Hello, my name’s Leanne Hassett, and I’m an academic at the University of Sydney. Welcome to Training Course One: Aerobic Training in Adults and Older Adults with Moderate to Severe Traumatic Brain Injury.
This is Lesson One, which is an introduction to the guideline recommendation for aerobic training.
The learning objectives for this lesson are to know the guideline recommendation for fitness training for adults and older adults, to understand the justification for the guideline recommendation, and to understand the current evidence-practice gap in fitness testing and training in Australia.
This is the evidence-based recommendation. For adults and older adults after moderate to severe traumatic brain injury, we suggest regular, structured aerobic exercise that is individually tailored and across the continuum of care.
Based on the evidence and other criteria, this is a conditional evidence recommendation with low certainty evidence.
To help implement this guideline recommendation, the guideline panel came up with a number of good practice points. These include: aerobic exercise aims to achieve participation-level goals established collaboratively; assessment of fitness is conducted prior to commencing an aerobic exercise programme using a standardised or modified protocol and pre-exercise screening; aerobic exercise is prescribed using the frequency, intensity, time, and type (FITT) principles according to the American College of Sports Medicine guidelines for stroke and brain injury; specificity of training is considered when prescribing mode of aerobic exercise; exercise dosage is monitored, preferably using a heart rate monitor when possible; timing of aerobic exercise training considers the impact of fatigue on behaviour and participation in other activities, including work and/or study; and aerobic exercise is transitioned from health settings to community-based physical activity settings where appropriate.
There are also a few precautionary points. For adults on anti-epileptic medication, moderate to high intensity aerobic exercise may increase the risk of seizure if they are medically unwell or not routinely taking their medication.
When calculating training heart rate for adults on beta blocker medication, predicted maximum heart rate should be adjusted to account for the medication’s heart rate-lowering effect.
In the acute stage of recovery, consider mode of exercise and seek medical advice prior to commencing aerobic exercise for adults who have additional complications such as orthopaedic injuries and craniotomy.
This guideline recommendation, along with the good practice and precautionary points, was developed by the guideline panel based on several key findings. First, the literature shows clear evidence that reduced aerobic fitness is a common secondary physical impairment after moderate to severe traumatic brain injury, and that low fitness can increase the risk of morbidity and mortality, as well as make it more difficult to participate in everyday activities.
The evidence suggests that fitness training is likely to have moderate to large effects on important outcomes, including increasing aerobic fitness and reducing depression. Overall, there are likely to be more desirable effects, and undesirable effects such as adverse events are likely small, typically muscle soreness and fatigue.
Consultation with a range of relevant stakeholders showed good acceptability, and the intervention was considered feasible to deliver across the continuum of rehabilitation care.
To help inform the guideline recommendation, an audit of rehabilitation services was conducted in 2023. This included 26 sites across all states and territories in Australia, with most working with adults and older adults with traumatic brain injury. The majority were specialist brain injury rehabilitation services, alongside other types of rehabilitation services.
From this audit, it was found that fitness testing was not conducted in paediatric services and was also not common in adult services, with only 45 percent conducting fitness tests and only 30 percent using a standard protocol.
In contrast, fitness training was very commonly delivered in rehabilitation for both adults and children, with a range of different training modes used.
In summary, fitness training is commonly delivered across both paediatric and adult services using a variety of modes, with treadmill training being the most common. Fitness testing is less common and not conducted in paediatric sites. The intensity of fitness training is monitored, but mostly subjectively. It is also common for family and attendant care workers to be trained to supervise aerobic training, and for services to refer patients to external providers to continue fitness training after discharge.
That’s the end of Lesson One. Take the quick quiz to check your understanding of the key content. Thank you.
Hassett L, Johnson L, on behalf of the BRIDGES Guideline Development Group. Australian Physical Activity Clinical Practice Guideline for People with Moderate to Severe Traumatic Brain Injury. The University of Sydney, Sydney, Australia, 2024. ISBN: 978-1-74210-577-2. https://8d847da2-043f-4c55-8d3b-8be0e2312c8f.filesusr.com/ugd/be2cac_bc56220e83194049bd04ab04fcef9ea2.pdf.
The BRIDGES Guideline Development Group. Australian Physical Activity Clinical Practice Guideline for People with Moderate to Severe Traumatic Brain Injury: Technical Report. The University of Sydney, Sydney, Australia, 2024. https://ses.library.usyd.edu.au/bitstream/handle/2123/32165/Technical%20Report_Aust%20PA%20CPG%20for%20msTBI.pdf?sequence=1&isAllowed=y.