The effect of aerobic training on rehabilitation outcomes after recent severe brain injury: a randomized controlled evaluation. Aquatics, health-promoting self-care behaviours and adults with brain injuries. Evaluation of an aquatics programme on fitness parameters of individuals with a brain injury. Cognitive rehabilitation for traumatic brain injury: A randomized trial. Defense and Veterans Head Injury Program (DVHIP) Study Group.
To examine the impact of fitness training with recently brain-injured inpatients on exercise capacity and functional and psychologic outcome measures.
                A randomized controlled trial of exercise versus relaxation training for 3 months. Blind assessments were conducted before and after the end of a 12-week training program, as well as at follow-up assessment 12 weeks posttraining.
                Four regional neurologic inpatient rehabilitation units.
                Of 157 patients recruited 24 +/- 14 weeks after single-incident brain injury, 142 patients were assessed at week 12, and 128 patients at follow-up.
                Patients were randomized between cycle ergometer aerobic training and a relaxation training control condition, which was theoretically inert with respect to cardiovascular fitness.
                Validation of exercise training (peak work rate, peak heart rate, body mass index); mobility and physical function (modified Ashworth scale, Berg balance scale, Rivermead Mobility Index, 10-m walk velocity); disability and dependency (Barthel index, FIMtrade mark instrument, Nottingham Extended Activities of Daily Living); and psychologic function (fatigue questionnaire, Hospital Anxiety and Depression Scale).
                Significant improvements in exercise capacity (p <.05) in the exercise training group (n = 70) relative to the control group (n = 72) were not matched by greater improvements in functional independence, mobility, or psychologic function, at either 12 weeks or follow-up.
                The benefits of improved cardiovascular fitness did not appear to extend to measurable change in function or psychologic state. To determine the effect of an aquatic programme on the health promoting behaviours of adults with brain injuries.
                Eighteen individuals participated in the programme and were randomly assigned to an experimental (n = 9) or control group (n = 9). Health promoting behaviours, physical self-concept and self-esteem were measured pre- and post-intervention. Significant differences and large effect sizes were found between scores for the experimental group only, indicating an increase in health promoting behaviours, physical self-concept and self-esteem.
                Results have useful implications for health professionals as exercise prescription may enhance health promoting behaviours and decrease health care costs after a brain injury. The primary objective was to determine the effect of an aquatic exercise programme on the physical fitness of people with a brain injury. A pre-test-post-test randomized-groups design was conducted. Sixteen outpatients with a brain injury were included in the study. Eight participants were assigned to an aquatic exercise group and eight to a control group. The components of physical fitness measured included cardiovascular endurance, body composition, muscular strength and endurance and flexibility. Measurements were taken pre- and post-programme. Results indicated an increase in components of physical fitness for the experimental group but not the control group. Increases in fitness were reported as having a positive impact on the functional capacity of individuals in the exercise group as well as enhancing the individual's ability to complete activities of daily living successfully. Results indicate that aquatic exercise may positively impact the primary and secondary physical injuries caused by a brain injury.
                Copyright 2004 Taylor and Francis Ltd Traumatic brain injury (TBI) is a principal cause of death and disability in young adults. Rehabilitation for TBI has not received the same level of scientific scrutiny for efficacy and cost-efficiency that is expected in other medical fields.
                To evaluate the efficacy of inpatient cognitive rehabilitation for patients with TBI.
                Single-center, parallel-group, randomized trial conducted from January 1992 through February 1997 at a US military medical referral center.
                One hundred twenty active-duty military personnel who had sustained a moderate-to-severe closed head injury, manifested by a Glasgow Coma Scale score of 13 or less, or posttraumatic amnesia lasting at least 24 hours, or focal cerebral contusion or hemorrhage on computed tomography or magnetic resonance imaging.
                Patients were randomly assigned to an intensive, standardized, 8-week, in-hospital cognitive rehabilitation program (n=67) or a limited home rehabilitation program with weekly telephone support from a psychiatric nurse (n=53).
                Return to gainful employment and fitness for military duty at 1-year follow-up, compared by intervention group.
                At 1-year follow-up, there was no significant difference between patients who had received the intensive in-hospital cognitive rehabilitation program vs the limited home rehabilitation program in return to employment (90% vs 94%, respectively; P=.51; difference, 4% [95% confidence interval ¿CI¿, -5% to 14%]) or fitness for duty (73% vs 66%, respectively; P=. 43; difference, 7% [95% CI, -10% to 24%]). There also were no significant differences in cognitive, behavioral, or quality-of-life measures. In a post-hoc subset analysis of patients who were unconscious for more than 1 hour (n = 75) following TBI, the in-hospital group had a greater return-to-duty rate (80% vs 58%; P=. 05).
                In this study, the overall benefit of in-hospital cognitive rehabilitation for patients with moderate-to-severe TBI was similar to that of home rehabilitation. These findings emphasize the importance of conducting randomized trials to evaluate TBI rehabilitation interventions. JAMA. 2000;283:3075-3081
There is insufficient evidence to draw any definitive conclusions about the effects of fitness training on cardiorespiratory fitness. Whilst it appears to be a safe and accepted intervention for people with TBI, more adequately powered and well-designed studies are required to determine the effects across a range of outcome measures.