Regional Acquired Brain Injury Program: Patients: Activity and exercise

People who have a concussion are often told to rest, but not how to return to activity and exercise. Activities that may have been simple and easy before a concussion such as grocery shopping, cleaning and driving can be difficult for your brain to manage after a concussion. Activities that require you to pay attention, plan and/or navigate busy environments may cause your symptoms to get worse.

When to return to activity after a concussion

Each individual is different. It’s important to talk to your family doctor or care provider to make a plan to return to work, exercise and activity that is safe for you.

How do you get back to doing activities after a concussion?

Returning to normal activities too quickly can make your concussion symptoms last longer. If you have returned to work, exercise, or activities at your usual pace you may have increased symptoms. These symptoms may be significant and worse than normal. Too much activity can cause you to crash. You can also setback your recovery and cause permanent damage to your brain.

Activity one to four weeks after injury

Within one to four weeks after your injury, you should gradually get back to activity. Your activity should cause minimal symptoms. Gradually increase your activity level over the four weeks. You may still have an increase or decrease in your symptoms, but they should be manageable.

Learn more and how to develop long-term strategies for symptom management with the Parkwood Institute Pacing Points Program®.

Remember to:

  • go slowly - it will take time to get back to the level of activity you could do before your concussion.  Start with short amounts of exercise or activity with a rest in between.
  • build tolerance – tolerance is how long or often you can do an activity before you need to stop. Start slowly. Gradually add time to your activities to build your tolerance. For example add one minute to your exercise routine each week.
  • pace yourself - break up large tasks. Schedule small parts in between rest breaks or over more than one day. Do not try to ‘push through’ and get things done all at once. 
  • pay attention to your symptoms - don’t push yourself too much.

Plan your activities

Planning activities in advance can help you organize tasks and set realistic goals. Setting goals helps to make sure you don’t push yourself too hard.

How to plan?

  1. Use a paper planner or the calendar on your phone, computer or tablet to keep track of appointments, tasks and activities.
  2. Schedule rest breaks. 
  3. Write down your activities and symptoms in a journal. This will help track patterns of setbacks and see what activities make your symptoms worse.
  4. Set a long-term goal to be able to participate in activities for longer periods of time without making your symptoms worse.

Pacing Points Program®

The Pacing Points Program® is a self-management strategy developed by Parkwood Institute to help patients plan and pace activity using an 'activity diet.' Similar to some weight management programs, each activity is assigned a point value based on how difficult the task is, how much energy it uses, and how many symptoms are triggered by it. Individuals are assigned a maximum number of points per day.

Watch an additional video and learn more in this article about the Points Program

Using a timer

After a concussion people may lose track of time easily. They push through symptoms because they don’t know how long they have been doing an activity. Using a timer can help plan rests and time to check on symptoms. 

Your concussion symptoms may be worse if you are in a busy environment. Think of how busy the grocery store is. There are many things and people to look at and noises to hear. That’s a lot of information for your brain to process. Using a timer to set time restrictions for activities like grocery shopping helps ensure you take a break before you have symptoms.

What kind of timer is best? Depending where you are, a timer could be on your microwave, oven, cellphone or tablet, as long as it has an alarm/beep/light that notifies you when the time is up.

How to use it: Set the timer for an amount of time. Then take a break from the task you are doing for a set amount of time. Rest during your break or do light activity. For example, with grocery shopping, plan for 20 minutes in the grocery store with a short list of items to buy. This will give your brain the break it needs for recovery and to prevent the onset of symptoms. For other activities, you can plan to read for 20 minutes then take a walk for ten minutes, rest or grab a healthy snack.

How to progress: Gradually set the timer for longer periods of time. Adding five minutes every few days is a good start. Your goal is to work symptom-free or without a lasting increase in symptoms.

Watch Planning and pacing, using a timer video on YouTube

You can also print instructions on how to use a timer

Meal planning

You may have problems making decisions after a concussion. This can include what to eat.

What can help?

Pre-plan your meals for the week. Learn how to plan a menu from EatRight Ontario. Don’t try to plan meals while in the grocery store when you may already be overwhelmed. Remember to follow Canada’s Food Guide to ensure your diet is healthy. Eating a balanced diet helps the brain heal.

