Exercise intervention for slow-to-recover mild traumatic brain injury patients

INTERVENTION: The intervention group will attend the health clinic 3 times per week and undertake the ACTIVE‐TBI protocol with the direct guidance of an accredited exercise physiologist. Prescribed exercise commences as soon as feasible after study entry. The delivery of the intervention is closely supervised by an experienced, Exercise and Sports Science Australia (ESSA) AEP. The Intervention Protocol incorporates: a) strictly defined warm‐up and cool down‐periods; b) a work phase (a circuit program that ensures sequenced exercises for antagonistic muscle groups); and c) cessation rules (the American College of Sports Medicine (ACSM) Guidelines). The work phase involves individually‐prescribed, supervised, and graded circuit resistance training. The requirements are individually determined using 1‐Repetition Maximum (1‐RM) strength testing for leg press, chest press and back pull exercises. The same person assesses the 1‐RM attempts for all participants. The work phase dose for each participant is set at 50% of 1‐RM, which is classified by ACSM as light intensity. The clinic is equipped with pneumatic resistance training machines, specially designed for clinical populations (Ab HUR Oy, Finland). These machines enable precise quantification of resistance, and automated load control, which aids accuracy, safety, and usability (users do not require prior experience with exercise machines). This equipment electronically records all individual work phase data (intensity, volume). The work phase comprises 13 light‐resistance machine‐based exercises in each aerobic circuit (chest press, leg press, shoulder press, lat pulldown, lat row, abdominals, back extension, tricep push down (cable), seated bicep curl (cable) and leg extension, leg curl, leg abduction and adduction). Participants will exercise for a 30‐second period that includes 20 repetitions at the prescribed load, followed by a 30‐second rest. All intervals are timed by the supervisor. The training is graduated by: a) increasing session duration e.g., from week, 1 circuit (12 mins) and up to week 8, 4 circuits (48 min), and; b) two repeat 1‐RM tests (Weeks 3, 5) for revised load prescription, if required. There are 8 weeks with 3 training sessions per week (24 sessions, total). The session duration varies as noted above. There is one session per day, with a minimum of 48 hours rest in between sessions. The pre and post assessments occur in the week immediately pre and post the intervention, respectively. Participants in the ACTIVE‐TBI group will be eligible to discontinue the exercise program if they meet any of the following criteria: The participant is not longer at risk of persistent symtoms (measured using the RPQ‐3) Have been medically cleared to return to contact sport by their doctor. 1. American College of Sports Medicine Guidelines for exercise testing & prescription. 2014. (9th ed.).Baltimore: Lippincott Williams & Wilkins. CONDITION: Slow‐to‐recover from mild traumatic brain injury PRIMARY OUTCOME: Neurobehavioural symptoms indicative of PCS diagnosis measured using the Rivermead Post Concussion Symptom Questionnaire. SECONDARY OUTCOME: Health service utilisation measured by patient‐reported, via a project questionnaire. ; Return to work or study measured by patient‐reported, via a project questionnaire INCLUSION CRITERIA: 1. Arrive at ETC within 24 hours of injury; aged 18‐65 years; adequate English. 3. They are willing to attend two fitness tests about 8 – 10 weeks apart, and if allocated to the gym group, to attend 3 gym sessions per week in between fitness tests. ; Physical fitness assessed by an Accredited Exercise Physiologist using standard anthropometric measures include Weight (kg), Height (cm) and BMI (kg/m2); tape‐measured assessment of waist and hip circumference; 6‐min walk: distance (m) + speed (m/sec) + heart rate (9); and chest, hand grip (10), back and leg dynamometer strength testing (kg). 2. Their mTBI is assessed medically by conventional standards, (i) greater than or equal to 1 of the following: confusion or disorientation; loss of consciousness for less than or equal to 30 minutes; posttraumatic amnesia less than 24 hours; and/or other transient neurological abnormalities such as focal signs, seizure, and intracranial lesion not requiring surgery, and; (ii) Glasgow Coma Scale of 13–15 at least 30 minutes post injury or later upon presentation for healthcare (all data are extracted); and iii) are medically cleared (not requiring neurosurgical follow‐up).