PURPOSE: To determine the proportion of adolescents at moderate/high risk for Persistent Postconcussion Symptoms (PPCS) who develop PPCS when randomized to early aerobic exercise or standard-of-care and examine exercise volume/intensity between groups. METHODS: Using a randomized clinical trial design, we enrolled patients 10 to 18 years of age who obtained a "Predicting/Preventing Postconcussive Problems in Pediatrics" (5P) risk score >= 6 and enrolled/tested <= one-week post-concussion (mean 5.5 +/- 1.5 days post-concussion). Participants were randomized to "Exercise" (5 days/week, 20 min/day aerobic exercise at individualized intensity [80% HR at exercise test cessation]) or "Standard-of-Care" (no exercise recommendations). They returned for re-testing one-month post-concussion, and we remotely monitored exercise between assessments. RESULTS: Sixteen participants enrolled (intervention: n = 9, 56% female, 14.2 +/- 2.1 years; standard-of-care: n = 7, 57% female, 13.6 +/- 1.7 years). A smaller proportion of the early aerobic exercise group developed PPCS when compared to the standard-of-care group (44% versus 86%; relative risk = 0.52; 95% confidence interval 0.34 to 1.36; number-needed-to-treat = 2.4). CONCLUSION: We observed that participants randomized to early aerobic exercise had a lower risk of PPCS compared to standard-of-care. Although not statistically significant, these results suggest early/individualized aerobic exercise among those at moderate/high PPCS risk may be effective at reducing that risk, and early aerobic exercise is not detrimental to recovery outcomes.

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