Developing the Fitness Program
Many individuals who are either in clinical rehabilitative settings or have made the transition from these programs into community-based settings have had their fitness levels seriously compromised. A proper medical referral and health evaluation screening should be made before implementing any fitness regimen. Any current health or physical limitation should be dealt with under the supervision of a medical professional. Individuals based in the community with brain injuries should also follow the same approach.
All successful fitness programs incorporate the three most important elements of physical conditioning: strength training, cardiovascular conditioning, and flexibility conditioning. Although the needs of an individual with a brain injury are the same as those of a non-injured person with regards to physical fitness, steps must be taken with each individual to ensure that the specific functional disabilities are addressed to ensure the success of the program. Each person has different needs based on health profiles and specific preferences in the activities chosen. Approaches to motivation, communication, and the individual's capacity to understand and follow a fitness program must be individualized. Information profiles from the person's rehabilitation case, team meetings, and consultations with professional resources such as neuro-psychologists, neuro-psychiatrists, and physical therapists can be very important in developing this individualized approach.
There may be other obstacles common to all individuals that should be identified and considered in the development of a fitness program. These include:
- Disabilities present prior to injury
- Embarrassment about appearance
- Mood-altering medications
- Poor nutrition contributing to lack of energy and motivation
- Allergies or allergy medications causing energy problems
- Misaligned joints or joint pain
- Orthopedic injuries
In developing a fitness plan for an individual with an acquired brain injury, six common dimensions should be considered:
- Fatigue remains a common yet often complex and multi-factoral problem for persons with brain injuries. There are many conditions that produce fatigue, including chronic pain, sleep disturbances, hypothyroidism, and depression, among others. Among the common benefits of a fitness regimen are improved stamina and strength, which will lower the fatigue factor.
- Depression may accompany traumatic brain injury at all levels of severity. Exercise is a cost-effective treatment of mild to moderate depression and enhances mood and intellectual function.
- Memory problems may be combatable by using repetition and constant review of the exercises and program.
- Slowed thinking - the individual cannot process information at the same rate as prior to the injury. By giving one-step directions in a clear and concise form, you help the participant to understand each instruction.
- Executive function problems, which are responsible for initiation and motivation, goal-oriented behavior, planning, orientation, and memory and learning, will be a factor when developing the fitness program. The coach should develop a clear understanding of each participant's impairments in order to properly structure the participant's training program.
- Physical impairments may be sustained at the time of injury or may develop later from a complexity of problems, including lack of use, sedentary lifestyle, and effects of long-term medication use. These problems may include visual impairments, sensory deficits, motor disturbances, and bowel and bladder dysfunction. Balance is a complex, integrative function involving not only the production and reception of adequate sensory information, but the appropriate interpretation of that information as well. Balance issues are very important when developing a program that is safe as well as effective.
In a study performed on adolescent traumatic brain injury subjects 16 months after injury, it was observed that there was a significant reduction in the performance of running speed, balance, strength, and bilateral coordination. Weaknesses in movement abilities can be addressed through an active range of motion and progressive resistance exercises.
From a previous study, it should be noted that exercise in individuals with brain injuries has been associated with less impairment, elevated mood, and perceptions of better health.