How physical activity fits into concussion recovery
When to rest, how to start moving again, and how to work around other crash injuries
After a crash, it can feel safest to stay on the couch and wait for your head to clear. Many people were once told to rest in a dark room until every symptom was gone. That advice has changed a lot in the past decade.
Today, guidelines recommend a short stretch of easy rest and then a slow, planned return to movement [1]. Walking and gentle exercise, added at the right pace, can help that recovery along [2].
This page walks through the stages of getting active again and what the research shows about memory. You will also find ways to adjust when a crash hurt your neck, back, ribs or limbs, and signs that contact sports, risky activities or driving should wait.
Why total rest is no longer the advice
For years, people with a concussion were told to avoid all activity. An international consensus statement on sport concussion, written in 2022 and published in 2023, moved away from that idea. It calls for relative rest, not strict rest, starting right after the injury [1]. Relative rest still includes everyday tasks and cutting back on screens [1].
A news summary of that statement put it simply: after a concussion, avoid strict rest [3]. The same statement says people can go back to light physical activity, such as walking, during the first 24 to 48 hours [1]. Walking around the house and doing normal daily tasks are fine right away [1].
Adult advice from other sources points the same way. A sample discharge sheet from an adult concussion guideline in Canada tells people to rest, both physically and mentally, for at least 24 hours and to avoid hard exertion [4]. It then says to ease back into your routine slowly [4]. A 2025 nonprofit summary of a medical journal article on concussion care describes 24 to 72 hours of relative rest before a gradual return to activity [5]. An editorial published alongside the 2022 statement urged clinicians to use exercise as part of early concussion care [6].
Guidance published in 2025 for U.S. primary care clinicians who treat adults with TBI lands in the same place. After an initial rest of up to the first 2 days, it strongly recommends that clinicians counsel patients to gradually resume their usual activities as tolerated [7].
What about screens?
Screens are a common worry after a concussion. The consensus statement found that cutting back on screens in the first 48 hours makes sense. It also found little evidence that limiting screens helps after that point [1]. A Canadian education tool gives similar advice: go light on screens for a day or two, then add them back bit by bit [8].
The first few days: what light activity looks like
Light activity means movement that does not push your heart rate high and does not make symptoms clearly worse. CDC advice for adults recovering from a mild brain injury suggests putting sleep first and adding light activity such as short walks [2]. If something you do makes symptoms worse, the advice is to stop and rest [2].
The CDC also says not to go back to work, driving, sports or other physical activity on the day you were hurt [2]. After that first day, small steps make sense. A short walk to the mailbox or around the block is a reasonable start for many people.
Using the 2 point rule
Many guidelines use a simple symptom score to judge how hard to push. Rate how you feel on a scale from 0 (no symptoms) to 10 (worst). A rise of up to 2 points during activity is considered mild and acceptable [1]. The consensus statement calls a flare brief if it settles within an hour [1].
If your symptoms jump by more than 2 points, stop for the day. One Canadian tool suggests trying again the next day [8]. The consensus statement notes that small flares during activity, exercise or thinking tasks are usually short lived [1].
Imagine a 41 year old driver who was rear ended at a stoplight. Her headache sits at a 3 most mornings. After a 10 minute walk, it rises to a 4 and fades within half an hour. That fits the mild and brief pattern. If it had climbed to a 6 and lasted all afternoon, she would stop, rest and try a shorter walk the next day.
Building up with symptom limited aerobic exercise
Once the first day or two have passed, the next stage is aerobic exercise that stays below your symptom threshold. Aerobic exercise is steady movement that raises your breathing and heart rate, such as walking, cycling on a stationary bike or using an elliptical. The consensus statement found that prescribed exercise of this kind, started within 2 to 10 days of a sport concussion, lowers the chance of symptoms lasting more than a month [1]. It describes strong evidence for activity and aerobic exercise as early treatments [1].
The CDC gives adults similar advice. As you start to feel better, it suggests 20 to 30 minutes of aerobic exercise to help recovery [2]. A guide for children and teens suggests starting with a stationary bike or walking at a slow to medium pace [9].
The stages below come from tools used in Canada that adapt the international consensus. Each step lasts at least 24 hours [8]. You move up only when the current step feels manageable.
