aerobic exercise can be safely integrated into their rehabilitation.

Participants successfully adhered to both the aerobic exercise and cognitive training, although measuring exercise intensity was challenging due to poor correlations between heart rate reserve and perceived effort.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Feasibility of Aerobic Exercise in the Subacute Phase of Recovery From Traumatic Brain Injury: A Case Series. Morris, TP., Costa-Miserachs, D., Rodriguez-Rajo, P., et al.[2021]

In a small clinical trial with 12 adults with traumatic brain injury (TBI), an 8-week program of rapid-resisted elliptical training significantly improved dynamic balance and motor processing speed, as measured by the High-Level Mobility Assessment Tool (HiMAT) and dual-task performance.

The training not only enhanced physical abilities but also positively impacted sleep quality, which correlated with reductions in depression and improvements in learning, highlighting the interconnectedness of physical and cognitive recovery in TBI patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of a rapid-resisted elliptical training program on motor, cognitive and neurobehavioral functioning in adults with chronic traumatic brain injury. Damiano, DL., Zampieri, C., Ge, J., et al.[2023]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10569252/

The Additive Benefits of Aerobic Exercise and Cognitive ... Current concussion rehabilitation paradigms using aerobic exercise may improve concussion symptoms. Additionally, cognitive training–focused rehabilitation ...

2. jamanetwork.com jamanetwork.com/journals/jamanetworkopen/fullarticle/2815228

Optimal Volume of Moderate-to-Vigorous Physical Activity ... A recent randomized clinical trial involving adolescents within 10 days of SRC reported a 48% lower risk of PSAC at 4 weeks among those assigned ...

3. bjsm.bmj.com bjsm.bmj.com/content/57/12/762

Rest and exercise early after sport-related concussion Importantly, there was a 48% reduction in PPCS incidence for the early aerobic exercise group (HR for stretching vs aerobic exercise=0.52 (95% ...

4. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8601125/

The Effect of Aerobic Exercise on Concussion Recovery In comparison, participation in high-intensity physical activity after concussion was associated with poorer neurocognitive performance (Majerske et al., 2008).

5. journals.lww.com journals.lww.com/ajpmr/fulltext/2025/10000/promoting_early_aerobic_exercise_initiation_after.3.aspx

Promoting Early Aerobic Exercise Initiation After Concussion Supervised initiation of aerobic exercise early after concussion appears to be feasible and improve outcomes compared to standard exercise recommendations.

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6422757/

The Role of Aerobic Exercise in Reducing Persistent Sport ... Exercise training has been reported to reduce symptoms and improve function for those experiencing persistent postconcussion symptoms.

7. sciencedirect.com sciencedirect.com/science/article/abs/pii/S1060187222000077

Sport-Related Concussion and Exercise Intolerance Controlled, sub-symptom threshold aerobic exercise prescribed early after SRC has been shown to safely reduce recovery time and may prevent some from ...