Improving Tolerance for Exercise After a Brain Injury

Improving Tolerance for Exercise After a Brain Injury

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.

Posted on BrainLine September 11, 2012. Reviewed December 13, 2017.

About the author: Elliot Roth, MD

Elliot 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, and chairman of the Department of Rehabilitation Medicine at Northwestern Memorial Hospital.

Elliiot Roth

Comments (5)

Please remember, we are not able to give medical or legal advice. If you have medical concerns, please consult your doctor. All posted comments are the views and opinions of the poster only.

My brain injury (DAI) occurred 20 years ago. Previously I had been following an intense fitness regime and I was able to return to it a year later. I completed Insanity and other physically challenging exercise programs. However, in the past year I have developed migraines after exercise. After reading this article and others, I am going to seek the help of a neurologist specializing in exercise intolerance. Thank you.

My experience is the same. Headaches with to much exertion. 3 years since head injury.

I am lucky, excerise makes me feel better. Even though the "feeling better" is for a short amount of time. Being TBI tired is something I have experienced every since my severe tbi in 2010. But I really like anything that helps me feel better, even exercising!

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.

Currently have that problem of exercise intolerance and have growth hormone treatment. Any idea how long it will take?