| Hassett et al. (2012)
Australia
RCT
PEDro=6
N=40 |
Population: Severe TBI=40; Experimental Group (n=20): Mean Age=39yr; Gender: Male=14, Female=6; Mean Time Post Injury=3.7mo. Control Group (n=20): Mean Age=29yr; Gender: Male=13, Female=7; Mean Time Post Injury=3.1mo.
Intervention: All participants wore a heart rate monitor and attended a 1hr circuit class 3/wk which included 10 workout stations, an abdominal exercise portion and a walk for 6min. The experimental group received encouragement from a physiotherapist and had their heart rate monitor uncovered which beeped when they did not reach their target heart rate. Those in the control group did not receive encouragement and had their heart rate monitor covered and muted.
Outcome Measure: Duration of Time spent in Heart Rate Target Zone. |
1. All participants achieved a mean of 13+14min in their heart rate target zone and expended >300cals.
2. For the class, the exercise intensity was low (mean heart rate reserve of 34.3+16.7%) but duration of exercise was long (mean of 52.1+3.1min).
3. For time spent in the heart rate target zone, the experimental group (mean 10.9±10.8min) performed better than the control group (mean 6.1±7.5min) but this was not significant (mean difference 4.8min, p>0.05). |
| Hoffman et al. (2010)
USA
RCT
PEDro=5
N=80 |
Population: TBI; Exercise Group (n=40): Mean Age=39.7yr; Gender: Male=15, Female=25. Control Group (n=40): Mean Age=37.1yr; Gender: Male=20, Female=20.
Intervention: Participants were randomly assigned to the exercise or control group. The 10wk community-based exercise intervention consisted of supervised aerobic exercise (1/wk) involving 30min of aerobic exercise and were instructed to complete aerobic exercise at home (30min, 4x/wk). The control group was waitlisted.
Outcome Measure: Borg Scale of Perceived Exertion, Brief Pain Inventory, Beck Depression Inventory (BDI), SF-12 Health Survey (SF-12), Perceived Quality of Life Scale (PQOL), Craig Handicap Assessment and Reporting Technique-Short Form (CHART-SF). |
1. The exercise intervention group reported exercising more days of the week than the control group (3.68 versus 2.05, p=0.004); however, the increase in minutes per week of exercise was not significantly different between groups (p=0.064).
2. The exercise group also reported less pain interference (p=0.021) and greater improvement on the Brief Pain Inventory (p=0.031) in comparison to the control group.
3. Post-hoc analyses compared highly active (>90min/wk) and low activity (<90min/wk) participants, regardless of initial grouping. Highly active participants reported significantly more community activity on the CHART-SF (p=0.028), greater PQOL scores (p=0.034) and greater SF-12 general mental health scores (p=0.024) than the low activity group.
4. The highly active group scored lower on the BDI after the 10wk intervention than the low active group (p=0.033). |
|
Hassett et al. (2009)
Australia
RCT
PEDro=7
N=62
Hassett et al. (2011)
Australia
RCT follow-up
N=30
|
Population: Severe TBI; Fitness Center Group (n=32): Mean Age=35.4 yr; Gender: Male=27, Female=5; Median Time Post Injury=2.6 mo. Home-Based Group (n=30): Mean Age=33 yr; Gender: Male=26, Female=4; Median Time Post Injury=2.3 mo.
Intervention: Participants were randomly assigned to either an exercise intervention group at a fitness-center or to a home-based exercise group. Fitness center participants were supervised by a personal trainer (1hr, 3x/wk, 12wk), whereas the home-based exercise group followed an exercise plan prescribed before discharge and were monitored by a physiotherapist. Assessment at baseline, end of intervention and 3mo follow-up.
Outcome Measure: Modified 20-metre Shuttle Test (MST), Depression Anxiety Stress Scale, Profile of Mood States (POMS), Sydney Psychosocial Reintegration Scale (SPRS), Brain Injury Community Rehabilitation Outcome.
Population: Severe TBI=30; Mean Age=33yr; Gender: Male=26, Female=4; Mean Time Post Injury=2.3mo.
Intervention: An in-home exercise program (36 sessions over 12wk) was completed in a previous study. Participants were then retrospectively divided into adherers (n=10) and non-adherers (n=20) and compared.
