Study conducted at Fort Riley to remediate symptoms of traumatic brain injury

FORT RILEY, Kan. -- A study on relieving the effects of mild traumatic brain injury through aerobic exercise is being conducted at Fort Riley and is in need of participants.

The study was approved by the Department of Defense last year and is being conducted at the TBI clinic on post through a joint partnership with the University of Kansas. Called the Intense Cardiorespiratory Exercise, the goal of this clinical research study is to see if intense exercise can improve symptoms experienced by people who have had head injuries or concussions, said Stafford Gosser, ICE researcher at Fort Riley. He said the idea behind the study mirrors the American College of Sports Medicine's mantra: exercise is medicine.

"The goal of the study is to evaluate the effectiveness of aerobic exercise and remediating some of the downstream effects of mild traumatic brain injury," Gosser said.

"I think we should see some significant improvement within the cognitive domain as well as depressive symptoms. We didn't pick aerobic exercise because it's a form of punishment or anything. It's scientifically based that aerobic exercise is one of the most important therapeutics having a positive influence on brain biochemistry."

The study was created by Dr. David K. Johnson, a neuropsychologist at the University of California-Davis Medical Center. Previously, Johnson was at the University of Kansas Medical Center Alzheimer's Disease Center and had an established relationship with Irwin Army Community Hospital and educated the medical staff on the similarities between traumatic brain injury and Alzheimer's disease.

"In Kansas, we had a growing and good relationship with the Irwin Army Community Hospital and over a period of four or five years where I would come in and give talks about Alzheimer's disease to the (traumatic brain injury clinic) and grew closer and piqued the interest of some of the neuropsychologist and commanding officers at the hospital about how TBI is a lot like Alzheimer's disease," Johnson said. "The way I usually talk about it is that traumatic brain injury is a model of Alzheimer's disease, it just happens usually in younger adults -- and in this case active-duty service members … so traumatic injury has the same type of neuropathology growth that we see as a result of the secondary injury in the brain. And that looks very, very, very similar that we see in Alzheimer's disease."

It was during the many visits to Fort Riley that Johnson proposed research partnership with the TBI clinic by trying to collect data that can be useful to link the similarities between the two cognitive declines as well as ways to alleviate the symptoms.

"During the last five years or so I've just been coming around (Fort Riley) talking about how similar it is and proposing that maybe we do a research study together, and here we are," he said. "You get a very similar profile of cognitive decline due to the neuropathology in memory and syncing, being able to plan and in particular how fast you are at and how well you can engage with the world."

How the study is conducted

Participants interested in the study will have to meet two required criteria: be an active-duty service member and have experienced a mild traumatic brain injury. Gosser said head injuries do not have to be recent or experienced during time in service and can be something the interested participant went through in their teen years.

After meeting these standards, participants will be involved in alternative physical training two to three times a week for a period of six months. During the six months, a bimonthly two-mile run challenge will be conducted.

"The protocol itself is six months in length and that is comprised of three two-month blocks," Gosser said. "We start out at 20 minutes per session running and that needs to be at or above 70 percent max heart rate. And what we do is we increase 10 minutes and 5 percent (maximum) heart rate every two months. So the second month we would be 30 minutes at 75 percent or greater max heart rate. And then the last two months would be 40 minutes at 80 percent or greater maximum heart rate."

Gosser said the structured PT sessions might seem easy at first, since the initial sessions could be less than what the participants are running. This is because they administer it in a way to prevent the participants from getting hurt.

"We are looking at implementing kind of that step (by step) program in order to minimize the risk of injury, but also elicit the type of adaptation that we are looking for," he said. "And that's almost some of the benefits for some of these guys, I mean those initial sessions -- 20 minutes that might be less than what they're running currently … I think over the course of the six months we will see significant improvements in cognition and oppressive symptoms in addition to significant improvements in APFT (Army Physical Fitness Test) scores as well."

Improvement in performance and mental state aside, there is a science behind how the study is conducted. A spit test is administered before and after the first two-mile run challenge and repeated at the final run at the end of six months. According to Gosser, a cotton swab is inserted under the participant's tongue for two minutes before and after the run it is placed in a bag to be frozen and sent to KU Medical Center for testing.

