Exercise to Improve Health Promotion and Self-Esteem post-ABI

Author/ Year/ Country/Study Design/N



Damiano et al. (2016)
Prospective Controlled Trial
NInitial=24, NFinal=15


Population: TBI=12, Healthy Subject=12; TBI group (n=12); Mean Age=31.3yr; Gender: Male=7, Female=5; Time Post Injury>6mo. Healthy Volunteers (controls; n=12); Mean Age=32.5yr; Gender: Male=7, Female=5.
Intervention: Participants with TBI followed a home-base exercise program with an elliptical (30min 5d/wk for 8wk). Resistance was added progressively each week. Controls did not complete the exercise intervention. Assessments were completed at baseline, 8wk and follow-up.
Outcome Measure: Limits of Stability Test (LOS), Motor Control Test (MCT), High-Level Mobility Assessment Tool (HiMAT), Hamilton Depression Inventory (HAM-D), Sensory Organization Test, gait, cadence, Dual-Task performance (DT), Hopkins Verbal Learning Test-Revised (HVLT-R), Finger Tapping Test (FTT), Pittsburgh Sleep Quality Index (PSQI), Beck Anxiety Inventory, and PTSD Checklist-Civilian Version (PCL-C).


  1. There was a significant difference in LOS between the TBI group and controls in 2 directions; backwards (TBI=71.6%, HV=89.3%, p=0.042) and left (TBI=37%, HV=49.6%, p=0.037).
  2. The TBI group had a significantly poorer DT performance on both motor (p=0.047) and cognitive (p=0.045) tasks when compared to controls.
  3. The TBI group was also significantly different from controls on HVLT-R (p=0.004), PCL-C (p=0.02) and HAM-D (p=0.04).
  4. Within the TBI group, maximal movement during the LOS test had a strong relationship with HVLT-R total recall (r=0.74, p=0.008) and delayed recall (r=0.81, p=0.003) and was related to fewer depressive symptoms (r=-0.63, p=0.04).
  5. Within the TBI group, slower walking velocity and slower FTT was related to higher depression scores (r=-0.65, p=0.03 & r=-0.72, p=0.04, respectively). FTT was also related to poorer sleep quality (r=-0.75, p=0.048).

Bellon et al.(2015)
Cross-Over RCT
NInitial=123, NFinal=69


Population: TBI; Mean Age=43.7yr; Gender: Male=41, Female=28; Mean Time Post Injury=100.5mo.
Intervention: All participants completed a 12wk home-based walking program. Participants were randomly assigned to Walking First group (WF; n=28), who underwent a home-based walking program utilizing a pedometer (given goals to increase by 5% every week) to keep track of their steps, or Nutrition First group (NF; n=39) who acted as the control group and were given information and weekly coaching on healthy nutrition. After 12wk the WF group completed the nutrition protocol and the NF group completed the walking protocol for an additional 12wk.
Outcome Measure: Centre for Epidemiological Studies-Depression and Perceived Stress Scale.


  1. Overall there was a significant reduction in depression from baseline (16.01) to 24wks (13.16) (p=0.007) in the WF group compared to the NF group; however, there was no between group significance on depression.
  2. Overall, there was a significant reduction in stress from baseline (25.55) to 24wks (21.28) in the WF group compared to the NF group (p=0.006).


Lee et al. (2014)
Prospective Controlled Trial
NInitial=21, NFinal=12
Population: TBI; Mean Age=46.09yr; Gender: Male=9, Female=12; Mean Time Post Injury=56.11mo.
Intervention: All participants completed an exercise and self-affirmation intervention program (IntenSati; 60min, 2d/wk for 8wk) where spoken affirmations were made while exercising in a group format. Participants received the intervention immediately (Group 1, n=5) or were waitlisted for 8 weeks (Group 2, n=7). Assessments were completed at baseline, 8wk and 16wk. 
Outcome Measure: Positive and Negative Affect Scale, Wechsler Adult Intelligence Scale - Digit Span Forward and Backward subtest, Stroop Colour and Word Test, Trail Making Test A & B, Beck Depression Inventory (BDI), and Life-3.
  1. At week 8, Group 1 reported experiencing less depressive symptoms on the BDI than Group 2 (-13.00 versus 1.57, p=0.045). There were no significant differences found on any other outcome measures.
  2. When combining data for all participants at 16wk, significant improvements were found post intervention for depression (p=0.005), positive affect (p=0.02), and quality of life (p=0.006).

