Is early activity resumption after paediatric concussion safe and does it reduce symptom burden at 2 weeks post injury? The Pediatric Concussion Assessment of Rest and Exertion (PedCARE) multicentre randomised clinical trial.


Objective: Investigate whether resuming physical activity (PA) at 72 hours post-concussion is safe and reduces symptoms at 2 weeks, compared with resting until asymptomatic.

Methods: Real-life conditions, multicentre, single-blinded randomised clinical trial, conducted in three Canadian pediatric emergency departments (ED). Children/youth aged 10–<18 years with acute
concussion were recruited between March 2017 and December 2019, and randomly assigned to a 4-week stepwise return-to-PA protocol at 72 hours post concussion even if symptomatic (experimental group (EG)) or to a return-to-PA once asymptomatic protocol (control group (CG)). The primary outcome was self-reported symptoms at 2weeks using the Health and Behaviour Inventory. Adherence was measured using accelerometers worn 24 hours/day for 14 days post injury. Adverse events (AE (worsening of symptoms requiring unscheduled ED or primary care visit) were monitored. Multivariable intention-to-treat (ITT) and per-protocol analyses adjusting for prognostically important covariates were examined. Missing data were imputed for the ITT analysis.

Results: 456 randomised participants (EG: N=227; mean (SD) age=13.3 (2.1) years; 44.5% women; CG: N=229; mean (SD) age=13.3 (2.2) years; 43.7% women) were analysed. No AE were identified. ITT analysis showed no strong evidence of a group difference at 2weeks (adjusted mean difference=−1.3 (95% CI:−3.6 to 1.1)). In adherent participants, initiating PA 72 hours post injury significantly reduced symptoms 2 weeks post injury, compared with rest (adjusted mean difference=−4.3 (95% CI:−8.4 to –0.2)).

Conclusion: Symptoms at 2weeks did not differ significantly between children/youth randomised to initiate PA 72 hours post injury versus resting until asymptomatic; however, many were non-adherent to the intervention. Among adherent participants, early PA was associated with reduced symptoms at 2weeks. Resumption of PA is safe and may be associated with
milder symptoms at 2weeks.

Lead Researchers

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  1. Sarah Reid

    Investigator, CHEO Research Institute

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  2. Andrée-Anne Ledoux

    Scientist CHEO Research Institute

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  3. Mark S. Tremblay

    Senior Scientist, CHEO Research Institute

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  4. Roger Zemek

    Senior Scientist, CHEO Research Institute

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  5. Nick Barrowman

    Associate Scientist, CHEO Research Institute

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