A traumatic brain injury (TBI) is caused by a blow, bump, or jolt to the head, impairing the normal function of the brain. It can affect a person’s balance, movement, cognition, and emotions.
Impairments in motor control, coordination, and a decreased range of motion can occur. Balance issues may be present, affecting sitting or standing, and seizures may occur. Cognition is affected, leading to possible mental confusion, memory loss, and impairing learning. Emotions may also be impacted leading to mood swings, anxiety, depression, aggression and irritable behaviour.
Individuals with brain injuries are often physically inactive. A safe and effective exercise program can be significant in improving a person’s health and fitness following a brain injury. Consistent physical activity is found to improve balance and coordination, and possibly reduce a person’s dependence on assistive devices, improve their ability to perform daily activities, and increase their level of independence.
Studies also indicate that individuals with brain injuries who exercise regularly, are less depressed and have an increased quality of life compared to those who do not exercise (Gordon et al., 1998)
As a fitness professional, when working with an individual who has a Brain Injury, it is important to maintain open communication with the person and customize the exercise program to address their goals, needs, desires and abilities. While keeping in mind, the impact of the brain injury on the range of motion, flexibility, tone, muscular endurance, strength and cognitive impairments. Exercise programs that work to improve the above-mentioned e.g. muscular endurance and strength, balance, etc., can increase one’s quality of life and performance of basic daily living skills.
Some experimental evidence indicates that brain health is positively influenced by moderate-to-vigorous physical activity, consistently performed. Physical exercise improves several components of cognition, such as, executive function, memory, treatment speed, and attention. Positive effects are evident in various physical activities, like aerobics and bodybuilding, and individuals with cognitive deficits as in traumatic brain injury.
According to the America College of Sports Medicine, it is recommended that individuals with a traumatic brain injury should exercise 3 to 5 times per week, at an intensity of 13/20 RPE (Rating of Perceived Exertion), for 20-60 minutes in duration, using the appropriate kind of exercise e.g. walking, cycling. The type of exercise will depend upon a person’s physical ability.
Before starting any exercise program, individuals with brain injuries should have their doctor examine and screen for secondary conditions or impairments that could limit or lead to adverse effects during physical activity. And for the fitness professional, it is beneficial to learn more about what medications a person with TBI may be taking, and how certain medications affect and are affected by exercise, prior to starting a program with them.
Strength Training:
Strength training is meant to challenge muscles by pushing or pulling against resistance, and can not only make you stronger but help improve balance and posture. By improving muscular strength and function, an individual with a brain injury will increase their independence.
If newer to strength training, start with circuit machines, bodyweight exercises, and resistance bands until coordination and form are good enough for free weight exercises. Make sure to begin each exercise from a stable position to reduce the risk of falls or additional injury. For example, a standing exercise can be performed seated or standing using a fixed support for safety if balance is an issue.
If cognitive issues exist, use multi-joint exercises to help develop retention of complex movements. As well, to ensure proper form and consistency, cueing during the exercise is beneficial.
The recommendations for a strength training program, include 2 to 3 sessions per week of moderate or high intensity, involving all major muscle groups with 1-3 sets of 8-12 reps. A minimum of 48 hours rest for the same muscle group. The program could include bodyweight exercises e.g. squats and exercises with resistance bands, training machines, and free weights.
Also, given that individuals with traumatic brain injuries fatigue quicker, it is important to ensure proper rest between exercises, and to do it during a time in day that will not increase their fatigue.
Cardiovascular training:
For persons with traumatic brain injuries, building their endurance can help make it easier for them to perform day-to-day activities. Strive for about 150 minutes per week of moderate-intensity cardiovascular exercise, or 75 minutes per week of vigorous activity. Examples of cardiovascular exercise include walking, swimming, aerobics or cycling. If balance is an issue, the recumbent bike and water exercises are great ways to train and help decrease the risk of falling. Circuit training has also shown to be effective in increasing the cardiovascular fitness of individuals with TBI. This kind of training combines resistance exercise with aerobic exercise through various types of movements
Balance Training:
Balancing exercises can help improve coordination, agility, muscular strength, make you feel steadier on your feet and help prevent falls. This kind of exercise can be significant following a traumatic brain injury, given the systems that aid in our balance, our vision, our inner ear, and our muscles and tendons are impacted. Aim for 2 to 3 sessions per week for balance training, and if possible, make it a part of the strength training program. Examples of balance exercises, include standing on one foot, walking heel to toe, and standing on an unstable surface.
Flexibility Training:
The effects of a brain injury include decreased range of motion, stiffness, spasticity and reduced tone, causing flexibility exercises to be harder to perform. Aim for a program of stretching, 2 to 3 times a day, and ideally for a 30 second hold. Stretching will help maintain flexibility. And better flexibility can help make it easier to do positions like bending and reaching. Examples of programs, include stretching, Yoga, and Tai Chi.
SUMMARY:
Educating someone with a brain injury about the benefits of physical activity will hopefully increase their desire to be more physically active and help to reduce their concerns about their own physical health, and point out the kinds of physical activity that could be most appropriate for them to begin with.
It is important to stress that some form of physical activity is always better than no activity, and persons with traumatic brain injuries should be encouraged to participate in some type of regular physical activity based on their abilities, and to avoid inactivity. As a fitness professional, focus on the small gains and exercises that an individual with TBI can make, as frustration may set in from time to time. And remember to discover which exercises a person with a TBI likes, and then create an individualized exercise program that accommodates each person’s needs, goals and abilities. Be ready to adapt the program as you go forward, and be educated on the safest and most effective way to deliver it.
Sources:
- “Fitness Considerations for Traumatic Brain Injury”: NCHPAD, Allison Holt
www.nchpad.org; - “Physical Activity Guidelines for Traumatic Brain Injury”
http://www.physio-pedia.com; - “American College of Sports Medicine: Physical Activity Guidelines for TBI”
