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Physical Activity After Traumatic Brain Injury

Published:February 17, 2021DOI:https://doi.org/10.1016/j.apmr.2020.12.020
      Traumatic brain injury (TBI) refers to damage to the brain from a physical force. This can include falls, car accidents, or gunshots, among other causes. TBI can cause difficulties with cognition (thinking) and function (movement). More than 2.5 million Americans experience a TBI each year. Many individuals with TBI do not complete regular physical activity.

      What is “physical activity”?

      • Physical activity is any bodily movement produced by skeletal muscles that results in the expenditure of energy
      • Exercise is a physical activity that is planned, structured, repetitive, and performed to improve health or fitness
      • The Health and Human Services Physical Activity Guidelines
        US Department of Health and Human Services
        Physical activity guidelines for Americans. 2nd ed.
        provide recommendations about the time and intensity of physical activity needed to maintain health and well-being
      • The Health and Human Services Physical Activity Guidelines
        US Department of Health and Human Services
        Physical activity guidelines for Americans. 2nd ed.
        advise individuals to get at least:
        • 150 minutes of moderate activity (eg, walking briskly, dancing, gardening) per week OR
        • 75 minutes of vigorous physical activity (eg, running, tennis, hiking uphill, heavy housework) per week AND
        • 2 or more days of strength training per week

      Benefits of physical activity after TBI

      • Physical activity increases the release of growth factors in the brain that help build new brain cells
        • Wogensen E.
        • Malá H.
        • Mogensen J.
        The effects of exercise on cognitive recovery after acquired brain injury in animal models: a systematic review.
        and increase brain size,
        • Erickson K.I.
        • Voss M.W.
        • Prakash R.S.
        • et al.
        Exercise training increases size of hippocampus and improves memory.
        which leads to:
      • Social benefits of physical activity
        • Eime R.M.
        • Young J.A.
        • Harvey J.T.
        • Charity M.J.
        • Payne W.R.
        A systematic review of the psychological and social benefits of participation in sport for adults: informing development of a conceptual model of health through sport.
        • Improved life satisfaction
        • Decreased stress
      • Social benefits of group physical activity
        • Eime R.M.
        • Young J.A.
        • Harvey J.T.
        • Charity M.J.
        • Payne W.R.
        A systematic review of the psychological and social benefits of participation in sport for adults: informing development of a conceptual model of health through sport.
        • Social interaction with peers
        • Opportunities to build new friendships
        • Increased communication skills
      • Physical health benefits of physical activity
        • Maintain healthy weight
          • Swift D.L.
          • Johannsen N.M.
          • Lavie C.J.
          • Earnest C.P.
          • Church T.S.
          The role of exercise and physical activity in weight loss and maintenance.
        • Prevent falls
          • Kovács E.
          • Sztruhár Jónásné I.
          • Karóczi C.K.
          • Korpos A.
          • Gondos T.
          Effects of a multimodal exercise program on balance, functional mobility and fall risk in older adults with cognitive impairment: a randomized controlled single-blind study.
        • Increase bone density
          • Jain R.K.
          • Vokes T.
          Physical activity as measured by accelerometer in NHANES 2005-2006 is associated with better bone density and trabecular bone score in older adults.
        • Improve your heart and lung function
          • Chin L.M.K.
          • Chan L.
          • Woolstenhulme J.G.
          • Christensen E.J.
          • Shenouda C.N.
          • Keyser R.E.
          Improved cardiorespiratory fitness with aerobic exercise training in individuals with traumatic brain injury.
          ,
          • Hassett L.
          • Moseley A.M.
          • Harmer A.R.
          Fitness training for cardiorespiratory conditioning after traumatic brain injury.

