We used to treat all kinds of disease with rest. Now we know that it is detrimental for everything. Even threatened miscarriage and twin pregnancy and heart failure should not be treated with rest, contrary to recent thinking. Sure, if you are too sick to get out of bed you can’t and won’t. But if you can you should. The most recent rest treatment to fall by the wayside of bad ideas is the treatment of concussion. (1)
In the study of 103 adolescent athletes aged 13 to 18 years old who had had a sports-related concussion, they got half to do a program of aerobic exercise and compared their outcomes with the remaining candidates who did stretching maneuvers that did not raise their heart rates. The exercise program involved jogging or walking to exhaustion on a treadmill, or outdoors, or riding a stationary bike, as long as it did not make them feel worse. The athletes in exercise group recovered from symptoms of concussion in an average of 13 days compared with 17 days for those in the stretching group.
Previous guidelines for the treatment of concussion emphasized total avoidance of physical activity, as well as avoiding screen time and social activity until symptoms resolved, sometimes for weeks or even months. This new exercise approach actually represents the first treatment that is proven to be helpful for this major public health problem of concussion.
In the olden days when doctors used to prescribe bed rest for everything, Virginia Woolf who had been prescribed the rest cure, wrote in her novel Mrs Dalloway (1925) the condemnation “you invoke proportion; order rest in bed; rest in solitude; silence and rest; rest without friends, without books, without messages; six months rest; until a man who went in weighing seven stone six comes out weighing twelve”.
Luckily for pediatricians, kids never follow the advice to rest.
1. Leddy JJ et al. JAMA Pediatr. 2019 Feb 4. doi:10.1001/jamapediatrics.2018.4397.
2. Chrisman SPD. JAma Pediatr. 2019 Feb 4. doi:10.1001/jamapediatrics.2018.5281.