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Improving Tolerance for Exercise After a Brain Injury
Elliot Roth, MD, BrainLine
I was hit with a spinnaker pole when sailing four years ago which resulted in a concussion. I have an ongoing problem with fatigue and, in particular, exercise intolerance. While I am fine at rest and doing gentle activity, any kind of more strenuous activity results in fatigue and headaches. Often these symptoms are delayed and appear after activity or the next day.
While the symptom threshold has improved over the four years (i.e., I can do more activity before symptoms appear), it is still a problem and a normal level of physical activity is beyond me (i.e., sailing for 30 minutes in moderate winds results in a return of symptoms). I would like to know if this is a common problem, why this might be happening, and if there is anything I can be doing to improve my exercise tolerance.
You are right, fatigue and headaches are frequent problems following traumatic brain injury, and your experience of having this occur only with greater amounts of activity is common. It’s also common to experience these symptoms following activity or exertion.
The reasons for these phenomena are unknown. Pain medications, ice, and certain select exercises might be beneficial for the headaches. Gradual and systematic increase in activity levels might be helpful for the fatigue. And finally, it might be beneficial to seek the advice of a specialist in traumatic brain injury for additional assistance.
Click here to go to About Ask the Expert.
Elliot J. Roth, MD is the Paul B. Magnuson Professor and chairman of the Department of Physical Medicine and Rehabilitation at Northwestern University Feinberg School of Medicine, chairman of the Department of Rehabilitation Medicine at Northwestern Memorial Hospital, and interim medical director of the Brain Injury Medicine and Rehabilitation Program at the Rehabilitation Institute of Chicago (RIC), where he also previously served as former senior vice president and medical director. He is project director of the Rehabilitation Research and Training Center on Stroke Rehabilitation, based at RIC and funded by the US National Institute on Disability and Rehabilitation Research (NIDRR), which he has led for the past 18 years. He currently is project director of the “Rehabilitation Research and Training Center on Enhancing the Functional and Employment Outcomes of Individuals Who Experience a Stroke,” and also the “Midwest Regional Traumatic Brain Injury Model System,” both of which are funded by grants totaling nearly $6 million from NIDRR. He also leads several other research projects, funded by Federal agencies and private foundations, primarily focused on neurorehabilitation. Dr. Roth is actively involved in patient care, teaching, research, program leadership, and community service.
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You should be screened for neuroendocrine dysfunction by an endocrinologist who has experience with this. The most up-to-date research suggests that between 18-52% of concussion survivors develop human growth hormone deficiency as a result of the injury. If you suffer from this deficiency it will need to be treated and your exercise tolerance should improve.
Mar 17th, 2013 10:59am