Adolescent concussion patients who performed more than 150 minutes of aerobic exercise per week scored better on a sleep quality questionnaire than a group who exercised less, according to a small study funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Many concussion patients experience sleep problems, which may worsen concussion symptoms. These preliminary findings suggest the possibility that a higher volume of aerobic exercise could potentially improve sleep quality among adolescent concussion patients, although more research is needed.
The study was conducted by David Howell, Ph.D, Mathew Wingerson, M.S., and their colleagues at the University of Colorado. It appears in the Journal of Head Trauma Rehabilitation.
Background
Concussion is a mild type of traumatic brain injury that may take from several minutes to several months to heal. It occurs when the brain moves rapidly inside the skull, usually from a blow to the head, or when a person is violently shaken. Numerous factors 
influence recovery from concussion, including severity of symptoms, age, biological sex, and prior concussion.
Concussions may result in sleep problems, and poor sleep quality after concussion may worsen symptoms, such as dizziness, headache, fatigue, and difficulty concentrating. Aerobic exercise, provided it is below a heart rate that worsens symptoms, has been reported to relieve symptoms. However, it is not known whether light exercise of 30 minutes a day (150 minutes per week) or a greater duration of activity is more effective at relieving symptoms.
Results
For the current study, researchers examined whether adolescent concussion patients who had more than 150 minutes of aerobic exercise a week had better sleep quality than those who exercised less. Participants were 10 to 17 years old, had been diagnosed with a concussion, and were still experiencing symptoms within 18 days of their diagnosis. Each was given a Fitbit smart watch to record their physical activity. Patients visited study staff an average of eight days after their diagnosis and again an average of 34 days later. At each visit, participants completed the Pittsburgh Sleep Quality Inventory, a questionnaire that assesses sleep quality.
A total of 36 adolescents completed the study. Of these, 15 had completed more than 150 hours per week of aerobic exercise, and 21 had logged fewer than 150 hours per week. By the second visit, the higher volume exercise group showed significantly greater sleep quality, improving their score on the sleep inventory scale by an average of 5 points, compared to a 1-point improvement for the lower volume group.
Significance
The researchers concluded that more than 150 minutes per week of aerobic exercise during concussion recovery was associated with better sleep quality. However, because the study was not designed to prove cause and effect, it is possible that those who slept better were better able to exercise because they were more refreshed, rather than that the exercise promoted better sleep. Still, the authors say their results may encourage health care professionals to consider counseling young concussion patients on the potential importance of sleep health and exercise in recovery from a concussion.
Reference
Howell, DR, et al. Exercising more than 150 min/wk after concussion is associated with sleep quality improvements. Journal of Head Trauma Rehabilitation. 2024. DOI: 10.1097/HTR.0000000000000918
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