Effects of Aerobic Exercise
on Health Related Physical Fitness
in Individuals with Traumatic Brain Injury
Erin Siebert
ESS 530
July 28th, 2011
Individuals with Traumatic Brain Injury (TBI) have suffered some degree of loss of brain
function as a result of some incident be it an accident, fall, gunshot wound, etc. This injury can
dramatically affect the way individuals physically interact with their environment. Individuals
with TBI will be treated, initially, in the hospital and stabilized by a trauma team, and then they
go through an intensive rehabilitation program in an inpatient clinical setting. At the rehabilitation
center and after individuals leave there, common movement areas of concern are balance,
posture, strength, need for assistive devices, quality of movement, spontaneous movement,
coordination of movement, increased sensation of sensory-motor activities and pain
management. However, for these areas to be addressed physicians, physical therapists,
occupational therapists, adapted physical education teachers and general education teachers
need to know what exercise interventions work for these individuals and what components of
their health related fitness are affect by various exercise interventions. One common exercise
intervention is aerobic exercise because of its proven health related benefits for non-disabled
individuals. Therefore it is important to know if aerobic exercise can benefit individuals with TBI
and how various components of aerobic exercise affect individuals with TBI compared to their
non-disabled individuals.
In the study, The Benefits of Exercise in Individuals with Traumatic Brain Injury: A
Retrospective Study, done in 1998, it compared a large group of over 350 people looking at the
effects of exercise on individuals with and without TBI. This study reasserts the well-known fact
that exercise is beneficial for non-disabled individuals and establishes that individuals with TBI
reap similar benefits from exercise as their non-disabled peers. Specifically, the results showed
that individuals with TBI that exercise were less depressed, reported fewer symptoms, and had
higher self reported health statuses than their non exercising peers with TBI (Gordon, 1998).
The ability to demonstrate that exercise is beneficial for individuals with TBI is important
because it allows other research to be done to discover the types of exercise that are more
beneficial than others and can allow for further investigation into the physiological limitations of
exercise in individuals with TBI.
Within the study, The Effect of Aerobic Training on Rehabilitation Outcomes After
Recent Severe Brain Injury: A Randomized Controlled Evaluation, the researchers looked at the
impact of fitness training on recently injured individuals and evaluated their exercise capacity,
functional measures and psychological outcomes. The study was designed with a randomized
control of exercise versus relaxation training for a period of 3 months. Individuals in the exercise
intervention participated in cycle ergometer aerobic training. It is important to note that the
control participated in relaxation training to establish that any differences shown were because
of the effect of the particular exercise intervention and not just that any exercise intervention
would cause this effect. Assessments were conducted at the beginning and end of the 12-week
training program, and 12 weeks after post training for a follow up assessment. All assessments
conducted were blinded, so that the individuals performing the assessment did not know which
exercise intervention the individual had been involved with. The experiment trail could not be
double blinded because clearly the individuals being tested would know which exercise
intervention they had participated in. The assessments conducted were, validation of exercise
training including peak work rate, peak heart rate and body mass index; mobility and physical
function included the modified Ashworth scale, Berg balance scale, Rivermead Mobility Index
and 10-m walk velocity; disability and dependency was assessed using the Barthel index, the
FIM™ instrument and the Nottingham Extended Activities of Daily Living; and psychological
function used a fatigue questionnaire and the Hospital Anxiety and Depression Scale(Bateman,
2001). Overall it was found that there was significant improvements in exercise capacity in the
exercise group but there was no difference in improvements functional independence, mobility
or psychological function both right at the end of the trail and the in post trail assessment. Thus
this study does not show that aerobic exercise for individuals with TBI to have a measurable
impact on daily functioning or mental state as compared to individuals in a relaxation-training
program. This study urges researchers to more closely look at the different kinds of exercise
and the potential benefits associated with each for individuals with TBI.
Next the study, Can Brain-Injured Patients Participate in an Aerobic Exercise Program
During Early Inpatient Rehabilitation, was evaluated. The point of this study was to see if
individuals with TBI could participate in aerobic exercise during early inpatient rehabilitation.
About ninety individuals with TBI participated in the study. Of the ninety individuals fifty-five
completed the study, those that did not complete the study dropped out because of their lack
disability as the exercise program progressed. Individuals in the study participated by cycling on
an ergometer for 30 minutes three times a week over a 12-week period. The study was
evaluated by the number of sessions needed to achieve a cycling time of 30 minutes, the overall
mean cycling time per session over 24 sessions and the mean time per session cycling at great
than 60% of age predicted maximum heart rate (HR max) over 24 sessions (Jackson, 2001).
Overall this study found that individuals with TBI can participate in an exercised program during
early inpatient rehabilitation, but those individuals may require a longer period of time than their
non-disabled peers to get achieve the same level of intense aerobic activity. This study is
important for individuals with TBI because it shows that early aerobic exercise is an important
part of their recovery process, especially if they are trying to achieve a specified level of aerobic
intensity before leaving an inpatient facility.
