Gentle Aerobic Exercise Guide for Post-Concussion Recovery
Important Safety Notice
Consult with a healthcare provider before beginning this program. This guide is intended for individuals recovering from concussion who cannot access or perform a Buffalo Concussion Treadmill Test (BCTT). All exercise should only be initiated after receiving clearance from a physician, neurologist, or qualified healthcare provider managing your concussion recovery.
Introduction
Research shows that carefully controlled aerobic exercise can help recovery from concussion when implemented appropriately. This guide provides a structured approach to begin light aerobic activity without access to a treadmill test, based on current clinical guidelines for concussion management.
Prerequisites Before Starting
Medical clearance from your healthcare provider
Stable symptoms (not worsening) at rest for at least 24-48 hours
A heart rate monitor (chest strap or reliable wrist-based)
A way to record data (notebook, smartphone app)
Someone nearby for safety (strongly recommended for initial sessions)
Knowledge of your symptoms and their severity (0-10 scale)
Understanding Your Symptom Baseline
Before starting any exercise program:
Document your symptoms daily for 2-3 days
Rate each symptom on a scale of 0-10
0 = no symptoms
10 = severe symptoms
Track common post-concussion symptoms:
Headache
Dizziness
Nausea
Light/noise sensitivity
Fatigue
Mental fogginess
Balance problems
Visual disturbances
Determining Your Starting Point
Without a BCTT to establish your threshold, you'll need to start conservatively:
Calculate a safe target heart rate range:
Formula: 30-40% of your heart rate reserve + resting heart rate
Heart rate reserve = (220 - your age) - resting heart rate
Example for a 30-year-old with resting heart rate of 70 BPM:
Max HR: 220 - 30 = 190 BPM
Heart rate reserve: 190 - 70 = 120 BPM
Target range: (120 × 0.3) + 70 to (120 × 0.4) + 70 = 106 to 118 BPM
For those without heart rate monitors:
Use the "talk test" - you should be able to speak in full sentences
Perceived exertion: 2-3 on a 10-point scale (very light effort)
Exercise Options
Choose activities that are:
Low-impact
Stable (minimal head movement)
Easily controlled for intensity
In environments you can control (lighting, noise)
Recommended Activities (in order of typical tolerance):
Stationary Walking or Marching in Place
Controlled environment
Minimal balance challenges
Easy to monitor symptoms
Recumbent Exercise Bike
Supported sitting position
Head stable during exercise
Easily adjustable resistance
Standard Exercise Bike
More upright but still stable
Minimal head movement
Elliptical Machine
Low impact but more complex motion
Try only after tolerating other options
The Protocol
Week 1: Establishing Tolerance
Session structure:
Duration: 5-10 minutes
Frequency: Every other day (3-4 sessions)
Intensity: Very light (30-40% of heart rate reserve)
Environment: Quiet, normal lighting
During each session:
Record pre-exercise symptoms (0-10)
Monitor heart rate throughout
Stop immediately if symptoms increase by ≥2 points
Record post-exercise symptoms immediately, then at 15 and 30 minutes
Week 2: Building Consistency
If Week 1 was well-tolerated (no symptom increase):
Duration: 10-15 minutes
Frequency: Every other day
Intensity: Maintain same target heart rate
Environment: Same controlled setting
Week 3: Gradual Progression
If Week 2 was well-tolerated:
Duration: 15-20 minutes
Frequency: Every other day
Intensity: Consider increasing to 40-50% of heart rate reserve if previous intensity was easy
Environment: Same controlled setting
Week 4 and Beyond: Structured Advancement
If Week 3 was well-tolerated:
Duration: Increase by 5 minutes each week until reaching 30 minutes
Frequency: Consider moving to 4-5 days per week
Intensity: Increase by 5-10% of heart rate reserve every 1-2 weeks as tolerated
Environment: Gradually introduce more normal environments
When to Progress Your Program
You can progress to the next level when:
You complete at least 3 consecutive sessions without symptom increase
Your symptom scores remain stable or improve 30 minutes post-exercise
You feel confident and comfortable at the current level
Guidelines for Safe Progression
Change only one variable at a time:
Either duration OR intensity OR frequency
Allow 2-3 sessions to adapt before changing another variable
Prioritize progression in this order:
First increase duration (up to 20-30 minutes)
Then increase frequency (up to 5 days per week)
Finally increase intensity (up to 70% of heart rate reserve)
Take a step back if needed:
If symptoms increase, return to the previous well-tolerated level
Rest an extra day before trying again
Consider reducing by 20% (duration or intensity)
Warning Signs: When to Seek Medical Advice
Contact your healthcare provider if:
Symptoms consistently worsen after exercise
Symptoms take longer than 30-60 minutes to return to baseline
New symptoms develop
Severe symptoms appear (significant headache, confusion, etc.)
No improvement in exercise tolerance over 2-3 weeks
Long-Term Progression Goals
With healthcare provider guidance, your long-term progression might look like:
Duration: 30-40 minutes per session
Frequency: 5 days per week
Intensity: 70-80% of heart rate reserve
Environment: Normal daily settings
Activities: Gradually reintroducing regular physical activities
Special Considerations
For Individuals with Vestibular Symptoms
Favour stationary equipment over activities requiring balance
Minimize head movement, especially rotation
Consider working with a vestibular therapist alongside this program
For Individuals with Visual Symptoms
Exercise in environments with controlled lighting
Avoid busy visual environments (crowded gyms)
Consider non-visual focus points during exercise
For Individuals with Autonomic Nervous System Dysfunction
Pay extra attention to heart rate variability
Progress even more gradually (5% increases)
Ensure proper hydration before, during, and after exercise
Disclaimer: This guide is for informational purposes only and does not replace professional medical advice. Always consult with a healthcare provider before beginning any concussion rehabilitation program.