Table 8.6 Physical Activity for the Treatment of Depression Post ABI
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Author Year Country Research Design PEDro Sample Size |
Methods |
Outcomes |
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Aerobic Exercise |
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Bellon et al. (2015) USA RCT PEDro=6 NInitial=123 NFinal=69 |
Population: TBI; Mean Age=43.7yr; Gender: Male=41, Female=28; Mean Time Post Injury=100.5mo; Severity: Mild=10, Moderate=10, Severe=35. Intervention: Participants were randomized into a walking group (treatment) or nutrition group (control). The home-based walking group was administered a pedometer to track steps taken weekly for 12wk, with a coaching call 3 days/wk to encourage increase in weekly step count. The home-based nutrition group learned about healthy eating habits through coaching calls 3 days/wk for 12 wk. After 12wk, participants crossed over. Measures were assessed at baseline, 12wk, and 24wk. Outcome Measure: Centre for Epidemiological Studies-Depression (CES-D), Perceived Stress Scale (PSS). | 1. Depression on the CES-D decreased significantly from baseline to 12wk and 24wk for all participants (p=0.007), but there was no significant difference between groups at 12wk or 24wk. 2. Stress on the PSS decreased overall from baseline to post-treatment for all participants (p=0.006), with a greater decrease in the walking group (p=0.006). |
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Wise et al. (2012) USA RCT PEDro=5 NInitial=84 NFinal=40 Follow-up to Hoffman et al. (2010) |
Population: TBI. Treatment Group (n=40): Mean Age=39.7yr; Gender: Male=15, Females=25. Control Group (n=40): Mean Age=37.1yr; Gender: Male=20, Female=20. Intervention: The treatment group received a 10wk exercise program with 15min education session, 15min of warm-up exercises, 30 min of aerobics, and 15min of cool-down exercises. Each participant was asked to perform 30min sessions for 4d/wk. The control group was given the opportunity to participate in the exercise program at the end of the trial. Measures were assessed at baseline, 10wk, and 6mo. Outcome Measure: Beck Depression Inventory (BDI), Perceived Quality of Life Scale (PQOL), Short Form Health Survey (SF-12). | 1. At 6mo, there was a reduction in the number of participants able to exercise >90min per week (77% versus 52%). |
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Hoffman et al. (2010) USA RCT PEDRo=5 NInitial=84 NFinal=76 |
Population: TBI. Treatment Group (n=40): Mean Age=39.7yr; Gender: Male=15, Females=25. Control Group (n=40): Mean Age=37.1yr; Gender: Male=20, Female=20. Intervention: The treatment group received a 10wk exercise program with 15min education session, 15min of warm-up exercises, 30min of aerobics, and 15min of cool-down exercises. Each participant was asked to perform 30min sessions for 4d/wk. The control group was given the opportunity to participate in the exercise program at the end of the trial. Measures were assessed at baseline, 10wk. Outcome Measure: Beck Depression Inventory (BDI), Perceived Quality of Life Scale (PQOL), Short Form Health Survey (SF-12). | 1. At 10wk, there were no significant differences between the exercise and control groups on the BDI (p=0.250). 2. Participants exercising >90 min/wk were found to have lower depression scores than those exercising <90 min/wk (p=0.033). 3. Those who exercised >90min per week, compared to those exercising <90min had lower BDI scores (p=0.037) and higher scores on PQOL (p=0.014) and SF-12 (p=0.014). |
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Driver & Ede (2009) USA RCT PEDro=5 N=16 |
Population: TBI; Treatment Group (n=8): Mean Age=38.78yr; Mean Time Post Injury=40.75mo. Control Group (n=8): Mean Age=37.62yr; Mean Time Post Injury=36.25mo. Intervention: Participants were randomised to aquatic exercise (treatment) or a vocational rehabilitation class (control) for 3 days/wk over 8wk. Measures were assessed at baseline and 8wk. Outcome Measure: Profile of Mood States (POMS). | 1. At 8wk, significant differences in total POMS scores were noted between the groups in favour of treatment (p<0.05). 2. Within-group scores for the treatment group showed significant differences on each of the POMS subscales (all p<0.05). 3. No significant differences were noted on each of the sub-scales for the control group (p>0.05). |
