TBI and Exercise
An Introduction to Traumatic Brain Injury
Traumatic brain injury, or TBI, affects an estimated 1.7 million Americans per year, according to the Centers for Disease Control and Prevention. With so many lives influenced by this condition and September being National Traumatic Brain Injury Awareness Month, it is important to understand the characteristics of a TBI and how health and fitness play a role. A TBI results from a sudden, violent blow to the head due to events like a fall, sports injury, vehicle accident, physical violence, or wartime activities. An event leading to a TBI can cause bruises on the brain, torn nerve fibers, and bleeding within the skull. A diagnosis of a TBI includes a wide range of short- and long-term impairments in physical, emotional, cognitive, and behavioral areas, depending on the severity of the injury, location on the head, and extent of trauma.
Traumatic Brain Injury and Exercise
People with a TBI are often physically inactive, leading to reduced fitness levels and secondary health conditions. A safe and effective exercise program can play an important role in improving a poor health and fitness profile following a brain injury. Additionally, regular physical activity can enhance balance and coordination, decrease reliance on assistive devices, and improve ability to perform activities of daily life and, therefore, foster independence. Studies also suggest that exercisers with TBI were less depressed and reported a better quality of life than those who did not exercise (Gordon et al., 1998). The key is to find which exercises the person with a TBI enjoys and develop an individualized exercise prescription that accommodates each person’s needs and abilities.
Aerobic (Cardio) Training
Improving cardiovascular fitness can be accomplished in many ways. If new to exercise, choose low-impact activities, such as walking or swimming, that still involve large muscle groups that are moving continuously. If balance is an issue, the recumbent bike, row ergometer, and water exercises are great modes of training that reduce the risk of falling.
Frequency (F): 3 to 5 days per week with the goal being to work up to most days of the week.
Intensity (I): Moderate to high intensity, or 60 to 90 percent of heart rate max. Start at the lower end of this range. Slowly and gradually increase the intensity over time.
Time (T): 20 to 60 minutes total. This can be broken into 10-minute bouts and done throughout the day to accumulate 20 to 60 minutes.
Type (T): Walking, running, bicycling (indoor or outdoor; upright or recumbent), swimming, rowing, aerobic classes, etc.
If new to resistance training, begin with circuit machines, resistance bands and body weight exercises until form and coordination have improved enough for free weight and kettle bell exercises. Regardless of the type of exercise, make sure to start each exercise from a stable position to reduce the risk of falls or further injury.
Frequency (F): 2 to 3 days per week. Each major muscle group (chest, back, shoulders, biceps, triceps, abdominals, quadriceps, and hamstrings) should be targeted. This can be in the same exercise session or separated into training certain muscle groups on certain days. A minimum of 48 hours rest should separate the training sessions for the same muscle group.
Volume (V): 3 sets of 8 to 12 repetitions per exercise. Start with 1 set of 8 to 12 repetitions and gradually build up to 3 sets.
Type (T): Body weight, TRX, free weights, circuit machines, kettle bells, resistance bands, etc.
Flexibility (Stretching) Training
Effects of a brain injury include reduced range of motion, stiffness, spasticity, ataxia, and reduced tone, which can initially cause flexibility exercises to be difficult to perform. A regular stretching routine can improve tightness and spasticity.
Frequency (F): As often as possible throughout the day. The goal should be to stretch in the morning after waking up, after a workout, and at night before going to bed.
Intensity (I): Perform the stretch until a point of tightness, but never to a point of pain.
Time (T): Hold the stretch for 10 to 30 seconds, but try for a full 30 seconds.
Type (T): Slow, static stretches for each muscle group. Static stretches involves slowly stretching a muscle or muscle group and holding that position.
Benefits of balance training for individuals with a TBI include improvements in coordination, agility, and muscular strength, which can reduce the risk of falls and fear of falling.
Frequency (F): A minimum of 2 to 3 days per week.
Intensity (I): An intensity level for balance exercises has not been established.
Time (T): 60 minutes total that can be broken into 20 to 30 minute bouts.
Type (T): Yoga, Pilates, Tai Chi, standing on 1 leg, heel-to-toe walk, standing on an unstable surface (i.e. BOSU ball, wobble board, etc.)
Gordon, WA., Sliwinski, M., Echo, J., McLoughlin, M., Sheerer, M., & Meili, TE. (1998). The benefits of exercise in individuals with TBI: a retrospective study. Journal of Head Trauma Rehabilitation, 13(4) 58-67.