Fitness training for cardiorespiratory conditioning after traumatic brain injury

  • Review
  • Intervention




Cardiorespiratory deconditioning is a common sequelae after traumatic brain injury (TBI). Clinically, fitness training is implemented to address this impairment, however this intervention has not been subject to rigorous review.


The primary objective was to evaluate whether fitness training improves cardiorespiratory fitness in people who have sustained a TBI.

Search methods

We searched ten electronic databases (Cochrane Injuries Group Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); EMBASE; PubMed (MEDLINE); CINAHL; AMED; SPORTDiscus; PsycINFO; PEDro and PsycBITE) and two clinical trials registers (TrialsCentral and Current Controlled Trials). The last search was August 2007. In addition we screened reference lists from included studies and contacted trialists to identify further studies.

Selection criteria

Randomised controlled studies with TBI participants were eligible if they compared an exercise programme incorporating cardiorespiratory fitness training to usual care, a non-exercise intervention or no intervention.

Data collection and analysis

Two authors independently screened the search output, extracted data and assessed quality. All trialists were contacted for additional information. Mean difference and 95% confidence intervals (CI) were calculated for continuous data and risk difference or odds ratio and 95% CI were calculated for dichotomous data. Data were pooled when there were sufficient studies with clinical and statistical homogeneity.

Main results

Six studies, incorporating 303 participants, were included. The participants were primarily males, in their mid thirties who had sustained a severe TBI. The studies were clinically diverse with regard to the interventions, time post-injury and the outcome measures used; therefore, the primary outcome could not be pooled. Three of the six studies indirectly assessed change in cardiorespiratory fitness after fitness training using the peak power output obtained during cycle ergometry (either at volitional fatigue or at a predetermined endpoint, that is, a percentage of predicted heart rate maximum). Cardiorespiratory fitness was improved after fitness training in one study (mean difference 59 watts, 95% CI 24 to 94), whilst there was no significant improvement in the other two studies. Four of the six studies had no drop-outs from their intervention group and no adverse events were reported in any study.

Authors' conclusions

There is insufficient evidence to draw any definitive conclusions about the effects of fitness training on cardiorespiratory fitness. Whilst it appears to be a safe and accepted intervention for people with TBI, more adequately powered and well-designed studies are required to determine the effects across a range of outcome measures.




心肺功能失調是一種腦部外傷(traumatic brain injury (TBI))後常見的後遺症。臨床上,實施體適能訓練是為了處理這種損傷的問題,然而這種介入措施並未被嚴謹的回顧。




我們檢索10種電子資料庫(Cochrane Injuries Group Trials Register;Cochrane Central Register of Controlled Trials (CENTRAL);EMBASE;PubMed (MEDLINE);CINAHL;AMED;SPORTDiscus;PsycINFO;PEDro與PsycBITE)及兩種臨床試驗登記庫(TrialsCentral與Current Controlled Trials)。最近一次檢索是在2007年8月。此外我們審閱納入研究的參考文獻並連絡試驗者以確認進一步的研究。




兩名作者分別審閱檢索結果,摘錄資料並評估品質。連絡所有的試驗者以獲得其他的資訊。對於連續性資料計算其平均差及95% confidence intervals (CI),類別資料則計算其風險差或相對風險。當有臨床及統計上同質性的充足研究時則加總資料。


納入六篇研究,共包含303名研究對象。研究對象主要為男性,其30多歲時遭受嚴重的腦部外傷。這些研究在介入措施,受傷後的時間及使用的測量結果上有臨床差異;因此,無法加總主要的結果。六篇研究中的三篇間接評估體適能訓練後心肺功能的改變,採用踏車運動期間的最大輸出功率(無論是在意志疲勞或預定的終點,其為預測最高心跳率的百分比)。一篇研究顯示心肺功能在體適能訓練後獲得改善(平均差為59瓦特,95% CI為24至94),但其他兩篇研究沒有統計顯著改善。六篇研究中的四篇顯示體適能訓練組沒有人退出研究且所有的研究皆報告沒有副作用。





此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。



Plain language summary

Fitness training to improve fitness after traumatic brain injury

Traumatic brain injury is the leading cause of long-term disability in children and young adults. Reduced fitness is a common problem after traumatic brain injury. Clinically, fitness training is used to address this problem.

Six studies, incorporating 303 people with traumatic brain injuries, were included in this review. The people were mostly male, in their mid thirties, and had sustained severe brain injuries. No studies were found that included children. Three of the six studies assessed change in fitness after fitness training. The results were mixed with one study showing an improvement in fitness and the other two studies showing no significant improvement. Four of the six studies had no drop-outs from the fitness training group and no adverse events were reported in any study.

There is insufficient evidence to draw any clear conclusions as to the effects of fitness training on fitness. Whilst it appears to be a safe and accepted intervention for people with traumatic brain injury, further well-designed studies are required to make any definite conclusions.