Virtual Aerobic Exercise Speeds Recovery After Concussion in Youth, suggests clinical trial

A new study published in the Journal of American Medical Association showed that when compared to stretching, a remotely administered aerobic exercise program sped up young people's recovery from concussions.

Aerobic exercise has been shown in trials to aid recovery in adolescents with concussion; however, previous research focused on acute concussion and needed many in-person visits. As a result, this study was set to see if a virtually delivered aerobic exercise program improves recovery after a concussion when compared to a stretching control, as well as to investigate potential moderators.

From 2021 to 2025, a randomized clinical study was done to compare the Mobile Subthreshold Exercise Program (MSTEP) to a stretching control in 11- to 18-year-olds with concussions up to one year after injury. A range of outpatient facilities in four US states—Washington, Utah, Wisconsin, and Oregon—were used to recruit participants. Data analysis was place between November 2025 and April 2026, whereas recruitment and data gathering took place between March 2021 and October 2025.

Activity trackers and an aerobic exercise program started at 60% of heart rate maximum were given to youth randomly assigned to MSTEP. Exercise was progressed in intensity and duration over 6 weeks through weekly videoconferencing conversations. Primary objectives comprised of concussive symptoms and health-related quality of life (HRQoL). Sleep, depression, and anxiety were all reported as secondary outcomes. Moderation by sex, age, and time since injury was explored and the patients were followed up for six months.

The sample included 210 individuals, of which 122 (58.1%) were female, mean (SD) age was 15.1 (2.2) years, and mean (SD) time since injury was 73.3 (63.3) days. Concussive symptoms and HRQoL significantly improved at all time periods, according to covariate-adjusted regression analysis, with MSTEP improving more than control at the 3-month time point for both HRQoL and concussive symptoms. No significant changes by group were detected at 6 months. When comparing MSTEP to control, nonlinear mixed-effects modeling with exponential decay revealed noticeably quicker symptom recovery.

All individuals had improvements in secondary outcomes, but there were no group differences. Only those who had been injured for less than three months benefited significantly from the intervention. No evidence was found for moderation by other factors. Overall, an aerobic exercise program improves the speed of recovery after concussion for youth when compared to stretching and can be delivered remotely. 

Source:

Chrisman, S. P. D., Bollinger, B. J., Flaat, A., Sahlberg, J., Zhou, C., Mendoza, J. A., Brooks, M. A., Palermo, T. M., Hansen, C. R., & Rivara, F. P. (2026). Mobile Subthreshold Exercise Program (MSTEP) for youth with prolonged concussion recovery: A randomized clinical trial. JAMA Pediatrics. https://doi.org/10.1001/jamapediatrics.2026.4927