Outcome Measure: Modified 20-metre Shuttle Test, Wechsler Memory Scale III, Wechsler Adult Intelligence Scale III, Controlled Oral Word Association Test, Depression Anxiety and Stress Scale. |
1. On average the fitness center group had better adherence than the home-based group (77% versus 44%, p≤0.001). The fitness center group completed a mean of 2.4 sessions/wk compared to the home group who completed 0.5 sessions/wk.
2. At the end of the program, both groups improved their fitness levels on the MST; however, there were no significant differences between groups (p>0.05).
3. Those in the fitness centre group achieved a significantly greater percentage of goals at the end of the intervention (76% versus 52%, p=0.005), but this difference diminished at follow-up (p=0.650).
4. No significant differences were noted when comparing psychosocial functioning or community integration measures between groups except for the POMS Confusion-Bewilderment (p=0.007) and the SPRS Living Skills (p=0.009) subscales at the end of intervention only, with greater improvements in the fitness center group.
1. Non-adherers were significantly younger than adherers (30 versus 39yr, p=0.04).
2. Results indicate that a greater number of participants in the adherence group reported walking or jogging pre-injury compared to non-adherers (7 versus 5, p≤0.05).
3. A greater portion of adherers had extremely severe injuries compared to non-adherers (90% versus 50%, p≤0.05).
4. There were no significant differences between groups on any of the cognitive functioning or psychological health measures. |
| Driver et al. (2006)
USA
RCT
PEDro=4
N=18 |
Population: TBI; Exercise Group (n=9): Mean Age=37.8yr; Gender: Male=5, Female=4; Mean Time Post Injury=40.3 mo.
Control Group (n=9): Mean Age=35.5yr; Gender: Male=5, Female=4; Mean Time Post Injury=41.2 mo.
Intervention: Participants were randomly assigned to either an 8wk aquatic exercise program involving 1hr sessions 3x/wk consisting of aerobic and resistance training or to a control group that received 8wk of vocational rehabilitation class to improve reading and writing skills.
Outcome Measure: Health Promoting Lifestyle Profile II (HPLP-II), Physical Self-Description Questionnaire (PSDQ). |
1. The exercise group experienced significant improvements on the health responsibility, physical activity (both p<0.05), nutrition, spiritual growth (both p<0.01), and inter-personal relationships (p<0.001) subscales of the HPLP-II after the intervention, but not the stress management subscale. The control group showed no significant improvements on any the subscales (p>0.05).
2. At the end of the program, the aquatic exercise group showed significant improvements on the self-esteem, co-ordination, body fat, strength, flexibility and endurance sub-scales of the PSDQ (all p<0.001). The control group showed no significant improvements.
3. No between-group calculations were completed. |
| Bateman et al. (2001)
UK
RCT
PEDro=7
N=157 |
Population: TBI=44, Stroke=70, Subarachnoid Hemorrhage=15, Other=28; Gender: Male=97, Female=60. Training Group (n=79): Mean Age=41.7yr; Mean Time Post Injury=22.2 wk. Control Group (n=79): Mean Age=44.7yr; Mean Time Post Injury=25.5wk.
Intervention: Participants were divided into either an exercise intervention (intervention group, cycle training) or relaxation training (control group). The interventions were 30 min sessions, 3x/wk for 12 wk.
Outcome Measure: Peak Work Rate, Berg Balance Scale, Rivermead Mobility Index (RMI), Barthel Index, Functional Independence Measure (FIM), Nottingham Extended Activities of Daily Living (NEDLI). |
1. The mean increase in peak work rate from baseline to 12wk was 25.8W and 11.7W, for the training and control group, respectively (p=0.02).
2. No significant differences were found between groups on the Berg Balance Scale, RMI, or the Barthel Index.
3. There was a trend towards significance, with the control group making greater improvements on the Berg Balance scale (p=0.06) and RMI (p=0.07) than the training group.
4. Greater FIM gains and improvements on the NEADLI were found for the control group between 12 and 24wk (p<0.05) compared to the training group. |
| Charrette et al. (2016)
USA
Pre-Post
NInitial=16, NFinal=14
|
Population: TBI=9, Stroke=3, Tumor=1, Encephalopathy=1; Mean Age=44.8yr; Gender: Male=12, Female=2; Mean Time Post Injury=20.5yr; Injury Severity: Moderate-Severe.
Intervention: Participants took part in an intensive exercise program consisting of endurance, full-body strength, stretching, and balance exercises (3d/wk for 6wk). Assessments took place at baseline, 6wk (exercise completion) and 12wk (follow-up).
