My Physical Activity Log Sheet Page 2
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1
2Return to Play/ Physical Activity recommendations
Stage
Activities
Exercise Examples
Goal of Activity Stage
I
No physical activity for at least
• Short walks around the house
• Recovery and elimination of
2 full symptom-free days AFTER
symptoms
• Light stretching
you have seen a physician
-No activities requiring exertion
(weight lifting, jogging, P.E.
Classes)
II-A
Light aerobic activity
• 10-15 min walking on treadmill or in
• Increase heart rate to no more than
quiet area
50% of perceived maximum (max)
Must be performed under direct
exertion (e.g.,< 100 beats per min)
• 10-15 min Stationary biking or elliptical
supervision by designated
• Monitor for symptom return
individual
• House work , water plants
• Light stretching
• Gentle restorative yoga
II-B
Moderate aerobic activity
• 20-30 min walking or jogging
• Increase heart rate to 50-75% max
exertion (e.g.,100-150 bpm)
• 20-30 min stationary biking, elliptical , swim
(Light resistance training)
• Monitor for symptom return
• Dance, Zumba, golf, bowling, fishing, Wii/
Xbox Kinect (if no symptoms provoked)
• Yard work, gardening, housework- rake
leaves, vacuum, sweep, water plants
• Body weight exercises: squats, lunges,
push-ups. Max 1 set of 10, no more than
10 min total
• Core work- sit ups, planks
• Yoga or stretching exercises
II-C
Strenuous aerobic activity
• 30-45 min running
• Increase heart rate to > 75% max
exertion
• Light hiking or stair climb
(Moderate resistance training
• Monitor for symptom return
• 30-45 min stationary biking, elliptical, swim
• Weight lifting ≤ 50% of max weight
• Increase body weight exercises to max 2 sets
of 10
• Core work- Work on increasing number of
reps or total time
Return to Sport for Athletes
II-D
Non-contact training with
• Non-contact drills, sport-specific activities
• Add total body movement
sport-specific drills
(cutting, jumping, sprinting)
• Monitor for symptom return
• No contact with people, padding or the
(No restrictions for weightlifting)
floor/mat
III
Limited contact practice
• Controlled contact drills allowed (no
• Increase acceleration, deceleration
scrimmaging)
and rotational forces
• Restore confidence, assess readiness
Full contact practice
• Return to normal training, with contact
for return to play
Full unrestricted practice
• Monitor for symptom return
• Return to normal unrestricted training
IV
Return to play (competition)
• Normal game play (competitive event)
• Return to full sport activity without
restriction
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