Fitness training for cardiorespiratory conditioning after traumatic brain injury

Leanne Hassett1,*, Anne M Moseley2, Robyn Tate3, Alison R Harmer4

Editorial Group: Cochrane Injuries Group
Published Online: 23 APR 2008
Abstract
Background
Cardiorespiratory deconditioning is a common sequelae after traumatic brain inju
ry (TBI). Clinically, fitness training is implemented to address this impairment
, however this intervention has not been subject to rigorous review.
Objectives
The primary objective was to evaluate whether fitness training improves cardiore
spiratory fitness in people who have sustained a TBI.
Search methods
We searched ten electronic databases (Cochrane Injuries Group Trials Register; C
ochrane Central Register of Controlled Trials (CENTRAL); EMBASE; PubMed (MEDLINE
); CINAHL; AMED; SPORTDiscus; PsycINFO; PEDro and PsycBITE) and two clinical tri
als registers (TrialsCentral and Current Controlled Trials). The last search was
August 2007. In addition we screened reference lists from included studies and
contacted trialists to identify further studies.
Selection criteria
Randomised controlled studies with TBI participants were eligible if they compar
ed an exercise programme incorporating cardiorespiratory fitness training to usu
al care, a non-exercise intervention or no intervention.
Data collection and analysis
Two authors independently screened the search output, extracted data and assesse
d quality. All trialists were contacted for additional information. Mean differe
nce and 95% confidence intervals (CI) were calculated for continuous data and ri
sk difference or odds ratio and 95% CI were calculated for dichotomous data. Dat
a were pooled when there were sufficient studies with clinical and statistical h
omogeneity.
Main results
Six studies, incorporating 303 participants, were included. The participants wer
e primarily males, in their mid thirties who had sustained a severe TBI. The stu
dies were clinically diverse with regard to the interventions, time post-injury
and the outcome measures used; therefore, the primary outcome could not be poole
d. Three of the six studies indirectly assessed change in cardiorespiratory fitn
ess after fitness training using the peak power output obtained during cycle erg
ometry (either at volitional fatigue or at a predetermined endpoint, that is, a
percentage of predicted heart rate maximum). Cardiorespiratory fitness was impro
ved after fitness training in one study (mean difference 59 watts, 95% CI 24 to
94), whilst there was no significant improvement in the other two studies. Four
of the six studies had no drop-outs from their intervention group and no adverse
events were reported in any study.
Authors' conclusions
There is insufficient evidence to draw any definitive conclusions about the effe

cts 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 ou
tcome measures.

Plain language summary

Fitness training to improve fitness after traumatic brain injury
Traumatic brain injury is the leading cause of long-term disability in children
and young adults. Reduced fitness is a common problem after traumatic brain inju
ry. Clinically, fitness training is used to address this problem.
Six studies, incorporating 303 people with traumatic brain injuries, were includ
ed in this review. The people were mostly male, in their mid thirties, and had s
ustained severe brain injuries. No studies were found that included children. Th
ree of the six studies assessed change in fitness after fitness training. The re
sults were mixed with one study showing an improvement in fitness and the other
two studies showing no significant improvement. Four of the six studies had no d
rop-outs from the fitness training group and no adverse events were reported in
any study.
There is insufficient evidence to draw any clear conclusions as to the effects o
f fitness training on fitness. Whilst it appears to be a safe and accepted inter
vention for people with traumatic brain injury, further well-designed studies ar
e required to make any definite conclusions.