Outcome Measure: 6-Minute Walk Test (6MWT), High Level Mobility Assessment Tool (HiMAT), 10-Metre Walk Test (10MWT). |
1. There was a significant increase in distance walked from baseline (431ft) to 6wk (1016ft) and 12wk (712ft) during the 6MWT (p<0.05).
2. There was a significant increase in mobility from baseline (3.5) to 6wk (9) and 12wk (8) on the HiMAT (p<0.05).
3. There was a significant increase in gait velocity from baseline (0.59m/s) to 6wk (1.11m/s) and 12wk (1.10m/s) measured by the 10MWT (p<0.05). |
| Damiano et al. (2016)
USA
Case Control
NInitial=31, NFinal=24
|
Population: TBI=12, Healthy Subject=12; TBI group (n=12); Mean Age=31.3yr; Gender: Male=7, Female=5; Time Post Injury>6 mo. Healthy Volunteers (controls; n=12); Mean Age=32.5yr; Gender: Male=7, Female=5.
Intervention: Participants with TBI followed a home-based exercise program with an elliptical (30 min 5d/wk for 8wk). Resistance was added progressively each week. Controls did not complete the exercise intervention. Assessments were completed at baseline, 8wk and follow-up.
Outcome Measure: Limits of Stability Test (LOS), Motor Control Test (MCT), High-Level Mobility Assessment Tool (HiMAT), Hamilton Depression Inventory (HAM-D), Sensory Organization Test, Gait, Cadence, Dual-Task performance (DT), Hopkins Verbal Learning Test-Revised (HVLT-R), Finger Tapping Test (FTT), Pittsburgh Sleep Quality Index (PSQI), Beck Anxiety Inventory, PTSD Checklist-Civilian Version (PCL-C). |
1. There was a significant difference in LOS between the TBI group and controls in 2 directions; backwards (TBI=71.6%, HV=89.3%, p=0.042) and left (TBI=37%, HV=49.6%, p=0.037).
2. The TBI group had a significantly poorer DT performance on both motor (p=0.047) and cognitive (p=0.045) tasks when compared to controls.
3. The TBI group performed significantly worse than controls on HVLT-R (p=0.004), PCL-C (p=0.02) and HAM-D (p=0.04).
4. Within the TBI group, maximal movement during the LOS test had a strong relationship with HVLT-R total recall (r=0.74, p=0.008) and delayed recall (r=0.81, p=0.003) and was related to fewer depressive symptoms (r=-0.63, p=0.04).
5. Within the TBI group, slower walking velocity and slower FTT was related to higher depression scores (r=-0.65, p=0.03 & r=-0.72, p=0.04, respectively). FTT was also related to poorer sleep quality (r=-0.75, p=0.048).
6. Within the TBI group, poorer DT performance was related to higher anxiety (r=0.71, p=0.02).
7. MCT and LOS improved following 8 wk of exercise and did not change at follow-up aside from increased LOS forward endpoint excursion (p=0.001). |
|
Ustinova et al. (2015)
USA
Pre-Post
N=22
|
Population: TBI; Mean Age=29.2yr; Gender: Male=13, Female=9; Mean Time Post Injury=23.6mo; Mean GCS=11.2.
Intervention: Participants completed a therapeutic exercise program supervised by a physical therapist designed for retaining whole-body coordination, posture and gait. The program included twenty 30-40 min sessions, increasing to 55-60 min as the patient became more comfortable (4-5d/wk for 4-5wk).
Outcome Measure: Berg Balance Scale (BBS), Functional Independence Measure (FIM), Functional Gait Assessment (FGA), Ataxia Scale. |
1. There was a significant improvement in static and dynamic balance from the pre-test to post-test on the BBS (45.2 versus 49.2, p=0.011).
2. There was a significant improvement in gait, as measured by the FGA, from pre to post intervention (22.8 versus 26.9, p=0.009).
3. Ataxia symptoms significantly decreased from pre-test to post-test (7.3 versus 5.9, p=0.012)
4. There was no significant difference between pre and post-test on FIM. |
| Chin et al. (2015)
USA
Pre-Post
N=10 |
Population: TBI; Mean Age=32.9yr; Gender: Male=4, Female=6; Mean Time Post Injury=6.6yr; Severity: Mild=5, Moderate=4, Severe=1.
Intervention: All participants underwent a supervised exercise training program with each session performed on a treadmill (30min 3d/wk for 12wk). The goal was to complete 30 minutes of continuous exercise at a target heart rate (HR) calculated from baseline measures.
