Fitness training for cardiorespiratory conditioning after traumatic brain injury

Background 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. Objectives The primary objective was to evaluate whether fitness training improves cardiorespiratory fitness in people who have sustained a TBI. Search strategy 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 primarilymales, 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.