Can exercise help with traumatic brain injury treatment?


New research is exploring exercise as a treatment for TBI.

More than 2 million people in the United States suffer a traumatic brain injury (TBI) each year. Most cases of TBI are caused by motor vehicle crashes and household accidents, such as falls. When these accidents happen, the brain is shaken about the skull, resulting in brain damage.

The majority of cases are mild to moderate – these patients recover at the hospital or at home, go back to work, and resume their lives as if their injuries never occurred. But do they really go back to normal?

Mild to moderate head trauma sufferers may seem like average, everyday people on the outside, but many struggle with long-lasting TBI symptoms:

  • Disturbed sleep
  • Memory loss
  • Difficulty focusing
  • Depression
  • Mood swings

These symptoms diminish their quality of life but can’t be detected on an MRI or CT scan. There has to be some way we can help these patients, and we think exercise may be the key.

My colleagues and I are conducting a preliminary research study funded by the Texas Institute for Brain Injury and Repair, which is part of the UT Southwestern Peter O’Donnell Jr. Brain Institute, to find out whether exercise could be an effective treatment for mild to moderate TBI. It may seem like an unlikely option, but the benefits of exercise go far beyond muscle tone and physical fitness.

For more information about the study, please contact Justin Repshas at 214-345-4734.

Why exercise to treat traumatic brain injury?

The idea for this project stemmed from my NIH-funded, multicenter study focused on the brain aging process and the development of Alzheimer’s disease. We believe that mild brain injury accelerates the aging process of the brain – in fact, TBI patients may face up to a three times greater risk of developing Alzheimer's disease than their peers.

For nearly 20 years, researchers have tried to develop effective medications to treat mild TBI, to no avail. The drugs offer only temporary relief, nothing permanent. We hypothesize that patients should be prescribed exercise as a treatment for mild brain injury instead of medications.

Why could this be effective? Exercise may be able to slow down the brain aging process. We’re finding out if this could allow patients to regain lost cognitive and emotional abilities.

Is exercise safe for TBI patients?

More than 90 percent of patients with mild TBI are physically able to exercise. But after an accident, many are leery of exercise for fear of making their symptoms worse. Others quit exercising because they develop depression after their head injury. Giving up exercise can lead to weight gain, heart or vascular issues, and simply missing out on activities they enjoy.

Healthy body, healthy mind – it’s all connected. The brain is complex. It’s like a computer – there are circuits, neurons, and pathways that can be damaged. A brain injury is vastly different from a broken bone or torn muscle, which can be more easily fixed. With the brain, there are a lot of complicated processes happening that control our thoughts, emotions, and bodily functions. So with traumatic brain injury patients, we really have two issues to treat: the patients’ physical brain damage and their cognitive/emotional side effects.

How we measure physical and emotional progress

Examining a person’s brain is easy, relatively speaking. With advanced CT scanning and MRI, we can see the gray matter and white matter structure that composes a person’s brain. The gray matter is a thin layer on the surface of the brain which contains dendrites and nerve cell bodies. The hippocampus – the part of the brain that helps process memory and emotion – is mostly composed of gray matter and located deep inside the brain. Damage to the hippocampus directly or indirectly can lead to memory problems. When these brain fibers are damaged, for example by a head concussion, a person can be affected emotionally or cognitively.

White matter houses the nerve fibers that, like computer cables, connect areas of gray matter. The white matter is what makes a person “unique” – it’s what moves brain signals from point A to point B. When these fibers can’t deliver their signals properly, the way a person responds to situations changes, for example, the person may have difficulty focusing or controlling anger, or may experience mood swings.

What we can’t see is how a person feels – and that’s what mild TBI patients need help with most of all. Neuropsychological measurement to quantify participants’ cognitive function and health-related quality of life is an emerging field, and we’re using it in our study. After baseline fitness testing, we collect patient-recorded outcome measures (PROM) from our participants to assess their emotions and cognition. PROM data allows us to quantify improvements after exercise treatment. We track physical changes in the participants’ brains with imaging scans and blood biomarkers.

Our team has set three main goals for this study:

  1. To transform the quality of life for TBI patients.
  2. To verify that most TBI patients can – and should – exercise.
  3. To find out how exercise affects the aging process within TBI patients’ brains.

The ‘brains’ behind the project

We couldn’t ask for a better research base than our Advanced Imaging Resource Center in Dallas. Here, we’re surrounded by a community of experts with years of experience in traumatic brain injury research. For a complex study such as this, we need "brains” – specialists to operate our imaging equipment and work one-on-one with the participants.

Kathleen Bell, M.D., is our in-house TBI expert. She has conducted extensive research on brain injuries and emotional and cognitive symptoms of TBI across the country. I’m also proud to work with my research partner, Chris Madden, M.D., from the O’Donnell Brain Institute.                                

Joining me as co-investigator is Kan Ding, M.D. We work closely with our UT Southwestern neurology faculty colleagues who maintain the Parkland Health and Hospital System comprehensive brain trauma registry. This registry, along with our location in the Metroplex, offers thousands of potential participants for the next phase of our study, which we hope will include many research centers across the country. We’re optimistic that our research will pave the way for better treatment of the hidden symptoms suffered by TBI patients.

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