Impact of Intensive Exercise on Physical Function of Adults with Chronic-Moderate-to-Severe Brain Injury

Abstract

Objective(s): Effects of high-intensity group exercise on the endurance, advanced mobility, and gait speed of adults with chronic moderate-tosevere acquired brain injury (ABI) were investigated. Design: Prospective, non-randomized, unblinded interventional trial. Setting: Fitness center in a community based, supported, independent living environment. Participants: Fourteen adults with chronic moderate-to-severe ABI in supported independent living who could stand with minimal or no assist and walk with or without ambulation device and/or bracing were studied. Eight presented with low ambulatory status, and six had high ambulatory status at baseline. Interventions: Subjects received a 6-week high-intensity exercise group intervention for 90 minutes, 3 days/week assisted by personal trainers under physical therapist supervision. Strengthening (e.g. lifting free weights), endurance, balance exercises and stretching, as recommended by the American College of Sports Medicine. Main Outcome Measure(s): Six Minute Walk Test (6MWT); Gait speed; High Level Mobility Assessment Tool (HiMAT); Participation Objective, Participation Subjective (POPS); Self-Efficacy Scale. Results: Changes in impairment and activity limitation measures were statistically significant for the group and greater than the minimal detectable change (MDC) for this population. Average change on the 6MWT from baseline to after the intervention was greater than five times the MDC for people with chronic stroke. 10MWT outcomes indicate that three subjects transitioned from low to high ambulatory status and maintained the change six weeks later. Conclusions: People living with chronic ABI can significantly improve endurance, demonstrate ability to do advanced gait, and improve ambulatory status with six weeks of intensive exercise. Study impact on participation in community life is not yet known. Challenges to sustainability of exercise programs for people with chronic moderate-to-severe ABI remain.