In the study, Reliability of Peak Cardiorespiratory Responses in Patients with Moderate
to Severe Traumatic Brain Injury, the researchers were evaluating the reliability of acute
physiologic responses in individuals with TBI. This study utilized the test-retest method by
administering various tests to thirty-six individuals after performing an incremental ergometer to
voluntary fatigue and then retesting those individuals within a week. The peak values for power
output; absolute oxygen uptake, relative oxygen uptake, heart rate, ventilation rate and
respiratory exchange ratio were measured and had a correlation coefficient between .81 and .98
(Bhambhani, 2003). Thus this study showed that aerobic exercise for individuals with TBI can
accurately be used as an intervention and any changes resulting from these interventions can
be assuredly evaluated for this population. This study is important when looking at any study
involving individuals with TBI and aerobic exercise because it provides reliable support for those
findings and allows the reader to adapt the aerobic exercise interventions into an exercise
regime and have that be of benefit to individuals with TBI.
The next study evaluated the Effects of Circuit Training on Body Composition and Peak
Cardiorespiratory Responses in Patients with Moderate to Severe Traumatic Brain Injury. The
researchers were evaluating changes in body composition and peak cardiorespiratory fitness in
individuals with TBI over a 12-week circuit-training program evaluated in the beginning, half way
through and at the end of the program. There was a significant change found in peak values of
power output, oxygen uptake, and ventilation rate, which increased as a result of the circuittraining, but there was no observable change in body mass and percentage body fat during the
study (Bhambhani, 2005).
Thus this study found that body composition and peak
cardiorespiratory responses were stabled over the first half of the exercise intervention and
require more than six weeks of training to elicit a change. Finally, the study found that the use of
the exercise intervention and control of caloric intake is effective in reducing body weight and
body fat percentage for individuals with TBI. This study established that the use of aerobic
exercise interventions could be used to improve health related fitness if the length of the
intervention is long enough.
Finally, this last study, Aerobic Capacity After Traumatic Brain Injury: Comparison with a
Nondisabled Cohort, established the difference in aerobic capacity between individuals with TBI
and those of their sex-matched non-disabled sedentary peers. This study did not have an
exercise intervention instead it did a descriptive comparative study of peak and sub-maximal
physiologic responses. It compared a convenience sample of 13 people with TBI and 13 nondisabled individuals of the same age and sex and, “all subjects could walk 5.3kph (3.3mph),
follow 2-step commands, and comply with testing using the gas collection apparatus (Mossberg,
2007).” All individuals were assessed after a graded maximal tread mill test and evaluated on
heart rate, minute ventilation, oxygen consumption, carbon dioxide production and respiratory
exchange ratio measured every minute until individuals were exhausted (Mossberg, 2007). This
study found that individuals with TBI had significantly lower levels of aerobic capacity than a
comparable group of sedentary non-disabled peers. Thus this study strongly supports the need
for individuals with TBI to participate in aerobic exercise programs to prevent additional health
concerns because of their de-conditioned physical states.
Overall these studies established the importance of aerobic exercise on various health
and fitness components in individuals with TBI. The previous studies showed that individuals
with TBI benefited from aerobic exercise. Specifically Gordon et. al, 1998, showed that
individuals with TBI who participated in aerobic exercise had increased mood levels. However,
Batman et. al, 2001, showed that it might not be just aerobic exercise that has this effect, but
any exercise intervention that provides a benefit to individuals with TBI. Jackson et. al, 2001,
found that individuals with TBI require long periods of time to gain the same benefits of exercise
than their non-disabled peers supporting the idea that individuals with TBI should begin aerobic
exercise as soon as possible in their rehabilitation. Bhambhani et. al, 2003, showed the
reliability of aerobic exercise for individuals with TBI and supported the any changes based on
the exercise interventions for this population. Additionally, Bhambhani et. al, 2005, showed that
aerobic interventions improve health related fitness if the intervention is long enough. Finally,
Mossberg et. al, 2007, found that individuals with TBI had significantly lower levels of aerobic
capacity than a comparable group of sedentary non-disabled peers. All of these studies support
the use of aerobic exercise interventions for individuals with TBI to increase health related
physical fitness. For future research into the field of aerobic exercise to increase health related
physical fitness with TBI there needs to be work done to establish what kinds of aerobic
exercise induce the greatest benefit, what is the optimum length of an exercise intervention and
what is the optimum level of intensity for an exercise intervention. Overall there has been great
progress on the effects of aerobic exercise on health related physical fitness for individuals with
TBI over the last 15 years, and has proven the benefit of such interventions.
References
Andrew Bateman, F. Jane Culpan, Alan D. Pickering, Jane H. Powell, Oona M. Scott, Richard J.
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Yagesh Bhambhani, Gary Rowland, and Mamdouh Farag. (2003). Reliability of peak
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