Goretti España-Irla, Madeleine Perko, Emma M Tinney, Mark C Nwakamma, Martina Anto-Ocrah, Timothy P Morris
Traumatic brain injury (TBI) is a complex neurological condition with enduring consequences that extend well beyond the initial insult. Once regarded primarily as an acute event, TBI is now increasingly recognized as a chronic disorder associated with cognitive, emotional, and physical impairments. These sequelae contribute to diminished quality of life and elevated long-term risks for adverse health outcomes. Despite growing awareness of its multifaceted nature, TBI recovery remains heterogeneous and is shaped by a range of individual-level determinants that remain insufficiently understood. Among these determinants, biological sex and gender have emerged as critical yet under-investigated influences on TBI outcomes. Sex refers to chromosomal, hormonal, and anatomical attributes, whereas gender encompasses socially constructed roles, identities, and norms that govern behavior, access to resources, and healthcare engagement. These dimensions interact in ways to influence not only TBI risk and presentation but also recovery trajectories. Although previous research has documented sex and gender disparities in TBI outcomes, limited attention has been given to how these factors intersect with lifestyle behaviors during rehabilitation. Modifiable lifestyle factors, including physical activity, sedentary behavior, and sleep, are essential for optimizing neuroplasticity, reducing inflammation, and promoting recovery following TBI. However, engagement in and physiological responses to these behaviors are shaped by both sex-specific biological mechanisms and gendered sociocultural contexts. Recognizing and addressing these intersecting influences is crucial for advancing equitable and individualized rehabilitation strategies. This narrative review critically examines how physical activity, sedentary behavior, and sleep influence TBI recovery, with an emphasis on variation by sex and gender.