The Role of Physical Activity in Traumatic Brain Injury Recovery

August 2, 2018

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Health

by

Meghan Gilmour

Research repeatedly demonstrates that exercise is beneficial to TBI recovery, improving balance, coordination, mobility, and overall quality of life. Recent research has shown that physical activity can improve patients’ cognitive function. It believed that this improvement is due to activity-induced regeneration of the hippocampus, the region of the brain responsible for memory. (3)

What is Traumatic Brain Injury?

Traumatic brain injury (TBI) refers to brain damage caused by an external force, such as a fall, sports injury, car crash injury or workplace accident. (1) TBI may result in temporary or permanent impairment to mobility, cognition, and social skills.1 Those with TBIs are also prone to depression, anxiety, mood swings, fatigue, and insomnia. (2) Full recovery from TBI is dependent on a variety of factors, including the severity of injury, age, and availability of medical interventions. In recent years, scientists have been exploring the impact of routine exercise on TBI outcomes. Numerous studies have found that exercise can aid in recovery from TBIs, reducing the incidence of fatigue, depression, and cognition problems in patients. (3)

Statistics

Traumatic brain injury (TBI) is extremely common, with approximately 1.6 million Australians suffering from some type of brain injury.6 (Though it should be noted that this statistic includes all types of brain injuries, including those from disease and substance abuse). Nonetheless, it is recognised that 50% of TBIs result from transportation-related accidents (such as car, motorcycle, and bicycle accidents), 20% from violent occurrences (such as gunshots or physical abuse), and 3% from sports-related injuries.4 The cause of injury also plays a role in prognosis. For example, 91% of gunshot-related TBIs result in death, while TBIs due to falls have an 11% fatality rate.4

Risk Factors

  • Alcohol abuse (50% of TBIs involve alcohol) (4)
  • Age (children under 4 years of age, young adults age 15 to 24, and adults over the age of 75 are particularly susceptible to TBI) (2)
  • Male Gender
  • Participation in Sports (cycling is most commonly associated with TBI)
  • Profession (soldiers, construction workers, and transportation workers (i.e. taxi drivers, delivery drivers, police officers, postal workers, etc.) are at an especially high risk for TBI)5

Physical Activity Guidelines

Take Caution

While exercise is crucial to recovery, it’s important to note that exercising too soon after TBI may actually be harmful. A period of rest is often required, and physical activity should not commence without a doctor’s permission. A recent animal study found that exercise within two weeks of injury caused increased memory loss and more pronounced learning deficits in rats, while exercise after two weeks resulted in improved cognition.7

Seek Professional Guidance

Most patients benefit from supervised exercise programs with physiotherapists. Physiotherapists use a variety of functional and range-of-motion exercises to help patients resume activities of daily living. Professionally-guided programs typically start gradually, eventually transitioning patients to independent workout programs.9

Begin Gradually

The duration, frequency, and intensity of workouts will vary based on health status, age, and fitness level prior to injury. It’s important to seek medical clearance before resuming exercise, and routines should be gentle, gradually increasing in intensity.

Cardiovascular Exercise

Cardiovascular (aerobic) exercise increases oxygen delivery to the brain, likely accounting for its positive effects on brain injury recovery. Any exercise that involves large, rhythmic movements (such as walking, cycling, swimming, or rowing) can get the heart pumping and provide cognitive benefits. With a physician’s permission, patients can start performing cardiovascular exercise very gradually, with no more than 20 to 30 minutes per session.10 Patients should, eventually, aim to perform at least 150 minutes per week of moderate physical activity.10

Resistance Training

Resistance training is especially useful for helping patients return to activities of daily living, as this type of training improves bone density, balance, and muscular strength. Resistance training (utilizing dumbbells, selectorised machines, body weight, or resistance tubing) should be performed at least 2 days per week.11

Flexibility/Balance Training

Flexibility and balance training can help patients improve coordination, regain independence, and prevent the pain and stiffness associated with TBIs. Patients should always stretch after training, and performing balance, coordination, and range-of-motion exercises under the guidance of a physiotherapist is highly recommended.

Conclusion

Traumatic brain injuries are all-too-common. Though the severity and outcome of injury depends on a variety of factors (including health status, type of injury, and availability of medical interventions), numerous studies prove that exercise (particularly aerobic exercise) can improve cognition and prevent depression and fatigue.3 However, patients should always seek clearance from a doctor before engaging in physical activity. Patients are also advised to begin exercise under the guidance of a physiotherapist. By beginning exercise gradually and seeking professional assistance, patients can improve their cognition and quality of life following traumatic brain injury. 

References

  1. Dawodu ST, Kishner S. Traumatic brain injury (TBI) – Definition and pathophysiology. Medscape website. http://emedicine.medscape.com/article/326510-overview. Published September 22, 2015. Accessed July 15, 2016.
  2. Traumatic brain injury. Mayo Clinic website. http://www.mayoclinic.org/diseases-conditions/traumatic-brain-injury/basics/symptoms/con-20029302. Published May 15, 2014. Accessed July 15, 2016.
  3. Gordon W. How exercise can help heal the brain after a TBI. Brainline.org website. http://www.brainline.org/content/multimedia.php?id=4638. Accessed July 15, 2016.
  4. What are the causes of and risk factors for TBI? Brainline.org website. http://www.brainline.org/content/2013/05/what-are-the-causes-of-and-risk-factors-for-tbi.html. Accessed July 15, 2016.
  5. At-risk groups for traumatic brain injury. Brain Injury Clubhouse website. http://www.braininjuryclubhouse.org/risk-groups-traumatic-brain-injury/. Published December 30, 2015. Accessed July 15, 2016.
  6. Research and statistics. HeadWest Brain Injury Association of WA Inc. website. http://www.headwest.asn.au/499/research-and-statistics. Accessed July 15, 2016.
  7. Griesbach GS. Exercise after traumatic brain injury: Is it a double-edged sword? PM R. Jun 2011;3(6 Suppl 1):S64-72.
  8. TBI and exercise. National Center on Health, Physical Activity and Disability website. http://www.nchpad.org/1407/6273/Exercise~for~People~with~a~Traumatic~Brain~Injury. Accessed July 15, 2016.
  9. Tinio Ward C. Exercise and traumatic brain injury. Upstate Medical University website. http://www.upstate.edu/pmr/pdf/Ward.pdf. Published October 17, 2014. Accessed July 15, 2016/
  10. Exercise following a traumatic brain injury. National Center on Health, Physical Activity and Disability website. http://blog.ncpad.org/2014/09/22/best-exercises-post-a-traumatic-brain-injury/. Published September 22, 2014. Accessed July 15, 2016.
  11. Esco MR. Resistance training for health and fitness. American College of Sports Medicine website. https://www.acsm.org/docs/brochures/resistance-training.pdf. Published 2013. Accessed July 15, 2016.
Meghan Gilmour
Rebecca Earl

ACE-certified Personal Trainer, Group Fitness Instructor, Nutrition Coach, Blogger. Qualified with Bachelor of Science in Nutrition Science & Master of Science in Applied Nutrition (Concentration in Fitness and Nutrition).

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