Physical Activity Interventions for Adults With Traumatic Brain Injury (2013–2020)

Full Systematic Review Question

This systematic review addressed the question “What is the evidence for effectiveness of interventions that address psychosocial, behavioral, and/or emotional skills to improve social participation and other everyday activities and occupations for persons with TBI?”

Current Theme Reported

The main theme of the studies included in this systematic review brief is physical activity interventions to improve psychosocial outcomes for adults with traumatic brain injury.

Clinical Scenario

Traumatic brain injury (TBI) is a leading cause of death and disability that affects about 2.5 million Americans each year. Although the symptoms and severity of TBI vary among people, psychosocial, behavioral, and emotional changes are common and significantly impact successful and satisfying community participation. The increased prevalence of psychological problems in people with TBI, including depression, anxiety, suicidal ideation, substance abuse, sleep disorders, and posttraumatic stress disorder, highlight the need for appropriate and empirically based interventions. Psychological issues are commonly cited among those unmet rehabilitation needs (Mahoney et al., 2021), and these directly fall within occupational therapy’s scope of practice.

Occupational therapy practitioners have knowledge, skills, and training in assessing and treating psychological impairments to improve occupational performance following TBI, making their role in the rehabilitation process vital across the continuum of recovery. Given the known psychological and general health benefits of participating in physical activity, there is a need to establish evidence-based programs for people with TBI (Driver et al., 2012). People with TBI can be prone to the effects of a sedentary daily routine and associated secondary health complications that affect quality of life (Hamilton et al., 2015; Morris et al., 2019; Stocchetti & Zanier, 2016). Decreased depressive symptoms, better sleep, increased community participation, and higher overall quality of life are among the benefits linked to increased exercise for people with TBI (Hoffman et al., 2010; Rzezak et al., 2015).

Summary of Key Findings

Six articles were included in the review related to physical activity as an intervention to improve psychosocial outcomes and other everyday activities and occupations for people with TBI. These six articles were further divided into two categories, depending on type of physical activity intervention and intensity (Table 1). The levels of evidence used in this review are from Oxford Centre for Evidence-Based Medicine (2009).

Bottom Line for Occupational Therapy Practice

Occupational therapy practitioners are trained to evaluate physical strength, endurance, activity tolerance, and productive daily routines (American Occupational Therapy Association [AOTA], 2020). Physical activity is commonly associated with improved psychological and emotional well-being, including relieving stress, improving mood, and reducing the tendency for aggressive behavior (Brymer & Davids, 2016). The systematic review provides evidence that physical exercise, both in isolation and in combination with education on lifestyle and health improvement, can increase participation and quality of life for people with TBI. The studies in this review support the use of exercise with people with TBI to improve psychological symptoms, sleep, and perceived self-efficacy. Interventions that included exercise as part of a more comprehensive lifestyle improvement program may provide additional health benefits related to stress management and quality of life. The exercise programs implemented in the studies were generally administered individually, a finding that may reflect the heterogeneity of TBI symptoms across people, including physical impairments, general activity tolerance, and safety considerations.

Given the residual physical, cognitive, and psychological impairments that may present following TBI, it is important that occupational therapy practitioners consider strategies to overcome potential barriers to program accessibility in a manner consistent with interests and abilities (Self et al., 2013). The positive effects of physical activity interventions on psychological well-being were based primarily on programming that was 8–12 wk with varying levels of intensity in terms of amount of activity (i.e., number of steps) frequency per week, and use of out-of-session activities (homework or cuing).