Try writing your meal plan down using our meal planning Eat Sheet. Write your choices for breakfast, lunch, dinner and snacks, as well as what groceries you will need to buy. Check to see what you food items you already have at home to make each meal. Remember to write down other supplies you need from the grocery store like toilet paper and toothpaste. Bring your Eat Sheet with you to the grocery store.

Can’t come up with meal ideas? Ask your family, co-workers, neighbours and friends for easy recipes.

Recipe websites:

Other tips:

  • keep a running grocery list available to write down items as they run out
  • reuse your menu plans. Plan out four weeks’ worth of meals, and then start rotating.
  • try a new recipe each week to see if you can build on your menu.

Print instructions on meal planning

Help making meals after a concussion

People with a concussion sometimes struggle with making complicated meals, or following a recipe. Things you can try to help are:

  • put your recipe in a page protector (clear sleeve). Cross off steps in the recipe with a dry erase marker as you complete them.
  • instead of having the recipe on the counter and having to look down at it, hang your recipe at eye level. This helps decrease the change you need in your vision to look at the recipe.
  • put all your recipes ingredients on one side of the counter. Say the name of the ingredient out loud as you add it to the dish. Then place it on the opposite side of the counter (or put them away). This will help you remember what you’ve done already.

Cooking a new meal every day may be too difficult and will drain your brain energy.

Try:

  • crock pot cooking:  use the crockpot to make meals on days when you are busy
  • pre-package veggies/snacks in containers for easy ‘grab and go’ bites
  • batch cooking:  double recipes for multiple meals and freezer meals
  • use leftovers:  don’t throw out leftovers, use them for another meal, or eat them for lunch
Grocery shopping 
You may be overwhelmed in the busy grocery store environment, or experience symptoms like headaches.
 
Tips to help with grocery shopping:
  • time of day: go grocery shopping when the store isn’t busy, such as early in the morning. Avoid going shopping on weekends and the Friday before long weekends.
  • location: choose a location you feel comfortable driving to or using other forms of transportation. Go to the same store every time. Do not go to ten different stores.
  •  aisle printout: ask the manager for a printout of the layout of the store to help you navigate the aisles and easily find items.
  • shop online
How to decrease symptoms when shopping:
  • use ear buds or musician ear plugs to decrease noise
  • use a cart or compression vest to increase your core stability and balance
  • wear sunglasses or a brimmed hat to decrease brightness
  • set a timer for one hour from store entry to exit to pace yourself (if this adds to anxiety, set a longer timeline, but no longer than two and a half hours)

Exercise

Exercise is important concussion recovery, but should be gradual. Exercise helps regulate blood pressure and releases feel good hormones (endorphins). Exercise can also:

  • reduce feelings of depression, anxiety and stress
  • help improve sleep and mood
  • reduce fatigue

Getting started:

  • choose an activity you enjoy
  • find a partner
  • start gently (don’t expect to do the level of exercise you did before your concussion)
  • schedule it into your day
  • plan a rest afterward
  • pay attention to how you feel

Walking program after a concussion

Having a planned walking program can improve your energy level and your tolerance of exercise.

To start:

  1. find a quiet place with a level surface. This could be in your home or outside. If you are walking outside, try not to walk on a busy road.
  2. monitor your heart rate or use the Borg Scale to help measure how hard you are working. This will help you to decide when to stop.
  3. use a timer. Time the length of your walk. Start with 10 minutes. If you feel symptoms of your concussion such as a headache, dizziness, nausea or tiredness before 10 minutes is up, take a break.
  4. record the length of your walk and how you felt during and after. Make sure to write down any symptoms.If symptoms increase after your walk, that’s OK. If your symptoms are worse for longer than an hour after your walk, plan a shorter walk next time.
  5. plan for a break after your walk.

Remember to:

  • make sure someone knows when to expect you back
  • walk for one to three minutes longer each week if you can

Walk as often as you feel you can. Consistency is important. Listen to your body. Don’t push yourself too hard but try to consistently participate in activity.

Want to return to running?

Wait until you are able to walk for 30 minutes consistently. Getting back to running can be a long, hard process. You may not be able to progress as quickly as you’d like.

To start:

  1. add a one-minute running interval to your walks. Try to walk for five minutes, run for one minute, walk for 25 minutes.
  2. add in another one-minute interval each week or as your symptoms allow.
  3. increase the number of running intervals. Eventually you will be able to run longer than you are walking in your 30 minutes.

Video resource: