May Is National Physical Fitness and Sports Month… And Yes! That Includes National Bike Month.
Let me start off with a short bio:
Hi, my name is Silvana.I am what they (the neuro community) consider to be a Moderate, Closed Head, Traumatic Brain Injury Survivor. I prefer the titles of TBI Warrior, Bicycle Nerd, or Super-Hero.
Time passed and eventually I started receiving Brain Injury rehabilitation therapy. I am told that each day I most wanted to sleep or to ride my bike. I was not allowed much of the sleep and definitely no riding a bicycle. So it was over two years and many tears before I started getting back into shape and rolling out the miles. There was nothing easy about the getting back into shape. Balance issues, PTSD, Neurological Vertigo, speech issues, brain fatigue, processing issues, cognitive disabilities, depression, nerve pain, complete memory loss -instant, short term and long term, as well as many more symptoms had invaded my brain and made it burdensome to say the least. But like many of my new brain injured super-hero friends, I am not a quitter. I began my physical fitness training one baby-step and one pedal-push at a time.
Staying physically fit after my brain injury in July 2010 when I was run down by a car while doing what I love has been a huge challenge. I consider myself one of the lucky ones, as many Brain Injury Survivors that I have met over the years have had a far more difficult journey than I. Somehow I was not terribly injured physically from the accident: A broken ankle joint along with many contusions, cuts and scrapes, and of course road rash were the primary extent of it. My brain, on the other hand, did not fare so well. Yes, I was wearing a helmet thankfully. It kept my skull from smashing up, but it could not deter the beating my brain took and the numerous symptoms a TBI delivered along the hilly road I have been traveling. Several health care providers indicated that perhaps because I was in such good physical shape prior to the accident, having been training for a century ride (a long distance 100 Kilometer/62 Mile bike ride) that would be particularly grueling as it traversed over three mountain passes, two of them over 10,000 ft, in So. Colorado. Cyclingis a mental endurance test, it often requires more mental focus than fitness. Your body can go much farther than your brain believes, so they both have to be strong and in sync. Also that natural instinct for survival; as one of the few things I recall of that morning that changed my life forever was a beautiful voice, calling out to me to “Hold onto your bike.” Not once, but twice, as it might have known that I may have needed a little extra encouragement to hold on to what I love. Being in shape along withsurreal intervention helped me survive a worse case scenario.
So here’s to improving your life with cardiovascular and respiratory fitness, increasing strength and flexibility, getting rid of the blahs, decreasing pain, learning to refocus your brain, and creating neuropathways. I like to call it rewiring your core.
The Bad News: According to the Center for Disease Control, over 3.2-5.3 million people in the country sustain a traumatic brain injury (TBI) every year. TBIs account for 30 percent of all injury-related deaths and lead to $76.5 billion in annual medical costs. These numbers are still growing. The World Health Organization predicts that TBIs will become the third leading cause of death and disability in the world by 2020.
The following is a list of the top 10 sports-related brain injury categories, in order of reports made by hospital emergency rooms:
Baseball and Softball
Skateboards and Scooters
Powered Recreational Vehicles
Trampoline and Gymnastics
In my humble opinion, and that of the reporting agencies involved in brain injury research, the statistics noted above are only those of ‘reported or individuals who received a proper diagnosis and treatment’. I for one would not have counted in the top sport as I was misdiagnosed and not given treatment immediately for a brain injury. Today, however, we have learned so much more about the degree of concussions and how they should be treated as different levels of brain injury.
The Great News: For the Brain Injury Community is that you have an arsenal of healthy tools available that are energizing and healing and the only prescription you need is some motivation, a bit of support, smart safety guidelines, and an “okay” from your physician/medical team to integrate this into your daily routine of self-care and recovery.
Up to this time there have been no established guidelines for exercise for brain injury survivors. Because of the many diverse and undiscriminating effects of short and long-term impairment that are incurred from a traumatic brain injury, content of an exercise and fitness plans will largely depend on the individual, their present and past health habits, and the extent and severity of impairment. The statements below by the APTA and ACSM are “guidance not individual guidelines”
A quick happy personal note on this:
Muscle memory is amazing! If only my mental thought processing could be so strong!
The American Physical Therapy Association (APTA), American College of Sports Medicine (ACSM), and National Center on Health, Physical Activity and Disability have released guidance on exercising with TBI. According to the APTA, appropriate exercise can benefit those with TBI who have issues with weight and stress management, emotions and mood, memory, attention, endurance, and energy. APTA suggests that low- resistance, rhythmic, dynamic aerobic exercise such as walking, stationary cycling, jogging, and the elliptical machine may be appropriate after TBI. Those with physical and cognitive limitations, however, may need to adjust the way in which they exercise. For example, a client with difficulty remembering directions shouldn’t jog or walk outside but should instead opt for home exercise on stationary exercise equipment.
Personal note- Get outside-, fresh air is a huge factor in recovery, mood enhancement and regaining bone strength. Just don’t go alone. Exercise buddies are the best. You keep each other motivated, engaged, and hopefully one of you knows how to get back home or at least use GPS. Hmmm, thinking of a few super-hero peeps I know.