Comparison compiled by Safety Behind the Wheel Foundation
Stages of returning to activity after a concussion
| Stage | What it can look like | Move on when |
|---|---|---|
| 1. Daily tasks and relative rest | Light chores, short walks, less screen time, for up to 24 to 48 hours | A day or two has passed and symptoms are steady |
| 2. Light, then moderate aerobic activity | Walking or a stationary bike, building to about 70 percent of maximum heart rate | You handle moderate effort with only mild, brief flares |
| 3. Harder exercise | Usual workouts at higher intensity, still with no contact | You tolerate your normal exercise level |
| 4. Full activity | Unrestricted activity, including contact or fall risk | A health care professional has cleared you |
Sources: Concussion Awareness Training Tool return to activity guide [8]; Living Guideline for Pediatric Concussion Care [9]; Amsterdam consensus statement [1].
Why a heart rate target can help
Some clinics use a treadmill or bike test to find the heart rate at which your symptoms start. In one well known trial, teens exercised at 80 percent of that threshold heart rate for about 20 minutes a day [10]. The idea was to keep each workout just under the level that set off symptoms [10]. Your own target, if you have one, should come from your care team.
What the research shows about recovery, and what it shows about memory
The best known trial on this topic was published in 2019. It included 103 teens aged 13 to 18 who were seen within 10 days of a sport concussion [11]. About half did aerobic exercise kept below their symptom threshold. The other half did gentle stretching. The typical (median) recovery time was 13 days with exercise and 17 days with stretching, a statistically significant difference [11]. Recovery lasting more than 30 days happened in 2 of the exercise group and 7 of the stretching group, a difference too small to be statistically certain [11, 12].
No harms from the exercise were reported. Teens said they did the prescribed exercise 89 percent of the time [12]. A review of the trial for family doctors recommended this approach for teens with a sport concussion [12].
The study had limits. It left out teens with ADHD, depression, anxiety or learning disorders [12]. It studied young athletes, not adults hurt in road crashes. Findings from other groups may differ.
Memory is a separate question
In that trial, recovery meant symptoms back to normal on a blinded doctor’s exam and the ability to exercise hard on a treadmill without symptoms getting worse [11, 12]. The published abstract and summary report recovery time and symptoms. Neither reports memory test results [11, 12].
If memory is your main concern, keep this gap in mind. Well planned exercise is safe and helps overall recovery, but whether it directly improves memory after a concussion has not been well tested.
Headaches, poor sleep, low mood and anxiety can all make memory feel worse. If exercise helps those symptoms settle, everyday thinking may feel easier as a side effect. That idea is reasonable, but trials have not proven it. The consensus statement notes that fear, anxiety and low mood are common during concussion recovery [1]. One research summary describes mild to moderate aerobic exercise as safe for people with a sport concussion, including those whose symptoms linger [13].
If memory problems continue, exercise alone is unlikely to be enough. The 2021 VA/DoD guideline on mild brain injury, written by the U.S. military and veterans health systems, offers another route. For lingering trouble with recall, focus or organizing, it suggests referral for a brief course of therapist led cognitive rehab [14]. The same guideline advises against relying on self directed computer training programs [14].
Comparison compiled by Safety Behind the Wheel Foundation
What exercise research covers so far
| Question | What the evidence shows | How sure we are |
|---|---|---|
| Is early light activity safe? | Yes, for most people, with symptoms watched | Strong, from the 2022 consensus |
| Does aerobic exercise speed overall recovery? | It lowered the chance of symptoms lasting over a month | Strong in athletes and teens |
| Does it work the same in adults after crashes? | Advice for adults is similar; effects of age are less well established | Less certain |
| Does exercise improve memory test scores? | Not well studied after concussion | Uncertain |
Sources: Amsterdam consensus statement [1]; CDC adult recovery fact sheet [2]; Leddy et al. 2019 trial [11]; VA/DoD guideline summary [14].
Working around other injuries from a crash
Road crashes rarely injure just the brain. You may also have whiplash, a broken wrist, cracked ribs, a sore lower back or a healing surgical wound. Any of these can change which kind of exercise is safe and comfortable.
The consensus statement says care should be planned for each person, taking their own situation into account [1]. A plan written for a teen soccer player may not suit an adult with a fractured ankle and bruised ribs.
Ideas to discuss with your care team
- With a neck injury, ask whether walking or a recumbent bike is safer than running, and whether you need a neck assessment first.
- With an arm or wrist fracture, walking or a stationary bike may still be possible, as long as you protect the injured limb.
- With a leg fracture, upper body or seated exercise may be options once your surgeon or bone specialist agrees.
- With rib, chest or back injuries, deep breathing and twisting may hurt, so ask what level of effort is safe for healing.
- If you take pain medicines that make you drowsy, plan workouts with your care team so you are not unsteady.
