Following a traumatic brain injury (TBI), aerobic exercise promotes cardiovascular fitness, cognitive recovery, and reductions in mood disorders.1
Cardiorespiratory Fitness
Physical inactivity, increased sedentary behavior, and greater perceived fatigue are commonly reported following TBI.2 Chin et al3 enrolled a small sample of adults with nonpenetrating TBI in a 12-week aerobic training program to assess the impact of vigorous exercise on cardiorespiratory fitness. Participants (N=10) completed a cardiopulmonary exercise test measuring gas exchange during exercise (ie, oxygen consumption and carbon dioxide output), and completed the Fatigue Severity Scale (FSS) at baseline and following the 12-week exercise training. Participants engaged in supervised exercise training on a treadmill for 30 minutes, 3 times per week at a vigorous intensity, maintaining 70% to 80% of heart rate reserve. At the training completion, statistically significant changes were noted in peak oxygen consumption, time to fatigue, and peak work rate. Participants also reported considerably lower fatigue as evidenced by statistically significant decreases in FSS composite scores.
Cognition
Exercise may promote cognitive recovery via mechanisms such as increasing neural repair and neuroplasticity, modulating neurotransmitter systems, and decreasing neuroinflammation.1In a systematic review of controlled clinical trials and randomized controlled trails with adults with neurologic disorders, McDowell et al reported that aerobic exercise improved cognition, particularly attention and cognitive flexibility in adults with TBI.4
Chin et al enrolled a small volunteer sample of ambulatory adults with chronic, nonpenetrating TBI into a 12-week aerobic exercise training program to determine the effect of exercise on cognitive performance.5 Participants (N = 7) received 30 minutes of supervised vigorous aerobic exercise training on a treadmill, 3 times per week. Cognitive function was assessed at baseline prior to the beginning of aerobic exercise training, and at the completion of the 12-week intervention. Cognitive function was assessed using the Trail Making Test, parts A and B, and the Repeatable Battery for the Assessment of Neuropsychological Status.
Mood
About 50% of individuals with TBI report clinically significant levels of anxiety and depression within the first year of injury.6
Weinstein et al7 enrolled 12 ambulatory adults with nonpenetrating TBI into a 12-week aerobic exercise training program to determine the effect of exercise on mood. Changes in mood before and after exercise were measured using the Profile of Mood Status—Short Form (POMS-SF), obtained at baseline (week 1), week 4, week 8, and week 12 (conclusion). The POMS-SF scoring generates a total mood disturbance (TMD) score, with higher scores indicating a more negative mood state. Participants were engaged in 30 minutes of intensive aerobic exercise, 3 times per week. Participants also engaged in a 5- to 10-minute warm-up and cooldown period. The exercise sessions were maintained at 70% to 80% of the participants’ heart rate reserve, which was continuously monitored during exercise. Target range was maintained by adjusting the speed and/or grade of the treadmill. Analyses showed improvement in mood as evidenced by significantly lower TMD scores between weeks 1 and 12. Improvements in mood were detectable after a single exercise bout in week 1. The greatest changes in POMS-SF scores were noted in the Fatigue-Inertia and the Anger-Hostility subscales.
In a pilot study to determine the feasibility of aerobic exercise for lowering depressive symptoms, Schwandt et al enrolled a small sample (N = 4) of community dwelling adults with TBI and residual physical impairments in a 12-week supervised aerobic exercise program.8 The primary outcome measure was the Hamilton Depression Rating Scale (HAMD), administered at baseline, midpoint, and 12 weeks following the conclusion. Additional measures obtained at baseline and at 12 weeks included assessment of functional aerobic capacity (heart rate above 70% of age-predicted maximum), perceived exertion as assessed by the Borg Rating of Perceived Exertion scale, the Rosenberg Self-Esteem Scale, and frequency of attendance. The intervention consisted of a warm-up (stretching or below target heart rate aerobic activity), 30 minutes of intensive aerobic exercise (intensity determined by a score of 5 to 6 on the Borg scale and a heart rate of 60% to 75% of age-predicted maximum), and a 10-minute cooldown. The intervention was delivered 3 times per week for 12 weeks. Participants worked with a research physical therapist to choose from a cycle, treadmill, or recumbent step machine to reach aerobic thresholds. After the 12-week intervention, HAMD scores decreased from the moderate-to-severe and severe levels of depression at baseline, to mild-to-moderate level or no symptoms at program completion. Additionally, heart rate was lower at post intervention, Borg scores were lower indicating less perceived effort, and self-esteem improved as evidenced by higher Rosenberg Self-Esteem Scale scores.
Concluding Thoughts
Aerobic exercise is associated with improved outcomes following TBI, not only in cardiovascular fitness but also in cognitive performance and mood disorders. However, many studies are proof-of-concept, pilot, or pre-post observational studies with small sample sizes, and have numerous methodological limitations. Well-designed randomized controlled trials are needed to test the efficacy of aerobic exercise and rehabilitation outcomes.
Dr Sealeis the regional director of clinical services at the Centre for Neuro Skills, which operates post-acute brain injury rehabilitation programs in California and Texas. He is licensed in Texas as a chemical dependency counselor and psychological associate with independent practice. He also holds a clinical appointment at the University of Texas Medical Branch (UTMB) in Galveston in the Department of Rehabilitation Sciences.
CALGARY – Alberta’s health minister says a new agency responsible for primary health care should be up and running by next month.
Adriana LaGrange says Primary Care Alberta will work to improve Albertans’ access to primary care providers like family doctors or nurse practitioners, create new models of primary care and increase access to after-hours care through virtual means.
Her announcement comes as the provincial government continues to divide Alberta Health Services into four new agencies.
LaGrange says Alberta Health Services hasn’t been able to focus on primary health care, and has been missing system oversight.
The Alberta government’s dismantling of the health agency is expected to include two more organizations responsible for hospital care and continuing care.
Another new agency, Recovery Alberta, recently took over the mental health and addictions portfolio of Alberta Health Services.
This report by The Canadian Press was first published Oct. 15, 2024.
New Brunswick‘s Liberal and Green parties are set to make announcements about health care on the campaign trail today as the provincial election race enters its second half.
Liberal leader Susan Holt is scheduled to hold her announcement this morning in Saint John, N.B., followed by lunch at the city’s market.
A spokesperson with the Progressive Conservative party shared few details about the event scheduled for leader Blaine Higgs in Fredericton this morning.
Green Party Leader David Coon will hold a news conference this morning about “local health-care decision-making” alongside deputy leader Megan Mitton in her Sackville, N.B. riding.
On Saturday, Coon said he was proud to put forward a gender-balanced slate among the party’s 46 candidates.
While the Liberals and Progressive Conservatives are running with full slates, the Greens are three candidates short and will not have full representation when the province’s residents go to the polls on Oct. 21.
This report by The Canadian Press was first published Oct. 7, 2024.
EDMONTON – The Health Quality Council of Alberta is investigating how some medical referrals weren’t properly processed, potentially affecting 14,000 patients over the last five years across the province.
The referrals were made to specialists outside of Alberta Health Services, such as physiotherapists and dietitians.
The health authority’s CEO, Athana Mentzelopoulos, says it does an average 100,000 referrals per year, but in some cases it can’t confirm if patients received referral services.
She says the problem was flagged in late September, and a preliminary estimate suggests 31 patients may have experienced a potential negative outcome due to the delays.
The provincial government requested the investigation, and the quality council is to find out how the snag occurred and how it can be prevented in the future.
The health authority says it has begun notifying patients who may have been affected by the disruption, and the cases could date back to 2019.
This report by The Canadian Press was first published Oct. 4, 2024.
