Virtual Aerobic Exercise Speeds Youth Concussion Recovery

A 6-week aerobic exercise program delivered virtually resulted in greater improvement in concussive symptoms and health-related quality of life (HRQoL) at 3 months than a stretching program among youth with concussion, according to a randomized clinical trial published in JAMA Pediatrics.

The trial (NCT04688255) included 210 participants aged 11 to 18 years who were up to 1 year from a concussion, recruited from outpatient locations in Washington, Utah, Wisconsin, and Oregon between March 2021 and October 2025. Their mean age was 15.1 years, 58.1% were female, and mean time since injury was 73.3 days. Participants assigned to the Mobile Subthreshold Exercise Program (MSTEP) received activity trackers and aerobic exercise starting at 60% of maximum heart rate, advanced in intensity and duration over 6 weeks through weekly video calls. The control group received stretching exercises and similar weekly calls. Follow-up lasted 6 months.

Symptoms and HRQoL improved significantly at all follow-up points, and at 3 months MSTEP produced greater improvement than control in both primary outcomes, concussive symptoms (β, −3.15; 95% CI, −6.05 to −0.25) and HRQoL (β, 4.15; 95% CI, 0.64-7.66). Modeling of symptom trajectories also showed faster symptom recovery with MSTEP. Group differences were not significant at 6 months, and sleep, depression, and anxiety improved in all participants without significant differences between groups.

In moderation analyses using unadjusted P values, the benefit was statistically significant only among participants less than 3 months from injury. The investigators found no evidence of moderation by sex or age.

The authors concluded that the program improves speed of recovery compared with stretching and can be delivered remotely, but appears most beneficial for youth with acute or subacute injury, less than 3 months after concussion.

Source: Chrisman SPD, Bollinger BJ, Flaat A, et al. Mobile Subthreshold Exercise Program (MSTEP) for youth with prolonged concussion recovery: a randomized clinical trial. JAMA Pediatr. Published online October 19, 2026. doi:10.1001/jamapediatrics.2026.4927