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Feasibility of Aerobic Exercise in the Subacute Phase of Recovery From Traumatic Brain Injury

A Case Series

Morris, Timothy P., PhD; Costa-Miserachs, David, PhD; Rodriguez-Rajo, Pablo, MSc; Finestres, Jordi, MSc; Bernabeu, Montserrat, MD; Gomes-Osman, Joyce, PhD; Pascual-Leone, Alvaro, MD, PhD; Tormos-Muñoz, Jose Maria, MD, PhD

Journal of Neurologic Physical Therapy: October 2018 - Volume 42 - Issue 4 - p 268–275
doi: 10.1097/NPT.0000000000000239
Case Studies

Background and Purpose: Aerobic exercise is as important for individuals with traumatic brain injury (TBI) as for the general population; however, the approach to aerobic training may require some adaptation. The objective of the trial program was to examine the feasibility of introducing aerobic physical exercise programs into the subacute phase of multidisciplinary rehabilitation from moderate to severe TBI, which includes computerized cognitive training.

Case Description: Five individuals undergoing inpatient rehabilitation with moderate or severe TBIs who also have concomitant physical injuries. All of these individuals were in the subacute phase of recovery from TBIs.

Intervention: An 8-week progressive aerobic physical exercise program. Participants were monitored to ensure that they could both adhere to and tolerate the exercise program. In addition to the physical exercise, individuals were undergoing their standard rehabilitation procedures that included cognitive training. Neuropsychological testing was performed to gain an understanding of each individual's cognitive function.

Outcomes: Participants adhered to both aerobic exercise and cognitive training. Poor correlations were noted between heart rate reserve and ratings of perceived effort. Two minor adverse events were reported.

Discussion: Despite concomitant physical injuries and cognitive impairments, progressive aerobic exercise programs seem feasible and well tolerated in subacute rehabilitation from moderate to severe TBI. Findings highlight the difficulty in measuring exercise intensity in this population.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at:

Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain (T.P.M., P.R.R., J.F., M.B., A.P.L., J.M.T.M.); Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain (P.R.R., J.F., M.B., J.M.T.M.); Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts (T.P.M., J.G.O., A.P.L.); Departament de Psicobiologia i Ciències de la Salut, Institut de Neurociències, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain (T.P.M., D.C.M.); and Department of Physical Therapy, University of Miami, Miller School of Medicine, Miami, Florida (J.G.O.).

Correspondence: Jose Maria Tormos-Muñoz, MD PhD, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Camí Can Ruti, s/n, 08916 Badalona, Barcelona, Spain (

This project did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. In part supported by the Barcelona Brain Health Initiative. Dr A. Pascual-Leone was partly supported by the Sidney R. Baer Jr Foundation, the Football Players Health Study at Harvard University, and Harvard Catalyst | The Harvard Clinical and Translational Science Center (NCRR and the NCATS NIH, UL1 RR025758). The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic health care centers, the National Institutes of Health, or the Sidney R. Baer Jr Foundation. Dr A. Pascual-Leone is listed as an inventor on several issued and pending patents on the real-time integration of transcranial magnetic stimulation with electroencephalography and magnetic resonance imaging.

The authors declare no conflict of interest.

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© 2018 Academy of Neurologic Physical Therapy, APTA