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:

  1. 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

  2. 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):

  1. Stationary Walking or Marching in Place

    • Controlled environment

    • Minimal balance challenges

    • Easy to monitor symptoms

  2. Recumbent Exercise Bike

    • Supported sitting position

    • Head stable during exercise

    • Easily adjustable resistance

  3. Standard Exercise Bike

    • More upright but still stable

    • Minimal head movement

  4. 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:

  1. Record pre-exercise symptoms (0-10)

  2. Monitor heart rate throughout

  3. Stop immediately if symptoms increase by ≥2 points

  4. 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.