Early Resumption of Physical Activity and Cognitive Outcomes at 4 Week Following Pediatric Concussion.

Abstract

Background: Early physical activity (PA) after concussion may aid in symptom recovery, though its impact on other recovery domains, such as cognitive functioning, remains less explored.

Objectives: (1) Examine the association between early PA (within 7 days post-injury) and cognitive inefficiency and impairment 4 weeks after pediatric concussion; (2) investigate the association between early PA and cognitive outcomes (memory and executive functioning, information processing speed, attention, visual-motor processing, and vocabulary) 4-week post-concussion.

Setting: Emergency departments (EDs) of four Canadian pediatric hospitals within the Pediatric Emergency Research Canada (PERC) Network.

Participants: Children aged 8-18 years presenting to the ED within 48 hours of a head injury and diagnosed with a concussion.

Design: Planned secondary analysis of data from a prospective multicenter cohort study.

Main measures: Participants' PA level was assessed at 1-week post-concussion through a self-report questionnaire in which they had to indicate their current level of recovery in terms of return to physical activities and sports. Early PA participation was defined as any level of PA other than "no activity" at the 1-week follow-up. Participants underwent comprehensive neuropsychological testing at 4-week post-concussion. Primary outcome measures included cognitive inefficiency and impairment (≥2 outcomes with z < -1.0 SD or <-1.5 SD below the normative mean, respectively). Secondary and tertiary outcome measures include t-scores and scaled scores from the 10 neuropsychological tasks, transformed to z-scores.

Results: Early PA was not significantly associated with the likelihood of cognitive inefficiency or impairment (Ps ≥ .38). The early PA*sex interaction was related to verbal cognitive flexibility (P = .02), with females engaging in early PA having better scores. Moreover, the early PA*age interaction was associated with attention (P = .03), with younger children engaged in early PA performing worse.

Conclusions: Early PA has no overall association with cognitive inefficiency or impairment but may be differentially associated with certain cognitive outcomes by age and sex.