A concussion can negatively impact nearly every aspect of daily life, causing everything from mood and cognitive changes to headaches and dizziness.
As part of his team’s ongoing research on concussions, Dr. David Howell, associate professor of orthopedics at the University of Colorado School of Medicine, and his colleagues have come to a recommendation for at least one of the negative aftereffects of concussions: poor sleep quality.
In an article published in July in the Journal of Head Trauma Rehabilitation, the study team found that 150 minutes or more of exercise per week was associated with improved sleep quality in adolescents who had recently suffered a concussion.
“We see this connection: People who exercise less tend to sleep worse, and people who sleep worse tend to exercise less,” says Howell, senior researcher in sports medicine at Children’s Hospital Colorado. “We realized that we may not be recommending enough exercise for concussions. We found that if you go beyond that 150-minute threshold, sleep quality tends to improve over time.”
Regular activity
The 150-minute limit is a practical, easy-to-implement recommendation, Howell says. Essentially, patients are advised to exercise for 30 minutes a day, five days a week.
“It doesn’t have to be every day,” he says. “You can take a few days off. But there is strong evidence that regular aerobic exercise at an intensity that won’t hurt you can lead to better recovery from a concussion. We don’t want people to exercise so much that they feel significantly worse – that they get dizzy or their headaches get worse than they would be at rest.”
For the published study, Howell and his research team did not prescribe a set amount of exercise; they simply asked the concussion patients – all patients at the Children’s Colorado Sports Medicine Clinic – to exercise as much as they felt comfortable. Sleep quality, as measured by the Pittsburgh Sleep Index, improved across the board during the study, but those who reached the 150-minute level between measurements saw even more improvement in sleep quality, according to Howell – by an average of five points on the scale, compared to one point for those who exercised less.
“We suspect that the improvement is partly due to the fact that the combination of exercise and healthy sleep promotes brain recovery after injury,” says Howell.
“The main problem with a concussion is what’s called an energy crisis,” he explains. “There are neurons in the brain that need to repair themselves, and to do that, more energy needs to come into the brain. But the concussion causes changes in cerebral blood flow, so the brain doesn’t get enough blood to deliver that energy. Exercise helps regulate that process so the brain gets the energy it needs. And afterward, sleep can also help clear some of the metabolic waste that builds up as a result of the injury.”
A practice regulation
As a next step in his research on concussions and sleep, Howell is now in the third year of recruiting for a randomized clinical trial in which one group of participants will be prescribed 150 minutes of exercise per week, while the other group will do the exercises their doctor would normally recommend.
“With the treatment group, we focus on prescribing and saying, ‘This is exactly what you should do for the next few weeks until you feel better,'” he says. “Currently, the standard for exercise is, ‘Do something, go out, be physically active, but if a change makes you feel worse, stop and try again tomorrow.’ It’s not quite as normative.
“We’re trying to move toward precision medicine, an individualized treatment approach where ultimately, for someone who comes in with a certain medical history, demographics or injury characteristics, we can create a more comprehensive plan: ‘Based on your medical history, this is going to be the heart rate you want to get to and the amount of exercise you want to do compared to someone else,'” he continues. “Exercise might be something we can prescribe to people and say, ‘Do this much every week, and that can help regulate some of your sleep patterns and help your brain recover.'”
