OBJECTIVE: Sport-related concussion (SRC) affects cognitive and oculomotor function. We evaluated recovery from SRC in athletes with cognitive symptoms and/or oculomotor impairments who were prescribed early aerobic exercise treatment. DESIGN: Secondary exploratory analysis of a randomized controlled trial. SETTING: Outpatient sports medicine clinics. PARTICIPANTS: Male and female adolescents (13-18 years) within 10 days of SRC who were prescribed aerobic exercise and who reported either a low (<
12 points) or high (≥12 points) burden of cognitive symptom scores on the Post-Concussion Symptom Inventory at initial assessment. INTERVENTIONS: Early aerobic exercise treatment. MAIN OUTCOME MEASURES: Recovery time and incidence of persisting postconcussive symptoms beyond 1 month. RESULTS: Adolescents with a high burden of cognitive symptoms (n = 24, 16.0 ± 1.3 years old, 50% male, 5.3 ± 2.4 days since injury) took longer to recover (34.4 ± 37.1 vs 15.3 ± 7.6 days) than adolescents with a low burden (n = 32, 14.9 ± 1.4 years old, 69% male, 6.1 ± 2.3 days since injury) and had 6-fold higher odds of developing persisting postconcussive symptoms (odds ratio = 6.17 [1.15-33.15]). Abnormal repetitive saccades and vestibular ocular reflex were independently associated with longer recovery after controlling for multiple comparisons ( P <
0.0125), but only abnormal smooth pursuits were a significant effect modifier for the association between cognitive symptoms and recovery (interaction term hazard ratio = 0.133 [0.035-0.504], P = 0.003). CONCLUSIONS: Individuals with impaired ability to smoothly track a moving target and whose cognitive symptoms are a significant burden are at substantial risk for delayed recovery from SRC. Early initiation of oculomotor rehabilitation may facilitate recovery in these patients. TRIALS REGISTRATION: Clinicaltrials.gov ID NCT02959216.