Outcome Measure: Treadmill Time, Oxygen Consumption (VO2), Work Rate (WR), Heart Rate (HR), Respiratory Exchange Ratio (RER), and Fatigue Severity Scale (FSS). |
1. There was a significant increase in treadmill time after training at both peak exercise (16.4 versus 17.8 min; p<0.001) and submaximal exercise (9.3 versus 11.0 min; p<0.001).
2. There was a significant increase in VO2 after training at both peak exercise (37.1 versus 40.2 mL/kg/min; p=0.002) and submaximal exercise (18.9 versus 22.5 mL/kg/min; p<0.001).
3. There was a significant increase in WR after training at both peak exercise (324 versus 383 W; p=0.002) and submaximal exercise (123 versus 160 W; p=0.007).
4. There was no significant difference in HR (p=0.369) or RER (p=0.448) between pre and post exercise.
5. There was a significant reduction (less fatigue) in FSS scores after training (4.1 versus 3.2; p=0.029). |
| Corral et al. (2014)
Spain
Prospective Control Trial
NInitial=21, NFinal=17
|
Population: TBI; Mean Age=35yr; Gender: Male=17, Female=0; Time Post Injury>1yr; Mean GCS=6.8.
Intervention: Participants were assigned to 1 of 4 groups: 1) Exercise Electro-stimulation group (EEG; n=5; exercise sessions 5d/wk; electrical stimulation 2x20min periods per session), 2) Cycling group (CyG; exercise sessions 3d/wk), 3) Intermittent-hypbaric-hypoxia (IHH) and muscle electro-stimulation group (HEG; n=6; IHH 2h 2d/wk & electro-stimulation 3h 3d/wk) or 4) Control group (CG; n=5; cognitive activities 1h 1d/wk). All groups continued sessions over 12wk.
Outcome Measure: Rey Auditory Verbal Learning Test (RAVLT), Trail Making Test A & B (TMT A & B), Stroop Test, Wechsler Adult Intelligence Scale (WAIS III), Barcelona Test, Tower of London Test (ToL), Reduced Paced Auditory Serial Addition Test (PASAT-G), Physical Stress Rest & VO2 Uptake, and Circulating Progenitor Cell (CPC) levels. |
1. There were no significant within group differences found for any of the psychological tests (RAVLT, TMT-A & B, Stroop, WAIS III, Barcelona and ToL).
2. The EEG group showed improvement in VO2 uptake and CPC levels.
3. CyG group showed a significant difference in oxygen uptake after 12wk (2.2 versus 2.67 L/min; p=0.043), as well as an improvement on the PASAT-G test.
4. HEG group showed a significant improvement in stress test load (200 versus 218 W; p=0.043); however, there was no significant change in CPC levels.
5. CG showed no significant change on any outcome measure. |
| Bhambhani et al. (2005)
Canada
Case Series
N=14
|
Population: TBI; Mean Age=31.8yr; Gender: Male=10, Female=4; Mean Time Post Injury=17.4mo; Mean GCS=4.6.
Intervention: Participants took part in a 12wk circuit training program consisting of 60min sessions designed to enhance muscular strength and aerobic fitness. Five evaluations (T1-T5) were administered during the course of the study period. The circuit training program began at T3.
Outcome Measure: Vo2 Levels, Peak Heart Rate, Power Output, Exercise Time, Body Mass Index, and Basal Metabolic Rate. |
1. No significant changes were observed in the body mass, basal metabolic rate, or body fat percentage during the study.
2. There were significant increases in peak values of power output, oxygen uptake, and ventilation rate (p values no listed). |
| Dault & Dugas (2002)
Canada
PCT
N=8
|
Population: TBI; Mean Age=29.6yr; Gender: Male=6, Female=2; Mean Time Post Injury=44.4mo.
Intervention: An individualized 12wk training program (TP; n=5) combining aerobic dance, and slide and step training for 30 min, 2x/wk was compared to traditional muscular training (TMT; n=3) for 60min, 2x/wk for 12wk.
Outcome Measure: Test for Sensory Interaction in Balance (CTSIB). |
1. Significant pre- and post-training differences were found in the temporal delay for the wrist (p<0.01), knee improvement (p<0.001), and sway area (p<0.05) for the TP group; no significant changes were noted for the TMT group.
2. The temporal delay in the wrist was 83ms in the TP group and 13ms in the TMT group. |
