Effect of a Digitally Monitored Walking Program on Functional and Psychological Outcomes in Individuals with Mild Traumatic Brain Injury: A Randomized Controlled Trial.

Objective: To evaluate the effects of a 12-week digital walking exercise program on functional capacity and psychological health in individuals with mild traumatic brain injury (mTBI) and examine the influence of exercise adherence.

Design: Randomized controlled trial with repeated measures.

Setting: Medical center-based recruitment with home-based intervention.

Participants: Fifty-two adults (mean age 43.98 ± 14.94, 57.7% female) diagnosed with mTBI (Glasgow Coma Scale score, 13-15) within 6 months post-injury.

Interventions: Participants were randomly assigned to either a digitally monitored walking program group (structured walking ≥30 min/session, ≥3 times/week, supported by a wearable fitness tracker and personalized feedback) or an active control group receiving standard exercise education.

Main Outcome Measures: Primary outcome was functional capacity measured by the 6-minute walk test (6MWT). Secondary outcomes included depressive symptoms (Beck Depression Inventory-II) and quality of life (QoL; WHOQOL-BREF). Assessments were conducted at baseline, 4, 8, and 12 weeks. Generalized estimating equations assessed between-group differences. Subgroup analyses evaluated outcomes in participants with ≥80% adherence to moderate-intensity exercise.

Results: The intervention group demonstrated significantly greater improvements in 6MWT distance at 4 weeks (+41.65 m, p = .02), 8 weeks (+61.31 m, p = .001), and 12 weeks (+65.29 m, p = .003) compared to controls. Between-group differences in depressive symptoms and psychological QoL were not statistically significant. However, in the high-adherence subgroup (≥80%), significant improvements were observed in functional capacity, as measured by the 6-Minute Walk Test (6MWT), as well as in depressive symptoms, and overall QoL.

Conclusions: A 12-week digital walking program significantly improved functional capacity in individuals with mTBI. Psychological health benefits were evident among those with high adherence to moderate-intensity walking. These findings support integrating wearable technologies and remote monitoring tools into structured rehabilitation to promote functional recovery in mTBI.