When dizziness or neck pain sticks around
Neck pain and dizziness can overlap with concussion symptoms. The consensus statement recommends a specific kind of therapy, called cervicovestibular rehabilitation, when dizziness, neck pain or headaches last more than 10 days [1]. This therapy works on the neck and the balance system of the inner ear. It is usually done with a physical therapist.
If symptoms last longer than 4 weeks, they are called persisting symptoms [1]. At that stage, the consensus statement says a broad assessment, ideally by a team from several fields, is the right next step [1].
People with moderate or severe brain injuries often need a different plan. A 2025 physical activity guideline from Australia, posted by the American Physical Therapy Association, offers 10 recommendations for people with moderate to severe brain injury [15]. If your injury was more serious than a concussion, ask your rehab team which guidance fits you.
Contact sports, risky activities and driving
Even when you feel ready, activities with a risk of a blow to the head, a collision or a fall should wait longer than a walk or a bike ride.
The consensus statement says athletes can move into stages with a risk of head impact only after symptoms, thinking problems and exam findings have fully cleared [1]. Each step of the return to sport plan usually takes at least 24 hours [1]. Across studies, the average time to return to sport was about 19.8 days. Full, unrestricted return usually happened within a month in children, teens and adults [1].
A Canadian tool calls for a medical decision before any activity with a risk of contact, collision or falls, and written clearance before activities with any chance of head impact [8]. Common examples include contact sports such as football and hockey, martial arts, rock climbing, horseback riding, skiing and outdoor biking.
An adult guideline handout keeps it short: do not return to sports until a health care professional clears you, and if in doubt, sit out [4]. The CDC notes that returning to sports is a process with several steps that can take a week or more [2].
Driving is its own decision
Driving uses attention, reaction time and memory all at once. A Canadian tool advises against driving during the first 24 to 48 hours after a concussion [8]. An adult guideline handout says to wait to drive until you feel a lot better and can focus well [4]. The CDC advises asking your doctor when it is safe to drive again [2].
Clearance to exercise and clearance to drive are separate decisions. Rules about driving after a brain injury also vary by state, so ask your care team what applies to you.
Making a plan you can follow
A simple plan makes it easier to stay steady on good days and bad days. Writing things down also helps when memory is unreliable, because you will not have to remember how yesterday went.
Keep a short daily log. Note what you did, for how long, your symptom score before and after, and how you slept. Over a week or two, patterns become easier to see. Bring the log to appointments.
Before each session
Checklist from Safety Behind the Wheel Foundation
- I rated my symptoms from 0 to 10 before starting.
- My activity matches the stage my care team and I agreed on.
- The activity does not risk a fall, a collision or a blow to the head.
- I have water and a safe place to stop and rest.
- Someone knows where I am if I am walking or cycling alone.
- I will stop if my symptoms rise more than 2 points or do not settle within an hour.
- I will write down what I did and how I felt afterward.
Pace the rest of your day
Exercise is only one part of the day. Thinking tasks, screens, noisy places and long drives as a passenger can also tire you out. Many people do better with short bursts of activity spread through the day, with breaks in between.
Most people recover. The CDC expects that, with proper care, most adults can resume their jobs, classes and usual routines within days or weeks [2]. An adult guideline handout says most people miss a day or two of work and return full time in under 2 weeks [4]. Some people take longer. If you are one of them, ask your care team about a fuller assessment and more support.
Get emergency care right away
Call 911 or go to the emergency department right away if you or someone you care for has any of these danger signs after a head injury [16]:
- A headache that grows worse and does not go away.
- Weakness, numbness, decreased coordination, convulsions or seizures.
- Repeated vomiting.
- Slurred speech or unusual behavior.
- One pupil larger than the other.
- Being unable to recognize people or places, or seeming confused, restless or agitated.
- Losing consciousness, looking very drowsy, or no one can wake the person.
Questions to ask your care team
Question checklist from Safety Behind the Wheel Foundation
- How much activity is safe for me this week, and what should I avoid?
- What symptom score or heart rate should I stay under when I exercise?
- Would an exercise test on a treadmill or bike help set my target?
- How do my other injuries, like my neck, ribs or broken bones, change my plan?
- Do I need physical therapy for dizziness, balance or neck pain?
- Could any of my medicines make exercise unsafe or make me unsteady?
- When can I go back to contact sports or activities with a risk of falling?
- Who decides when I can drive again, and what rules apply in my state?
- If my memory problems continue, should I be referred for cognitive rehabilitation?
Frequently asked questions
Can exercise make my concussion worse?
