A randomized controlled trial of exercise to improve mood after traumatic brain injury

Objective: To test the hypothesis that a structured aerobic exercise regimen would decrease the severity of depressive symptoms in people with traumatic brain injury (TBI) who reported at least mild depression severity at baseline. Design: Prospective, randomized, controlled trial. Setting: Community gymnasium. Participants: Subjects with a history of a prior TBI (6 months to 5 years post-injury), recruited from the community. Inclusion criteria included scoring >5 on the Patient Health Questionnaire-9. Subjects were excluded if they were non-English speakers, had a medical condition precluding exercise, had suicidal ideation, regularly exercised, or could not use standard aerobic exercise equipment. Intervention: Weekly supervised exercise sessions over a 10-week period consisted of education, warm-up, 30 minutes of aerobic exercise, and cool down. The exercise intensity was adjusted to reach a heart rate goal of 60% of the participant's estimated maximal heart rate. Main Outcome Measurement: Beck Depression Inventory (BDI) comparing exercise to control groups. Post hoc analyses compared groups exercising >90 minutes or <90 minutes per week. Results: Between-group comparisons at 10 weeks revealed no difference between groups on the BDI (P = .250). For the groups divided by minutes exercised per week, the high-activity group had significantly better depression scores than those in the low-activity group (P = .033). Conclusions: Although there was no statistically significant difference between the treated and the control group on mood after intervention, those persons with TBI who recounted higher levels of exercise per week also reported less depression and improved sleep, community participation, and overall quality of life.