Emma M. Tinney, Mark Nwakamma, Goretti España‐Irla, Lauren L. Kong, Colette Chen, Jeremy Hwang, Amanda O’Brien, Madeleine L. Perko, Ryan Luke Sodemann, Jacqueline Caefer, Julia Manczurowsky, Charles H. Hillman, Alexandra M. Stillman, Timothy P. Morris
These findings establish that virtual, supervised, symptom-guided exercise interventions are feasible and safe for mTBI populations, with preliminary evidence suggesting aerobic exercise specifically benefits cognitive flexibility and sleep quality after mTBI.
BACKGROUND: Mild traumatic brain injury (mTBI) affects millions worldwide, with cognitive impairment substantially affecting daily functioning. Despite this burden, evidence-based nonpharmaceutical interventions remain lacking in clinical practice. Emerging evidence suggests aerobic exercise may improve post-mTBI cognition; however, the methodological limitations, particularly inadequate control groups, prevent definitive conclusions. OBJECTIVE: This pilot randomized controlled trial examined the feasibility and preliminary efficacy of a 12-week virtual exercise intervention for community-dwelling adults aged 18-55 years with mTBI within 1 year of injury. METHODS: Thirty-seven participants were randomized to either symptom-guided aerobic exercise or active balance control; both delivered virtually 3 times weekly for 30 minutes over 12 weeks. Primary outcomes assessed feasibility metrics; secondary outcomes examined cognitive function including Trail Making Test (TMT) Part A and Part B. RESULTS: Of enrolled participants, 75% completed the intervention with 94.2% session adherence and zero adverse events, demonstrating excellent feasibility and safety. The aerobic group demonstrated greater improvements in executive function compared with balance controls, with large effect sizes for TMT B-A difference scores in both postintervention comparisons (Hedges' g = 1.20, 95% CI [0.00-2.41]) and Group × Time interactions (Hedges' g = 1.38, 95% CI [0.27-2.49]). In addition, the aerobic group self-reported fewer sleep disturbances postintervention (g = 1.65, 95% CI [0.22-3.09]). CONCLUSION: These findings establish that virtual, supervised, symptom-guided exercise interventions are feasible and safe for mTBI populations, with preliminary evidence suggesting aerobic exercise specifically benefits cognitive flexibility and sleep quality after mTBI. A fully powered randomized controlled trial is warranted to confirm these effects.