Activity that pushes symptoms up a lot can set you back for a day, which is why guidelines use a symptom limit. On a 0 to 10 scale, a rise of 2 points or less that fades within an hour is considered acceptable [1]. If symptoms rise more than that, stop and try again the next day [8].
Do I need a heart rate monitor?
Not everyone does. In the 2019 teen trial, exercise was set at 80 percent of the heart rate at which symptoms began, which kept workouts below the point where symptoms got worse [10]. Your care team can tell you whether a target like this would help you, or whether a symptom score is enough.
The bottom line
Recommendation from Safety Behind the Wheel Foundation
After a concussion, a day or two of easy rest followed by light, steady activity is the current standard. Exercise that stays below your symptom limit is safe for most people and can help you recover sooner, although its effect on memory itself is still uncertain.
Build your plan around your whole body, including any neck, bone or chest injuries from the crash. Wait for clearance before contact sports, risky activities and driving. If memory or other symptoms linger past a few weeks, ask for a fuller assessment.
Sources and further reading
- 1Patricios JS, Schneider KJ, Dvorak J, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport, Amsterdam, October 2022. British Journal of Sports Medicine. 2023;57(11):695-711. doi.org/10.1136/bjsports-2023-106898
- 2Centers for Disease Control and Prevention. Recovering from a Mild Traumatic Brain Injury or Concussion. Patient fact sheet. CDC Stacks. stacks.cdc.gov/…/cdc_158934_DS1.pdf
- 3HMP Global Learning Network. No strict rest after concussion and other new guidelines released. hmpgloballearningnetwork.com/…/no-strict-rest-after-concus…
- 4Guidelines for Concussion/mTBI and Persistent Symptoms, 3rd edition. Appendix 1.4: Examples of discharge advice. concussionsontario.org/…/appendix-1-4.pdf
- 5Concussion Alliance. After a concussion, active management is the most effective treatment. Summary of a New England Journal of Medicine clinical practice article (doi:10.1056/NEJMcp2400691). February 2025. concussionalliance.org/…/after-a-concussion-active-m…
- 6Schneider KJ, Patricios JS. Amsterdam 2022 International Consensus on Concussion in Sport: calling clinicians to action! British Journal of Sports Medicine. 2023;57(11):615. bjsm.bmj.com/content/57/11/615
- 7Silverberg ND, Lee K, Mikolić A, et al. Action Collaborative on Traumatic Brain Injury Care: adapted clinical practice guideline. Annals of Family Medicine. 2025;23(6):552-569. doi.org/10.1370/afm.250352
- 8BC Injury Research and Prevention Unit, Concussion Awareness Training Tool. Return to Activity. Version 3, updated September 2023. concussionsontario.org:443/…/CATT-Return-to-Activity.pdf
- 9Living Guideline for Pediatric Concussion Care. Return to activity/sport and return to school/learn protocols. Updated September 2023. pedsconcussion.com/…/return-to-activity-sport-sc…
- 10University at Buffalo. Concussion treatment: Adolescent athletes who were “prescribed” aerobic exercise recovered faster. News release. February 2019. buffalo.edu/news/releases/2019/02/002.html
- 11Leddy JJ, Haider MN, Ellis MJ, et al. Early subthreshold aerobic exercise for sport-related concussion: a randomized clinical trial. JAMA Pediatrics. 2019;173(4):319-325. doi.org/10.1001/jamapediatrics.2018.4397
- 12Stem L, Castelli G. Getting a jump on recovery from sports-related concussion. The Journal of Family Practice. 2022;71(3):135-137. mdedge.com/…/1
- 13Foster Yardley K, Marley N. Physical activity and recovery from sport-related concussion. Sport Information Resource Centre. sirc.ca
- 14American Speech-Language-Hearing Association. Evidence Map summary: VA/DoD Clinical Practice Guideline for the Management and Rehabilitation of Post-acute Mild Traumatic Brain Injury, version 3.0 (2021). apps.asha.org/…/f28e156a-8117-ee11-8145-005…
- 15American Physical Therapy Association. A Physical Activity Clinical Practice Guideline for People With Moderate to Severe Traumatic Brain Injury (Hassett L, Johnson L, Williams G, et al). Posted August 2025. apta.org/…/physical-activity-clinical-…
- 16Centers for Disease Control and Prevention. Symptoms of Mild TBI and Concussion. Updated September 15, 2025. cdc.gov/…/index.html
This article reflects the safety priorities of brain injury recovery and road safety education. It offers general education and is not medical advice for any one person. Activity plans after a concussion depend on your symptoms and any other injuries, so check official sources and talk with your own care team before changing what you do. Reviewed October 2026.
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