      Reasons you might not be physically active and ways to overcome them

      There are many reasons why you may find it challenging to be physically active.
      • Driver S.
      • Ede A.
      • Dodd Z.
      • Stevens L.
      • Warren A.M.
      What barriers to physical activity do individuals with a recent brain injury face?.
      ,
      • Hassett L.M.
      • Tate R.L.
      • Moseley A.M.
      • Gillett L.E.
      Injury severity, age and pre-injury exercise history predict adherence to a home-based exercise programme in adults with traumatic brain injury.
      Table 1 identifies some of the barriers and potential solutions.
      Table 1Possible solutions to overcome barriers to physical activity
      Barriers to Physical ActivityPotential Solutions
      Transportation
      • Use public transportation or ride sharing applications
      • Ask family or friends
      Access to fitness center
      • Complete activity in a large room in your home
      • Go to the local park
      Cost
      • Find low cost or free activities such as brisk walking
      • Use resistance bands or household items as weights
      Do not know how to exercise
      • Ask a certified inclusive fitness trainer or physical therapist
      • Talk with your doctor
      Cognition and memory
      • Keep a consistent routine
      • Use a planner to schedule physical activity
      • Set reminders on electronic devices such as your phone
      • Use written step-by-step directions
      Poor motivation
      • Find a partner or group
      • Explore what inspires or motivates you and others
      Fatigue
      • Participate during times you have more energy
      • Start with tasks at home that do not cause fatigue
      • Know your limits and schedule rest breaks
      The key is to be as active as you can—do what you can when you can. Even if you can only tolerate a few minutes of physical activity at a time, try to do it 2 to 3 times per day. Gradually increase your activity goal to 30 minutes daily. Table 2 lists example activities and ways to modify them according to your fitness and functional levels
      Table 2Examples of activities and modifications.
      ActivitiesModification
      Improve Endurance
      WalkIf too easy: increase the speed, time, or distance

      If too hard: slow down, take shorter walks more often
      BicycleIf too hard: use a stationary bicycle with a back rest to help with balance
      Improve Leg Strength
      Squats: stand with legs shoulder-width apart and lower your buttocks toward the ground slowly before coming back upIf too easy: add weights or try 1 leg at a time

      If too hard: practice standing up from a chair
      Heel raises: stand up on your tip toesIf too easy: do 1 leg at a time

      If too hard: hold on to the wall or a table for balance
      Improve Arm Strength
      Bicep curls: hold a weighted object (such as a can of soup) in each hand at your side and bring up to the shoulder while bending your elbowIf too easy: increase the weight or use a resistance band by standing on the band with your feet

      If too hard: do without a weight
      Shoulder abduction: hold a weighted object in each hand at your side and move your arms away from the body until they are parallel to the groundIf too easy: increase the weight or use a resistance band by standing on the band with your feet

      If too hard: do without a weight
      Pushups: keep your hands on the ground next to your shoulders and toes on the floor. Push up from the ground keeping your body straightIf too easy: increase the number you do

      If too hard: put your knees on the ground when completing the movement. You can also do when standing next to a wall and push off from the wall
      Improve Balance
      Yoga, tai chi, and leg strength exercisesIf too easy: close your eyes

      If too hard: use a chair or the wall for challenging poses

      Your health care team can help you be more physically active

      • Consult your physician if you are unsure how to safely start adding more physical activity into your daily life
      • Physical therapists are rehabilitation professionals who diagnose and treat a variety of movement impairments associated with health-related conditions or injuries to improve quality of life
      • Certified inclusive fitness trainers have advanced training and can help safely adapt physical activities for individuals with physical, sensory, and cognitive disabilities

      Resources for becoming more physically active

      Authorship

      This page was developed by Shanti M. Pinto, MD (e-mail address: [email protected] ); Eric M. Watson, PhD; Wendy A. Contreras, MD; Kaitlin A. Luffman, PT, DPT, CBIS; and Mark A. Newman, PhD, MPH.

      Disclaimer

      This information is not meant to replace the advice of a medical professional and should not be interpreted as a clinical practice guideline. This Information/Education Page may be reproduced for noncommercial use for health care professionals and other service providers to share with their patients or clients. Any other reproduction is subject to approval by the publisher.

      Acknowledgment

      Supported by the Brain Injury-Interdisciplenary Special Interest Group (BI-ISIG) Chronic Brain Injury Task Force.

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