Effect of aerobic training on functioning activities in patients following acquired brain injury: Changes in exercise capacity, strength, mobility and functionalindependence in response to cycle ergometer exercise training in adultsundergoing rehabilitation following acquired brain injury

Acquired brain injury (ABI) often results in prolonged periods of immobility which exacerbates physiological and psychological problems resulting from initial injury. A randomised controlled study had determined the effect of 3 months of exercise training on rehabilitation outcomes, impairment, mobility and activity in adults with ABI. This thesis reports changes in exercise capacity related to impairment, mobility and activity following exercise training during rehabilitation following ABI. Exercise capacity was compared using maximum oxygen uptake (VO2) and heart rate monitored graded exercise testing (HR GXT) with a cycle ergometer; changes in impairment were assessed by Motricity Index, isometric muscle strength; mobility with Berg Balance Scale, Rivermead Mobility Index, 10-m walk velocity; and activity with Functional Independence Measure , Barthel Index and Nottingham Extended Activities of Daily Living Index.

Data was collected at 4 regional neurological rehabilitation units. Logistics, protocols and methodological issues associated with reliability were explored. Blind assessments were completed at baseline, 6 weeks (T2), at end of training 3 months (T3), and 3 months after training (T4) in 157 adults 43.2 ± 13.9 years old recruited 24.2 ± 14.7 weeks after a single incident ABI.

Differences between VCh GXT and predicted maximal exercise data were found (p<0.000) and correlations (p<0.01-0.05) were established between VCh max and functional scores in a sample of the study population at baseline (n=43). After training, exercising subjects (n=20) increased their VChmax (p<0.02), cycled for longer and were more efficient than relaxation control subjects (n=22, p=0.03). Changes in HR GXT performance were examined in depth in a different subgroup (n=61) and exercising subjects (n=30) showed larger (p=0.02) increases at T3 than controls (n=31) for maximum work rate, but there were no associated changes in measures of impairment, mobility or activity. The improvements in exercise capacity were similar to changes seen in the VCh tested subjects. Comparison of HR GXT with VOi max testing validated the use of HR GXT in the clinic. Guidelines based on mobility and activity for selecting suitable patients for exercise testing are proposed and analysis of exercise training has provided guidelines for increasing exercise capacity. This study demonstrated that younger adults in the first year after ABI have markedly reduced exercise capacity which can be increased and responds normally to cycle ergometer training undertaken in the clinical setting.

This thesis supplied via ROAR to UEL-registered users is protected by copyright and other intellectual property rights, and duplication of any part of the material is not permitted, except for your personal use for the purposes of non-commercial research and private study in electronic or print form. You must obtain permission from the copyright-holder for any other use. Electronic or print copies may not be offered, for sale or otherwise, to anyone. No quotation from the thesis may be published without proper acknowledgement.