Concussion Exercise Prescription Calculator

Medically reviewed by Dr. Rob Letizia, PT, DPT — owner, Spectrum Therapeutics of NJ. Last reviewed 2026-10-29.

Enter the heart rate at which symptoms rose on a Buffalo Concussion Treadmill or Bike Test, and this calculator gives the sub-symptom target band (80–90% of that threshold), the daily session, the retest window and a printable card for the athlete. It is a free tool for physical therapists, athletic trainers and physicians running an exercise-based concussion return. It was built by Dr. Rob Letizia, PT, DPT, at Spectrum Therapeutics in Wayne, NJ.

It is for clinicians who have already done an exertion test. It is not a self-test, and it does not decide when an athlete returns to sport.

How the numbers are set

The Buffalo Concussion Treadmill Test (or the bike version) raises exercise intensity step by step until concussion symptoms rise. The heart rate at that point is the symptom threshold. Exercise kept below it is called sub-symptom threshold aerobic exercise.

• The low end, 80% of threshold, is the dose in the randomized trial by Leddy and colleagues (JAMA Pediatrics, 2019): adolescents within 10 days of a sport-related concussion did 20 minutes a day at 80% of the threshold from a weekly treadmill test. They recovered faster than a stretching group (median 13 versus 17 days).
• The high end, 90% of threshold, is the outpatient method described by Bezherano, Haider, Willer and Leddy in the Clinical Journal of Sport Medicine: 90% (±5 bpm) of threshold, a 5-minute warm-up, and at least 20 minutes of aerobic exercise.
• The stop rule comes from the same paper: a rise of 2 or more points on a 0–10 symptom scale means stop, cool down, and go lower the next day.
• The retest window follows both: the trial retested weekly, and the outpatient method retests every 1 to 2 weeks to set a new target.

When recovery stalls, the same authors advise looking for other symptom generators: the neck, the vestibular system, the eyes, mood or migraine. At our clinic, dizziness that outlasts the exercise intolerance is assessed as part of our vestibular and vertigo care. For how the Buffalo test compares with computerized cognitive testing, see ImPACT vs the Buffalo Concussion Treadmill Test.

Sources

• Leddy JJ, Haider MN, Ellis MJ, et al. Early subthreshold aerobic exercise for sport-related concussion: a randomized clinical trial. JAMA Pediatrics. 2019;173(4):319–325.
• Bezherano I, Haider MN, Willer BS, Leddy JJ. Practical management: prescribing subsymptom threshold aerobic exercise for sport-related concussion in the outpatient setting. Clinical Journal of Sport Medicine. doi:10.1097/JSM.0000000000000809.
• Centers for Disease Control and Prevention, HEADS UP: concussion danger signs.

Why 80 to 90 percent instead of a single number?

The two main published sources use different ends of that range. The randomized trial by Leddy and colleagues prescribed 80% of the threshold heart rate; the outpatient method from the same group prescribes 90%, plus or minus 5 beats. The band lets the supervising clinician pick a point that fits the athlete and how they responded to the test.

Can an athlete use this without a treadmill or bike test?

No. The calculator needs a symptom-threshold heart rate measured on a supervised exertion test. Without that number there is nothing to calculate from, and the test itself screens for athletes who should not be exercising yet.

Does this tell me when the athlete can return to play?

No. It sets the daily exercise dose between tests. Return to sport follows a graded return-to-play protocol and medical clearance, which this tool does not replace.