Physiological Outcomes of Physical Activity Interventions in Persistent Postconcussive Symptoms: A Scoping Review.

Abstract

Persistent postconcussive symptoms (PPCS) are associated with prolonged functional impairment and physiological dysregulation following mild traumatic brain injury, yet objective markers of recovery and treatment response remain limited. The objective of this review was to synthesize the impact of aerobic exercise on physiological alterations in PPCS. This paper is a scoping review reported in accordance with PRISMA-ScR. A protocol was published in advance, with the last search conducted on 31 May 2025. This review scanned the following databases: PubMed, MEDLINE, EMBASE, Cochrane Library, Web of Science, and Scopus. Eligible studies were original human studies with clinically diagnosed persistent postconcussive symptoms or mild traumatic brain injury that implemented a physical activity or aerobic exercise intervention and reported at least one physiological outcome (e.g., blood pressure, cerebrovascular indices, or heart rate variability). The exclusion criteria were as follows: moderate/severe traumatic brain injury, self-reported concussion without clinical diagnosis, non-English studies, animal studies, and review papers. Of 1451 papers found, five were eligible. Individualized sub-symptom-threshold aerobic exercise consistently improved exercise tolerance and heart rate thresholds; several studies showed normalization of exertional blood pressure responses and improved CO₂ sensitivity/cerebral blood flow control. Resting heart rate variability and resting blood pressure findings were mixed. Evidence gaps include small sample sizes and limited equity-relevant reporting. Aerobic exercise yields physiological benefits in PPCS and is actionable for management and progression. Future studies should standardize physiological endpoints, include underrepresented populations, and test predictive markers to allow for precise rehabilitation.