04/11/2025
Cardiovascular exercise plays a key role in physiological recovery from concussion, particularly when it is introduced at the right stage of recovery and at the appropriate intensity. Key ways cardiovascular exercise helps concussion recovery include:
1. Restores Autonomic Nervous System Function
After a concussion, the autonomic nervous system (ANS) — which controls things like heart rate, breathing, and blood pressure — can become dysregulated. This may lead to:
- Exertional intolerance
- Heart rate variability issues
- Poor regulation of blood pressure during activity
Low- to moderate-intensity aerobic exercise has been shown to help normalize ANS function, improving heart rate control and exercise tolerance.
2. Increases Cerebral Blood Flow
Concussion can impair the brain’s ability to regulate blood flow, which contributes to symptoms like dizziness, brain fog, or headaches.
Gradual cardiovascular exercise helps:
- Improve cerebral perfusion (blood flow to the brain)
- Support oxygen and nutrient delivery
- Enhance the removal of waste products like lactate and metabolic byproducts
3. Supports Neuroplasticity and Healing
- Brain-derived neurotrophic factor (BDNF), which supports neuroplasticity, neuronal repair, and cognitive recovery
- The production of growth factors that aid in brain healing and adaptation
This makes cardio not just about fitness, but also about stimulating repair at a cellular level in the brain.
4. Reduces Inflammation and Stress Hormones
- Regular moderate-intensity aerobic activity reduces systemic inflammation, which is often elevated after a concussion.
- It also helps regulate cortisol levels, which can be dysregulated post-injury, affecting mood and sleep.
5. Improves Mood, Sleep, and Cognitive Function
- Fatigue
- Mood disturbances (like anxiety or depression)
- Sleep difficulties
Cardiovascular exercise after concussion must be prescribed carefully. Overexertion too early can worsen symptoms and delay recovery, yet too little exercise can prolong recovery.
To determine the correct and safe threshold for exercise after a concussion, physiotherapists will often use the Buffalo Concussion Treadmill or bike test. This is used to find symptom threshold heart rate and guide safe aerobic exercise (Leddy et al., 2010). Based on the outcome of this test, an early sub-symptom threshold aerobic exercise program can be prescribed to help reduced time to recovery, and support early introduction of guided cardio in both youth and adults.
