Casola Brendan E, Hall Michael J, Fraser John J, Oldham Jessie R, Lempke Landon B, DeJong Lempke Alexandra F, Cifu David X, Walker William C, Walton Samuel R
Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.
Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences School of Medicine, Bethesda, Maryland, USA.
PM R. 2025 Aug 21. doi: 10.1002/pmrj.13436.
Mild traumatic brain injury (mTBI) is common among military service members. Moderate-to-vigorous aerobic exercise (MVAE) is a modifiable behavior with potential benefits for individuals following mTBI but is poorly understood for long-term mTBI health.
To explore the associations between mTBI history and MVAE participation and appreciate their association with health-related quality of life (HR-QOL) among service members and Veterans.
Data from a larger study were used in these secondary cross-sectional analyses. Lifetime mTBI history (0, 1-2, 3+) was captured via validated structured interviews. Self-reported weekly MVAE (none, below, meeting, or ≥2 times the recommendation) was recorded from the Behavioral Risk Factor Surveillance System questionnaire. Participants' HR-QOL was self-reported via Traumatic Brain Injury-Quality of Life instrument and the Patient Health Questionnaire-9 (depression symptoms). Univariate mTBI history and MVAE associations were assessed via Pearson's chi-square and Kendall's Tau. Multivariable linear regression models with unstandardized beta values and 95% confidence intervals were fit for each HR-QOL questionnaire outcome, with current age, sex, and posttraumatic stress disorder symptoms as covariates (α = .05).
Among the 1995 participants (87.7% male; aged 41.7 ± 10.1 years), those meeting or exceeding (≥2 times) MVAE recommendations had significantly higher HR-QOL for fatigue, executive function, pain interference, resilience, social participation, and depression than the inactive MVAE group. Exceeding MVAE recommendations by ≥2 times was also significantly associated with better self-reported cognition - general concerns. Those who participated in exercise but didn't meet the MVAE recommendations had higher pain interference, social participation, and depression scores compared to the inactive group. More lifetime mTBIs were associated with worse HR-QOL across all domains. Level of MVAE participation was not dependent on mTBI history.
More MVAE was associated with better TBI-related HR-QOL regardless of mTBI history. MVAE is recommended for service members and Veterans due to these findings and previously reported health benefits.
