Intensive Cardiorespiratory Exercise (ICE) to Remediate Mild Traumatic Brain Injury in Active Duty Service Members
Abstract
Head injury affects the health and well-being of active duty Service members (ASDMs) throughout their lives. Cognitive decrements associated with mild traumatic brain injury (mTBI) reduce ADSMs effectiveness in their ability to self-regulate and function independently. Fluctuating symptoms include poor attention, inertia, depression, anxiety, and post-traumatic stress disorder (PTSD). Unfortunately, our understanding for the relationship between injury severity, cognitive symptoms, and clinical outcome is poor. Recognizing the potentially negative impact of mTBI, the Department of Defense has made it a research priority. Much of the current research focuses on discovering the neurobiological mechanisms of chronic mTBI and their relationship to other chronic illnesses like cardiovascular disease, diabetes, and Alzheimer s disease. Although the development of active treatments that interfere with the mTBI cascade requires a thorough understanding of complex neurodegenerative processes, the application of behavioral interventions to improve memory and thinking with aerobic exercise (AEx) is available now. AEx is a well-documented pathway to health and resilience, especially in ADSMs. Exercise increases our ability to withstand, recover, and grow in the face of stressors and changing demands. In its absence (physical inactivity), individuals are more likely to gain weight and to succumb to preventable disease like cardiovascular disease, hypertension, type 2 diabetes, metabolic syndrome, insulin resistance, hyperlipidaemia, breast and colon cancers as well as depression and anxiety. Exercise has a biologically plausible and temporal relationship with coronary heart disease, atherosclerosis, stroke, type 2 diabetes, some cancers, and all-cause mortality. Regular exercise induces positive physiological and psychological benefits and prevents many of the same chronic illnesses that have been shown to be exacerbated by mTBI. AEx is viewed widely as a potentially effective therapeutic for chronic mTBI (after acute trauma has diminished), and multiple reviews have called for the increased application in clinical trials to evaluate its efficacy as an intervention. Our observational studies suggest cardiorespiratory (CR) fitness is associated with brain structure both cross-sectionally and longitudinally. We have also executed two randomized control clinical trials to investigate 6-month regimens of AEx. The neurocognitive benefit of AEx has become starkly apparent. The data strongly suggest that AEx focused on optimizing an individual s gains in CR fitness may be therapeutic to enhance the brain benefits of AEx. However, exercise interventions are difficult to implement and sustain even though individuals know that adopting a lifestyle that includes exercise will promote mental health, longevity, and decrease preventable diseases. Thus, intervening with an intensive cardiorespiratory intervention (ICE) in ADSMs (who already engage in 1-hour of morning exercise as a part of their service commitment) is a great opportunity for mTBI treatment research to apply cutting-edge behavioral and organizational technologies to better understand how individuals with mTBI respond to aerobic exercise under ideal conditions. This type of intervention study will provide new empirical benchmarks for the optimal benefits of AEx. The current proposal seeks to empirically test the benefits of AEx as an intervention for active duty Service members with mTBI (with and without depression/PTSD) and to examine its effect on patient outcomes and quality of life. Specifically, this study will use ICE to improve memory and thinking in mTBI. We will enroll ADSMs from the 1st Infantry Division for a 6-month ICE intervention. In this randomized clinical trial, ADSMs will be assigned to either physical training enhanced with ICE (n=67) or usual mandatory morning physical training exercise as part of their active duty assignment (n=33).
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 31, 2017
- Source ID
- W81XWH1610519
Entities
People
- David M Johnson
Organizations
- United States Army
- University of Kansas