The ACSM emphasizes the need for those with TBI to choose exercises that suit their motor control and balance abilities and to ensure that protective headgear is worn for activities that involve a risk of falling; the rate of a second head injury is three times greater after an initial head injury. For individuals with balance issues, the National Center on Health, Physical Activity and Disability recommends always choosing aerobic exercises with a low risk of falling, such as water exercise, rowing machine, or recumbent cycle. Furthermore, strength exercises should always should be performed from a stable position to reduce fall risk. Yoga, tai-chi, and Pilates are suggested to improve balance and reduce the risk of falls.
Here is a guide to start you off, but is by no means all that is available, nor is it recommended for all forms of brain injury recovery. Please always consult your physician/medical team/health provider and caretaker before starting any form of exercise or new routine.
Always consider safety first,have a safety workout-buddy or professional teach you, guide you and share in the experience.
Also, very important note here… Do Have Fun! Because smiling is also a great exercise, and it’s contagious 😉
Exercise for People with a Traumatic Brain Injury
Aerobic (Cardio) Training
Improving cardiovascular fitness can be accomplished in many ways. If new to exercise, choose low-impact activities, such as walking or swimming, that still involve large muscle groups that are moving continuously. If balance is an issue, the recumbent bike, row ergometer, and water exercises are great modes of training that reduce the risk of falling.
Frequency: 3 to 5 days per week with the goal of working up to most days of the week.
Intensity:Moderate to high intensity, or 60 to 90 percent of heart rate max. Start at the lower end of this range. Slowly and gradually increase the intensity over time.
Time:20 to 60 minutes total.
Personal Note: How do you find the time? Break it down into 10 minute spurts throughout your day. Soon you’ll be working it up to 20 minutes of walking, running, swimming, indoor or outdoor workout, boxing or yoga or 20+ miles of pedaling. Can’t you feel those muscles strengthening, those synapses connecting and that smile growing?
Did you knowthat the Greek word for synapse is sun-hapsis? Sun meaning together and Hapsis meaning joining.
If new to resistance training, begin with circuit machines, resistance bands and body weight exercises until form and coordination have improved enough for free-weight and kettle-bell exercises. Regardless of the type of exercise, make sure to start each exercise from a stable position to reduce the risk of falls or further injury.
Frequency: 2 to 3 days per week. Each major muscle group (chest, back, shoulders, biceps, triceps, abdominals, quadriceps, and hamstrings) should be targeted. This can be in the same exercise session or separated into training certain muscle groups on certain days. A minimum of 48 hours rest should separate the training sessions for the same muscle group.
Volume: 3 sets of 8 to 12 repetitions per exercise. Start with 1 set of 8 to 12 repetitions and gradually build up to 3 sets.
Type: Body weight, TRX, free-weights, circuit machines, kettle-bells, resistance bands, etc.
Flexibility (Stretching) Training
Effects of a brain injury include reduced range of motion, stiffness, spasticity, ataxia, and reduced tone, which initially can cause flexibility exercises to be difficult. A regular stretching routine can improve tightness and spasticity.
Frequency: The goal should be to stretch in the morning after waking up, after a workout, and at night before going to bed.
Intensity: Perform the stretch until a point of tightness, but never to a point of pain.
Time: Hold the stretch for 10 to 30 seconds, but try for a full 30 seconds.
Type: Slow, static stretches for each muscle group. Static stretches involve slowly stretching a muscle or muscle group and holding that position.
Benefits of balance training for individuals with a TBI include improvements in coordination, agility, and muscular strength, which can reduce the risk of falls and fear of falling. Regardless of the type of exercise, make sure to start each exercise from a stable position to reduce the risk of falls or further injury.
Frequency: A minimum of 2 to 3 days per week. Intensity: An intensity level for balance exercises has not been established.
Time:60 minutes total that can be broken into 20 to 30 minute bouts.
Type:Yoga, Pilates, Tai- Chi, standing on 1 leg, heel-to-toe walk, standing on an unstable surface (i.e.,BOSU ball, wobble board, etc.)
Personal Note:Yoga and Mindfulness Meditation are awesome and finally becoming more accepted in the arsenal of brain injury recovery tools. I used to do yoga with my 3rd grade students for a few minutes each morning. It helped improve their focus, their energy and made them laugh: a great way to start any day. Now neurologists, physical rehabilitation professionals, and physicians are recommending it as one form of treatment for brain injury survivors. It really does help improve sleep, energy, flexibility and strength, and has been shown to decrease anxiety and depression.
A recent study conducted at Indiana-Purdue University School of Health and Rehabilitation affirmed this. Adults in the study with TBI demonstrated improved balance, flexibility, strength, endurance and walking speed after initiating a yoga practice.
That’s it for now. Hope to catch you out in the sunshine. Let’s keep proving we are strong and will carry on. Or in my case Pedal on…
Silvana Montero Founder/Designer bicibits.com Follow the mission and journey to Get Your Ride Smile On,One Pedal Push at a Time.
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Report to Congress: traumatic brain injury in the United States: epidemiology and rehabilitation.
American College of Sports Medicine. Exercising following a brain injury: prescription for health. Medscape website.
The benefits of exercise in individuals with TBI: a retrospective study. Journal of Head Trauma Rehabilitation, 13(4) 58-67.