The feasibility and efficacy of a virtual, symptom-guided aerobic exercise intervention to improve cognition in mild traumatic brain injury: A single-blind pilot randomized control trial with an active comparator group.

BackgroundMild traumatic brain injury (mTBI) affects millions worldwide, with cognitive impairment substantially impacting daily functioning. Despite this burden, evidence-based non-pharmaceutical 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. ObjectiveThis 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 one year of injury. MethodsThirty-seven participants were randomized to either symptom-guided aerobic exercise or active balance control; both delivered virtually three times weekly for 30 minutes over 12 weeks. Primary outcomes assessed feasibility metrics; secondary outcomes examined cognitive function. ResultsOf 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 to balance controls, with large effect sizes for TMT B-A difference scores in both post-intervention comparisons (Hedges g = 1.20, 95% CI [0.00, 2.41]) and Group x Time interactions (Hedges g = 1.38, 95% CI [0.27, 2.49]). Additionally, the aerobic group reported fewer sleep disturbances post intervention (g = 1.65, 95% CI [0.22, 3.09]). ConclusionThese 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 following mTBI. A fully powered randomized controlled trial is warranted to confirm these effects