Physical Activity Guidelines for Traumatic Brain Injury

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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. [1] 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. [2] 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. [3]Cite error: Closing </ref> missing for <ref> tag:

Individual: lack of knowledge about where to exercise; fear of falling; the nature of the impairment can produce pain; lack of energy

Social: children with disabilities depend more on parents than healthy children do; Physical Education teachers lack professional preparation or equipment and have to exclude students with disabilities; doctors provide unnecessary blanket medical excuses which allow students with disabilities to skip Physical Education; lack of friends to play for children; physical abilities are underestimated by health professionals

Environmental: wheelchair; lack of place to play for children; health clubs are not accessible; barriers in outdoor areas (e.g. poorly lit or wooded walking paths, traffic lights lack audible signals) [4]

Benefits Physical Activity

PA is essential for quality of life reasons and as a public health promoter [4]
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:
    • PA also has amplified importance for cognitive, emotional and social difficulties
    • Psychological benefits such as enhanced self-perception through successful PA experiences
    • PA can reduce stress, pain, and depression → ADLs are perceived to be easier
  • Social contact:
    • PA can reduce the stigmatisation process and negative stereotypes
    • PA can contribute to improve social status: non-disabled people see physically active individuals with disabilities more favourably than non-active people
    • Social benefits as the nature of many sport activities leads to increased social integration, bonding and friendship
  • Fun:
    • PA leads to mood benefits
    • Enjoyment through social interaction of both fitness staff and other participants

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 WHO 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. [6]

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

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  1. Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public health reports. 1985 Mar;100(2):126.
  2. Physical Activity Guidelines Advisory Committee. Physical Activity Guidelines Advisory Committee Report, 2008. Washington, DC: U.S. Department of Health and Human Services, 2008. 
  3. Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT, Lancet Physical Activity Series Working Group. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. The lancet. 2012 Jul 27;380(9838):219-29.
  4. 4.0 4.1 Cite error: Invalid <ref> tag; no text was provided for refs named Martin.2C_2013
  5. Brainline. How Exercise Can Heal the Brain after a TBI. Available from:[last accessed 30/08/19]
  6. World Health Organization. Global recommendations on physical activity for health. World Health Organization; 2010.