High-intensity training is better than conventional training for locomotion, cognition, and aerobic capacity in moderate-to-severe TBI

By Josh Wu. This article was initially published in the 3/7/24 edition of our Concussion Update newsletter; please consider subscribing.

The Journal of Neurotrauma recently published a study that investigated the efficacy of high-intensity training (HIT) in improving “locomotion” (patients’ ability to walk, run, or climb stairs smoothly) after traumatic brain injury (TBI)––while also looking at secondary benefits like aerobic and cognitive improvements. *Note: This study by Abbey Plawecki et al. addresses improving locomotion impairments in individuals with chronic moderate to severe TBI. However, we thought this study was interesting, as it parallels studies about more vigorous exercise promoting faster concussion symptom recovery and reducing concussion-related anxiety.

Plawecki et al. selected 17 participants with a TBI of at least six months in duration for the study. For this randomized controlled trial, participants were divided into two groups, one doing HIT and the other doing conventional training; each group switched to the other intervention after four weeks. The HIT intervention maximized cardiovascular intensities (> 70% heart rate reserve) and overall exertion intensity, making use of Ratings of Perceived Exertion to ensure proper HIT training. The HIT session included treadmill training, stair climbing, and walking at faster speeds while performing variable stepping tasks (e.g., walking over uneven terrain). The conventional training group performed traditional rehabilitation exercises “focused on impairment-based and functional exercises with no restrictions on intensities achieved.” The results show that HIT training participants showed better outcomes in the physical tests used to measure locomotive outcomes (6-min walk test and peak treadmill speed). There were also more improvements in aerobic capacity and cognitive functioning after HIT. 

This study is critical because it is the first to investigate the effectiveness of HIT training in ameliorating chronic TBI symptoms. Past studies have looked at HIT for stroke patients but not TBI patients. While limitations of this study include a small sample size and an inability to discern casual relationships from specific exercises, the results indicate that HIT training intervention could provide a beneficial rehabilitation procedure that can improve movement and other secondary factors like health and cognition.