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Damiano et al. (2016) USA Pre-Post N=12 |
Population: TBI; Mean Age=31.3yr; Gender: Male=7, Female=5. Intervention: Participants completed a home-based, aerobic exercise program for 5 days/wk over 8wk. Training included exercise of moderate intensity for 30 min on the elliptical machine. Measures were assessed at baseline, 8wk, and 16 wk. Outcome Measure: Hamilton Rating Scale for Depression (HAM-D), Beck Anxiety Inventory (BAI), Pittsburgh Sleep Quality Index (PSQI). | 1. No significant changes in HAM-D or BAI scores from baseline to 8wk or 16wk were found. 2. Walking on the elliptical at a slower speed was associated with higher scores on HAM-D (p=0.03), whereas large excursion movements to the right was associated with lower scores (p=0.04). 3. Better sleep scores on PSQI post exercise were associated with decrease in depressive symptoms (p=0.04). 4. Larger gain in excursion was associated with decreased scores on BAI (p=0.02) and HAM-D (p<0.01). |
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Weinstein et al. (2017) USA Pre-Post NInitial=12 NFinal=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: Participants completed one-on-one supervised aerobic exercise sessions (3 days/wk for 12wk) where they reached 70-80% of maximum heart rate. Assessments were conducted before and after sessions at baseline, 4wk, 8wk, and 12wk. Outcome Measure: Profile of Mood States – Short Form (POMS-SF). | 1. Significant improvement from baseline to 12wk were found, as 80% of participants reported less mood disturbance on POMS-SF (p=0.04); there was a 9% reduction in POMS-SF scores (p=0.04). 2. There were significant short-term changes in POMS-SF scores in response to singular exercise sessions, with the most substantial changes in fatigue inertia (p=0.01) and anger hostility (p=0.09). |
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Gordon et al. (1998) USA Case Control N=240 |
Population: TBI. Non-Exercise Group (n=176): Mean Age=37.1yr; Mean Time Post Injury=9.1yr. Exercise Group (n=64): Mean Age=37.8yr; Mean Time Post Injury=11.2yr. Intervention: Retrospective comparison of exercisers and non-exercisers. Outcome Measure: Beck Depression Inventory (BDI), The Institute for Rehabilitation Research (TIRR) Symptom Checklist. | 1. Individuals who exercised had less depressed mood (BDI) than those who did not exercise (p<0.01). 2. Individuals who exercised reported significantly fewer symptoms on the TIRR checklist compared to those who did not exercise (p<0.0004). |
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Tai Chi |
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Blake & Batson (2009) UK RCT PEDro=6 N=20 |
Population: TBI; Gender: Male=15, Female=5; Injury Severity: Mild=7, Moderate=8, Severe=5. Treatment Group (n=10): Mean Age=44.5yr; Mean Time Post Injury=16.4 yr. Control Group (n=10): Mean Age=46.2yr; Mean Time Post Injury=13.62 yr. Intervention: The treatment group performed tai chi (qigong) for 1 hr/wk over 8wk. The control group attended non-exercise social and leisure activities for 1 hr/wk over 8wk. Measures were assessed at baseline and 8wk. Outcome Measure: General Health Questionnaire-12 (GHQ-12), Physical Self-Description Questionnaire. | 1. At 8wk, GHQ-12 showed a significant improvement in mood scores for those in the treatment group compared to the control group (p=0.026). 2. Physical self-esteem was found to improve significantly from baseline to 8wk for those in the treatment group (p=0.017). |
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Gemmell & Leathem (2006) New Zealand RCT PEDro=6 N=18 |
Population: TBI; Mean Age: Males=51.2yr, Females=40.2yr; Gender: Male=9, Female=9; Mean Time Post Injury=8.7yr. Intervention: The treatment group (n=9) performed tai chi (chuan) for 6wk. The control group (n=9) was waitlisted for tai chi. Measures were assessed at baseline, 6wk, and 9wk. Outcome Measure: Visual Analog Mood Scale (VAMS), Medical Outcome Scale Short Form 26 (MOS SF-36), Rosenberg Self-Esteem Scale (RSES). | 1. At 6wk, the treatment group reported significant improvements on VAMS (fear, confusion, sadness, anger, tiredness, tension, happiness, energy; not fatigue) compared to the control group. 2. When compared to the control group, the differences on the MOS SF-36 and the RSES were not significant. 3. At 9wk, the treatment group reported feeling less impaired due to emotional problems (RSES, p=0.007). |