Can brain-injured patients participate in an aerobic exercise programme during early inpatient rehabilitation?

Objective: We investigated the capacity of brain-injured patients to participate in an aerobic exercise programme early after injury. Design: Retrospective analysis of exercise achievements in patients participating in a randomized controlled trial. Setting and subjects: Ninety patients participated in an exercise training programme on a cycle ergometer at four inpatient neurological rehabilitation units for younger patients. At intake, impairments and function were rated on: Motricity Index, Ashworth Scale, Berg Balance Scale, Barthel Index and Functional Independence Measure. Interventions: Patients cycled for up to 30 minutes three times weekly for 24-36 sessions over 12 weeks. Main outcome measures: Exercise performance was measured by: (a) number of sessions to achieve a cycling time of 30 minutes, (b) overall mean cycling time per session over 24 sessions and (c) mean time per session cycling at >60% of age predicted maximum heart rate (HR max) over 24 sessions. Results: Fifty-five patients completed 24 sessions. Thirty-five withdrew, largely for logistic reasons, before completing training; they were significantly less disabled than the 55 who remained. Forty-four of the 55 patients trained for an average of at least 20 minutes per session, 18 training at >60% HR max for this time. There were no differences in performance on the three exercise parameters between two groups of patients with baseline Barthel scores of less than or equal to 12 and greater than or equal to 13. Conclusions: Brain-injured patients with a range of disabilities have the capacity to participate in an exercise programme during early inpatient rehabilitation, though some may take longer to achieve adequate intensity of aerobic exercise.