Return-to-sport (RTS) strategy—each step typically takes a minimum of 24 hours
| Step | Exercise strategy | Activity at each step | Goal |
| 1 | Symptom-limited activity | Daily activities that do not exacerbate symptoms (eg, walking). | Gradual reintroduction of work/school |
| 2 | Aerobic exercise 2A—Light (up to approximately 55% maxHR) then 2B—Moderate (up to approximately 70% maxHR) | Stationary cycling or walking at slow to medium pace. May start light resistance training that does not result in more than mild and brief exacerbation* of concussion symptoms. | Increase heart rate |
| 3 | Individual sport-specific exercise Note: If sport-specific training involves any risk of inadvertent head impact, medical clearance should occur prior to Step 3 | Sport-specific training away from the team environment (eg, running, change of direction and/or individual training drills away from the team environment). No activities at risk of head impact. | Add movement, change of direction |
| Steps 4–6 should begin after the resolution of any symptoms, abnormalities in cognitive function and any other clinical findings related to the current concussion, including with and after physical exertion. | |||
| 4 | Non-contact training drills | Exercise to high intensity including more challenging training drills (eg, passing drills, multiplayer training) can integrate into a team environment. | Resume usual intensity of exercise, coordination and increased thinking |
| 5 | Full contact practice | Participate in normal training activities. | Restore confidence and assess functional skills by coaching staff |
| 6 | Return to sport | Normal game play. | |
*Mild and brief exacerbation of symptoms (ie, an increase of no more than 2 points on a 0–10 point scale for less than an hour when compared with the baseline value reported prior to physical activity). Athletes may begin Step 1 (ie, symptom-limited activity) within 24 hours of injury, with progression through each subsequent step typically taking a minimum of 24 hours. If more than mild exacerbation of symptoms (ie, more than 2 points on a 0–10 scale) occurs during Steps 1–3, the athlete should stop and attempt to exercise the next day. Athletes experiencing concussion-related symptoms during Steps 4–6 should return to Step 3 to establish full resolution of symptoms with exertion before engaging in at-risk activities. Written determination of readiness to RTS should be provided by an HCP before unrestricted RTS as directed by local laws and/or sporting regulations.
HCP, healthcare professional; maxHR, predicted maximal heart rate according to age (ie, 220-age).