Schwandt et al. (2012a)

Population: TBI: Mean Age=29yr; Gender: Male=3, Female=1; Mean Time Post Injury=2.6yr.
Intervention: Subjects met with a physical therapist 3/wk for 12wk to complete aerobic exercises for 30min, with a warm-up and cool-down lasting 10min each. The subjects could choose between a cycle ergometer, a treadmill or a recumbent step machine. 
Outcome Measure: Hamilton Rating Scale for Depression (HAMD) and Rosenberg Self-Esteem Scale (RSES).

*no p-values provided.

  1. At baseline measurements, HAMD scores revealed the subjects suffered from moderate to severe levels of depression.
  2. As the intervention progressed participant’s scores on the HAMD decreased by 9-16 points. 
  3. Improved aerobic fitness was indicated by increased peak power outputs from baseline to post-intervention.
  4. RSES scores indicated improved self-esteem after the intervention. The subjects reported perceived benefits of improved fitness, mood and social contact.   
Hoffman et al. (2010)
Population: TBI; Exercise Group (n=40): Mean Age=39.7yr; Gender: Male=15, Female=25. Control Group (n=40): Mean Age=37.1yr; Gender: Male=20, Female=20. 
Intervention: Participants were randomly assigned to the exercise or control group. The 10wk community-based exercise intervention consisted of supervised aerobic exercise (1/wk) involving 30min of aerobic exercise and were instructed to complete aerobic exercise at home (30 min, 4x/wk). The control group was waitlisted. 
Outcome Measure: Borg Scale of Perceived Exertion, Brief Pain Inventory, Beck Depression Inventory (BDI), SF-12 Health Survey (SF-12), Perceived Quality of Life Scale (PQOL), Craig Handicap Assessment and Reporting Technique-Short Form (CHART-SF).
  1. The exercise intervention group reported exercising more days of the week than the control group (3.68 versus 2.05, p=0.004); however, the increase in minutes per week of exercise was not significantly different between groups (p=0.064).
  2. The exercise group also reported less pain interference (p=0.021) and greater improvement on the Brief Pain Inventory (p=0.031) in comparison to the control group.
  3. Post-hoc analyses compared highly active (>90min/wk) and low activity (<90min/wk) participants, regardless of initial grouping. Highly active participants reported significantly more community activity on the CHART-SF (p=0.028), greater PQOL scores (p=0.034) and greater SF-12 general mental health scores (p=0.024) than the low activity group.
  4. The highly active group scored lower on the BDI after the 10wk intervention than the low active group (p=0.033). 
Blake & Batson (2009)

Population: TBI; Exercise Group (n=10): Mean Age=44.5yr; Gender: Male=9, Female=1; Mean Time Post Injury=16.4yr. Control Group (n=10): Mean Age=46.2yr; Gender: Male=6, Female=4; Mean Time Post Injury=14.89yr.
Intervention: Participants were randomly assigned to either the exercise group, who participated in Tai Chi Chuan Qigong 1hr/wk for 8wk, or to the control group who participated in non-exercise social and leisure activities. Assessments conducted at baseline and at 8wk follow-up.
Outcome Measure: General Health Questionnaire-12 (GHQ-12) and Physical Self-Description Questionnaire (PSDQ).

  1. The attendance rate was 72.5% and 80% for the exercise and control group, respectively.  
  2. At follow-up, the only significant between group difference was on the GHQ-12, median change for the exercise and control groups was -1.5 and -1.0, respectively (p=0.026).
  3. Those in the intervention group demonstrated significant improvements in mood on the GHQ-12 (p=0.042) and PSDQ Self-Esteem scores (p=0.017) from baseline to follow-up.
Driver et al. (2006)

Population: TBI; Exercise Group (n=9): Mean Age=37.8yr; Gender: Male=5, Female=4; Mean Time Post Injury=40.3mo. 
Control Group (n=9): Mean Age=35.5yr; Gender: Male=5, Female=4; Mean Time Post Injury=41.2mo.
Intervention: Participants were randomly assigned to either an 8wk aquatic exercise program involving 1hr sessions 3/wk consisting of aerobic and resistance training or to a control group that received 8wk of vocational rehabilitation class to improve reading and writing skills. 
Outcome Measure: Health Promoting Lifestyle Profile II (HPLP-II) and Physical Self-Description Questionnaire (PSDQ). 


  1. The exercise group experienced significant improvements on the health responsibility, physical activity (both p<0.05), nutrition, spiritual growth (both p<0.01), and inter-personal relationships (p<0.001) subscales of the HPLP-II after the intervention, but not the stress management subscale. The control group showed no significant improvements on any the subscales (p>0.05). 
  2. At the end of the program, the aquatic exercise group showed significant improvements on the self-esteem, co-ordination, body fat, strength, flexibility and endurance sub-scales of the PSDQ (all p<0.001).  The control group showed no significant improvements.
  3. No between group calculations were completed.