Effect of aerobic training on functioning activities in patients following acquired brain injury: Changes in exercise capacity, strength, mobility and functional independence in response to cycle ergometer exercise training in adults undergoing 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.

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