Physical Activity Guidelines for Traumatic Brain Injury

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Introduction

Although many people think of health in terms of illness, health is a much broader positive concept that covers your physical, mental and social well-being. Physical activity, defined as any bodily movement produced by skeletal muscles that requires energy expenditure, benefits every aspect of health and in daily life can be categorized into occupational, sports, conditioning, household, or other activities, including exercise, which is planned, structured, and repetitive and has as a final or an intermediate objective the improvement or maintenance of physical fitness. Regular physical activity shows benefits for everyone including children, adolescents, adults, older adults, and people with a disability across all ethnic groups and most importantly has been shown to reduce the risk of non-communicable diseases, such as Coronary Heart Disease, Type 2 Diabetes, Stroke, Cancer, Osteoporosis and Depression. Physical activity can also improve bone and functional health and as a key determinant of energy expenditure, is fundamental to energy balance and weight control.

Physical inactivity has been identified as the fourth leading risk factor for global mortality causing an estimated 3.2 million deaths globally or 6% of deaths. : Globally 23 percent of adults 18+ and 80 percent of adolescents are insufficiently active, and this number is higher among individuals with a disability. Current evidence suggests that inactivity has negative effects on everyone, but the effects appear to be worse for people with disability, particularly for those with a traumatic brain injury.

Physical Activity and Traumatic Brain Injury

Barriers to Physical Activity

A wide range of barriers exist that limit and in some cases prevent individuals with a traumatic brian injury from being active, which increases the risk of developing further secondary and chronic health conditions. Barriers to participation in physical activity vary depending on age, severity of traumatic brain injury, type of impairment and length of tie since initial injury.

Personal

• Feel Self-Conscious
• Lack of Time
• Lack of Interest
• Lack of Energy
• Lack of Knowledge regarding Benefits of Physical Activity 
• Lack of Knowledge of Where to Exercise
• Lack of Knowledge of Types of Physical Activity
• Lack of Counselling by a Physician

Condition Related

Physical Impairment

• Decreased Mobility
• Decreased Balance
• Decreased Muscle Strength
• Changes to Oxidative Metabolism
• Increased Fatigue
• Pain limits physical activity

Cognitive & Psychosocial

• Diminished drive / motivation to participate in physical activity

Environmental

• Barriers in Outdoor Areas i.e. uneven pathways
• Lack of Accessible Facilities e.g. limited adaptive equipment or space between equipment, no ramps or elevators, poor signage
• Lack of Transportation
• Cost of the Program
• Poor Trainer / Coach Knowledge or Awareness of Traumatic Brain injury and feel they are unable to hel

Societal

• Lack of Support
• Poor Community Integration

Benefits Physical Activity

PA is essential for quality of life reasons and as a public health promoter
In people with disabilities PA has an amplified importance based on higher rates of chronic diseases which PA can influence. Above those metabolic advantages individuals with disability can further profit from PA:

Health

• Improved Cognitive Function including improved processing speed, executive functioning, learning ability and overall cognitive function
• Higher Perceptions of Global Health, Health Status and Quality of Life
• Decreased Incidence of Depression
• Improved Sleep

Psycho-Social

• Improved Mood
• Increased Self Esteem
• Increased Social Participation

Physical Activity Guidelines

The World Health Organisation developed Global Recommendations on Physical Activity for Health with the overall aim of providing national and regional level policy makers with guidance on the dose-response relationship between the frequency, duration, intensity, type and total amount of physical activity needed for the prevention of Non Communicable Diseases. While these guidelines were not specifically tailored to the traumatic brain injury population, the World Health Organization suggest that the recommendations could be applied to adults with disabilities with adjustment to the guidelines for each individual based on their exercise capacity and specific health risks or limitations.

American College of Sports Medicine Physical Activity Guidelines for Traumatic Brain Injury

Exercise guidelines for individuals with a traumatic brain injury have been published by the American College of Sports Medicine, which recommend exercising at a frequency of three to five times per week, at an intensity of 40% to 70% of peak oxygen uptake, or a 13/20 Rating of Perceived Exertion (RPE), and for a duration of 20 to 60 minutes using an appropriate mode of exercise e.g. walking, swimming, cycling, that will depend upon the individual's physical ability. 

Conclusion

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References