Exercise is one of the most evidence-backed tools for concussion recovery. It's also one of the hardest to get right when your capacity has changed dramatically. The goal isn't to push through. It's to find the level that helps rather than hurts, and build from there.
What the research says
The old advice was rest until all symptoms resolve. The current evidence is clear that this is wrong for most people. Sub-symptom threshold aerobic exercise, activity that raises your heart rate without triggering symptoms, is now considered one of the most effective interventions for post-concussion syndrome.
Here's why movement matters for a recovering brain:
- Mood and mental health: exercise increases brain sensitivity to serotonin and norepinephrine, and stimulates endorphin production. The research on exercise for depression and anxiety is robust and consistent.
- Brain-derived neurotrophic factor (BDNF): often called "fertiliser for the brain," BDNF supports the growth and maintenance of neurons. Aerobic exercise is one of the most reliable ways to increase it.
- Cerebral blood flow: gentle cardiovascular exercise improves circulation to the brain, supporting recovery and reducing brain fog.
- Muscle and bone health: concussion recovery often involves reduced activity for extended periods. Muscle loss and bone density reduction add to the overall recovery burden. Movement counteracts this.
- Sleep quality: regular gentle exercise improves sleep architecture, and sleep is the primary mechanism for brain repair.
- Autonomic regulation: progressive exercise has been shown to improve heart rate variability and autonomic nervous system function, both of which are often disrupted after concussion.
Types of exercise and how they fit recovery
Aerobic: walking, swimming, cycling
The foundation of concussion recovery exercise. Start with what doesn't trigger symptoms. For most people this means walking. Even 10 to 15 minutes is meaningful. Build duration before intensity.
Flexibility and mobility: yoga, stretching, Pilates
Excellent for nervous system regulation, reducing muscle tension, and maintaining range of motion. See the Yoga article for more on adapting practice post-injury.
Strength training
Builds and maintains muscle, supports metabolism, and reduces injury risk. Approach carefully post-concussion. Avoid heavy loading of the neck and shoulders early on. Bodyweight and light resistance work is a good starting point.
Balance and stability
Particularly relevant after concussion, which often affects vestibular function and balance. Simple balance exercises, standing on one leg, slow controlled movements, can support vestibular rehabilitation.
High intensity interval training
Efficient and effective for cardiovascular fitness. Not appropriate in early or active recovery. Return to HIIT only once baseline capacity is well established and symptoms are consistently low.
The key principle: sub-symptom threshold
The goal is to exercise at a level that does not trigger or worsen symptoms. This is your sub-symptom threshold. It will change over time, hopefully rising as you recover. The Buffalo Concussion Treadmill Test is a clinical tool that helps establish this threshold precisely. Ask your physiotherapist or sports medicine doctor about it if you're working with a team.
If symptoms worsen after exercise, you've exceeded your threshold for that session. Rest, reduce intensity next time, and don't treat it as failure. It's information.
Ally's experience
Going from football and bush walks to a 30-minute daily walk
I've been into sports and fitness all my life. Football, bush walking, swimming. It was how I managed stress, how I felt like myself, how I spent time with people I cared about. After my serious concussion in 2015, all of that changed significantly.
Heart rate regulation became a real problem. Even moderate exertion would spike my symptoms. The activities I'd used to feel well were suddenly making me feel worse. That loss was genuinely grieving-worthy. I don't think people talk about it enough, the identity piece of losing your physical capacity.
What I rebuilt around was a daily walk. 30 minutes, every day, without pushing. On bad days, shorter. On good days, sometimes a bit longer. It wasn't impressive by previous standards. But it was consistent, and consistency turned out to be the thing that mattered most.
Over time I added gentle stretching. Then some light resistance work. Then yoga. The progression was slow. There were setbacks. But the direction was forward, and that was enough.
The thing I'd tell my earlier self: don't measure your recovery against your pre-injury capacity. Measure it against last month. The comparison that counts is the one going in the right direction.