Critical Review
Physical Exercise and Cognitive Recovery in Acquired Brain Injury: A Review of the Literature
Jennifer M. Devine MD,
Ross D. Zafonte DO,
Jennifer M. Devine MD
Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
Disclosure: nothing to discloseSearch for more papers by this authorCorresponding Author
Ross D. Zafonte DO
Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, 125 Nashua St, Boston, MA 02214
Disclosure: 2A, BHR and Allergan; 7A, Neurohealing - Drug Phase II Study Cosponsored by FDA, Funded by Orphan Drug; 8B, NIH, NIDRR, DOD-Supported ResearchAddress correspondence to: R.D.Z.Search for more papers by this authorJennifer M. Devine MD,
Ross D. Zafonte DO,
Jennifer M. Devine MD
Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
Disclosure: nothing to discloseSearch for more papers by this authorCorresponding Author
Ross D. Zafonte DO
Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, 125 Nashua St, Boston, MA 02214
Disclosure: 2A, BHR and Allergan; 7A, Neurohealing - Drug Phase II Study Cosponsored by FDA, Funded by Orphan Drug; 8B, NIH, NIDRR, DOD-Supported ResearchAddress correspondence to: R.D.Z.Search for more papers by this authorDisclosure Key can be found on the Table of Contents and at www.pmrjournal.org
Abstract
Objective
Physical exercise has been shown to play an ever-broadening role in the maintenance of overall health and has been implicated in the preservation of cognitive function in both healthy elderly and demented populations. Animal and human studies of acquired brain injury (ABI) from trauma or vascular causes also suggest a possible role for physical exercise in enhancing cognitive recovery.
Data Sources
A review of the literature was conducted to explore the current understanding of how physical exercise impacts the molecular, functional, and neuroanatomic status of both intact and brain-injured animals and humans.
Study Selection
Searches of the MEDLINE, CINHAL, and PsychInfo databases yielded an extensive collection of animal studies of physical exercise in ABI. Animal studies strongly tie physical exercise to the upregulation of multiple neural growth factor pathways in brain-injured animals, resulting in both hippocampal neurogenesis and functional improvements in memory.
Data Extraction
A search of the same databases for publications involving physical exercise in human subjects with ABI yielded 24 prospective and retrospective studies.
Data Synthesis
Four of these evaluated cognitive outcomes in persons with ABI who were involved in physical exercise. Three studies cited a positive association between exercise and improvements in cognitive function, whereas one observed no effect. Human exercise interventions varied greatly in duration, intensity, and level of subject supervision, and tools for assessing neurocognitive changes were inconsistent.
Conclusions
There is strong evidence in animal ABI models that physical exercise facilitates neurocognitive recovery. Physical exercise interventions are safe in the subacute and rehabilitative phases of recovery for humans with ABI. In light of strong evidence of positive effects in animal studies, more controlled, prospective human interventions are warranted to better explore the neurocognitive effects of physical exercise on persons with ABI.
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