Cardio - A Vital Part of Concussion Recovery

We've talked about concussions and the importance of physiotherapy treatment to help with symptom management.

Neck/postural exercises, balance training, visual and vestibular exercises are all very important aspects of concussion rehabilitation.

However, another important part of care that is often overlooked is adding cardio into the mix.

February is heart month, so it's the perfect time to talk about how you can stay heart-healthy and how cardio can help with not only heart health but in managing concussion symptoms.

Let’s talk about cardio! 

Cardio, short for cardiovascular training, is any form of exercise that gets your heart rate up and increases the body's demand for oxygen. Aerobic activity is another common name for this type of exercise. 

Cardiovascular training is vital for heart health. The heart is a muscle, and just like other muscles (glutes, quads, biceps, hamstring) the heart needs exercise.

The average heart beats about 100,000 times a day!

Each time the heart beats it is pumping oxygenated blood into your blood vessels and all throughout the body delivering the oxygen to your organs, muscles, etc which allows everything to function properly.

Given how important the heart muscle is, we have to make sure we exercise it regularly to make it strong. This is where cardio comes into play. 

Cardio exercise has so many benefits for your health, including:

• Boosts mood by releasing endorphins in the brain making it a great way to help manage stress and depression. 
• Regulates blood sugars and blood pressure to help prevent heart disease
• Aids in preventing numerous diseases
• Helps to manage chronic conditions
• Weight management 
• Increases overall health and fitness 

The CSEP Canadian 24H movement guidelines recommend a minimum of 150 minutes of moderate to vigorous aerobic exercise every week.This can be broken down into 30 minutes 5 days a week or about 20 minutes a day!

Moderate exercise means that your breathing rate goes up to the point where you should be able to hold a conversation but not sing. If you're unable to get more than a few words out at a time without having to pause for a breath,  that is generally considered vigorous exercise.

Life gets busy and it's not always easy to fit exercise into your daily routine, but to really reap the rewards of exercise it needs to be done consistently. It needs to become a habit. One of the most important ways to form a habit is to do something you enjoy. That way it’ll be easier to stick to.

There are lots of different ways to get in your cardio: 

• Running/Jogging
• Cycling
• Swimming
• Dancing
• Stairs 
• Brisk walking
• Hiking
• Anything that gets your heart pumping!

Now that we’ve talked about how cardio is great for health in general, let's dive into how it can help with concussion recovery. 

After a concussion the brain is in an energy crisis due to the swelling and reduced blood flow. This causes symptoms such as headaches, fatigue, sensitivity to stimulus, all those things that are referred to as post-concussion symptoms.

A lot of people think that if they are experiencing these symptoms, they should be resting and this is how concussions have traditionally been treated, however recent research has shown that the opposite is true!

Including cardiovascular exercise after concussion has been shown to speed up recovery, reduce symptoms and reduce the chance of developing post-concussion symptoms. It does this by increasing blood to the brain and stimulating something called brain derived neurotrophic factor (BDNF) which helps to support neurons and helps the brain to adapt to change.

Even though cardio is great for the brain, it’s important to avoid doing too much too quickly as this can cause symptoms to flare up.

But how can you know if you’re doing too much? This is a very common question!

It’s all about finding a balance and a slow, controlled progression back into activities. 

Walking is a great aerobic activity to start with after a concussion to ease your way back into some physical activity.

After a concussion, when introducing walking, you may notice you get to a point during the walk where your symptoms, (headache or dizziness, etc.), seem to get worse. This is an indication that your body is over-exerting itself and the level you are exercising at is too much for the brain’s recovery.

A great way to find an activity level to start at is to use your heart rate to guide intensity level.

Here's how: 

• Your heart rate threshold represents the upper limit of your heart rate that your body can handle before symptoms start. 
• While walking or doing another form of activity, whenever you notice an increase in symptoms, check your heart rate.
• Having a smart watch with a heart rate monitor can be helpful for this but you can always check your pulse manually on your neck at the base of your jaw or on your wrist
• Manual check: count the number of beats for 15 seconds and multiply this number by 4 to get your heart rate in beats per minute (BPM).
  

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Exercise at 80% of your Heart Rate Threshold

• After finding your heart rate threshold, take 80% of that number.
• This is the heart rate that you should be able to exercise at without increasing concussion symptoms, while still getting all the great benefits of cardio.
• This way your body will still be getting what it needs all while respecting your symptoms. 

Progress slowly

• Exercise at the heart rate identified above for 20 minutes a day.
• This heart rate can slowly be increased as your symptoms allow and as your tolerance increases.
• Always listen to your body and remember to not push yourself too hard. The idea is to respect the brain’s healing capacity and avoid doing too much too quickly.

Gentle aerobic activity should be started ASAP after a concussion.

Rest should be kept to 48 hours maximum but light aerobic activity can even be started within the first 24 hours of sustaining a concussion. 

If you are struggling with any post-concussion symptoms you are not alone.

For more guidance on how to manage them, you can book in with one of our physiotherapists who can help you develop a personalized plan to deal with symptoms such as headaches and dizziness. They will guide you through a gradual return to physical activity and help to accelerate healing through movement!

Physiotherapists Miriam Mulkewich and Ally Ferguson have additional training in concussion rehabilitation, and can help you get back on track after a concussion.