# Modulating Exercise Dosage to Improve Concussion Rehabilitation: A Randomized Clinical Trial

> **NIH NIH R01** · UNIVERSITY OF COLORADO DENVER · 2022 · $662,706

## Abstract

Project Summary
Concussions are defined as a mild form of traumatic brain injury that result in acute neurological dysfunction.
Recent work suggests post-concussion aerobic exercise at an intensity level below symptom exacerbation is
safe. Yet, clinical benefits from existing randomized controlled trials indicate substantial room for improvement.
Also, we currently have an incomplete understanding of the neurophysiology underlying changes in response to
exercise treatment. Identifying the precise exercise dose (volume/intensity) required to elicit a therapeutic
response following concussion will lead to enhanced and more precise post-concussion rehabilitation strategies.
Our published and pilot data indicate light post-concussion exercise was associated with faster symptom
resolution time and less severe symptoms, yet we relied on self-reported data and observational designs.
Furthermore, we have identified that the optimal exercise volume to differentiate those with/without concussion
symptoms after one month was >160 minutes/week, which is higher than standard exercise volumes prescribed
(>100 minutes/week), and in line with existing recommendations for cardiovascular health (>150 minutes/week).
Beyond this, given the positive effects of regular moderate exercise to reduce inflammation (e.g., interleukin 6)
and restore cerebrovascular regulation, these physiological functions represent viable and feasible rehabilitation
targets. Thus, using a prospective randomized clinical trial design, we aim to identify if high dose exercise >(150
minutes/week at an individualized intensity level), relative to standard-of-care, results in: faster/slower symptom
resolution, altered physiological function, or reduced secondary sequalae. Our multidisciplinary investigative
team has expertise investigating concussion, exercise physiology, fluid biomarkers, cerebrovascular physiology,
and psychosocial outcomes. Thus, we will enroll, initially test, and randomize adolescents ages 13-18 years old
≤10 days post-concussion to high dose aerobic exercise or standard-of-care (symptom limited, self-guided
physical activity), and reassess upon symptom resolution and 8-weeks post symptom resolution. We will obtain
cerebrovascular function and serum biomarker data at each visit, and quantify exercise, symptoms, and
secondary sequalae continuously. First, we aim to examine how the dose (intensity, duration, and frequency) of
an aerobic exercise program initiated within 10 days of concussion affects time to symptom resolution, relative
to standard-of-care, among adolescents. Second, we aim to assess the mechanistic relationship between
aerobic exercise, biomarkers of neuroinflammation, and cerebrovascular function. Third, we aim to elucidate
how high dose exercise after concussion affects persistent secondary sequalae development (anxiety,
depression, kinesiophobia, peer relationships, academic concerns). By challenging the currently accepted,
exercise recommendations for spo...

## Key facts

- **NIH application ID:** 10412780
- **Project number:** 1R01HD108133-01
- **Recipient organization:** UNIVERSITY OF COLORADO DENVER
- **Principal Investigator:** David R. Howell
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $662,706
- **Award type:** 1
- **Project period:** 2022-05-15 → 2027-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10412780

## Citation

> US National Institutes of Health, RePORTER application 10412780, Modulating Exercise Dosage to Improve Concussion Rehabilitation: A Randomized Clinical Trial (1R01HD108133-01). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10412780. Licensed CC0.

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