"What the spit test is testing is stress response," he said. "So we are actually measuring testosterone, cortisol and alpa-amylase. The very first (spit test) is the baseline when you conduct the study … What we are looking at analyzing from that is the hypothesis that as a results of these concussions, the mechanisms that control what is called the glucocorticoid cascade, which is basically a stress response, the sensitivity of certain receptors within that cascade are impaired. What that means is these individuals are walking around with consistently high levels of cortisol. So every little event that they face, there's that fight or flight response that is activated. And it can be to the smallest of things. That can lead to a lot of other things like adrenal fatigue and stuff like that."

At the end of the study after the six months of guided aerobic training, Gosser said he hopes to find the levels of stress hormones acquired from the final spit test have been reduced from the baseline results.

Additional benefits

Gosser said regulating stress response receptors through the program might have long-term benefits.

"We are looking, in the long term, helping return them to normal functioning when it comes to the stress response," Gosser said. "Again, that's an exploratory aim, but not the primary outcome of the study, but I think it's one of the more interesting (potential outcomes) and it can have significant implication for future studies, especially for the mental wellbeing for these guys. It can't be fun walking around like that all the time."

The program is recognized by the division as an acceptable form of alternate PT because it is conducted during PT hours. The sessions are conducted not only to improve performance, but is also educate.

"So we are looking at running with a purpose," he said. "There will be an educational component as well. Sometimes they go for unit PT, they might run to run, but we are teaching these guys how to run, keeping them at specific intensities so they elicit the type of adaptations that we want to see."

Gosser, who previously served as an infantryman in the National Guard, is a certified strength and tactical coach with a degree in exercise physiology. He administers these sessions directly. He said his background as a Soldier and his current knowledge in fitness gives him an edge and makes him the ideal candidate to conduct this research.

"I think the insights and oversights I can provide is pretty invaluable," he said. "You pay big money to have that direct coaching on the civilian side … I will be going over everything from running mechanics and some classes on lifting weights -- because that's my specialty and that's what I like to do -- and educate these individuals as much as I can … Perhaps some of them might even be interested in taking on a career in the same field that I'm in. I can give them advice in that regard. But really, it should be fun for these guys-bottom line."

During sessions, Gosser is out alongside the participants because he feels his involvement can impact their attitude.

"For example, this morning I actually had a guy that I ran with, it was only his second session and it was pretty cold right now," he said. "I go out and I run with him to try to improve, the not only the morale, but give him some motivation. If they're going to be out there suffering, I'm going to be right alongside them, giving them feedback as they're running, making sure that they're where they need to be as far as intensity."

Numbers on the rise

According to data collected by the Defence and Veteran Brain Injury Center, dvbic.dcoe.mil/dod-worldwide-numbers-tbi, the number of service members diagnosed with traumatic brain injury has increased from about 23,000 in 2007 to more than 370,000 this year. Gosser said the crux of the ICE study is that people who suffer from TBI are more likely to suffer from Alzheimer's when they age.

"What is significant about that is those concussions actually increase the risk of developing Alzheimer's later in life by approximately 60 percent," he said quoting some of the data used to support the ICE grant. "Not to mention the most common indicator … PTSD (Post Traumatic Stress Disorder), and that brings with it a whole host of issues ranging from depression, anxiety, some cognitive symptoms … as to why this research is important, there was an article that was published by the Department of Veterans Affairs, that further highlighted the impact that this is going to have in the future and what they found is that from 2004 to 2014, the number of enrollees with Alzheimer's doubled. And that number is only expected to increase and to really put that into perspective, the article also said there were over 760,000 veterans who now suffer from Alzheimer's or related forms of dementia."

And in Alzheimer's Association website, alz.org, it says "certain types of traumatic brain injury may increase the risk of developing Alzheimer's or another form of dementia years after the injury takes place."

Gosser notes the rise in reported TBI cases can be costly to patients financially and timewise.

"You take the increased risk from these concussion from these active-duty service members, and it really will present to be a problem in the future not only cost wise, but also the cost to families and caregivers as well," he said.

For more information, please call Stafford Gosser at 785-787-3703 or the TBI Clinic at 785-239-7863, or email stafford.j.gosser.civ@mail.mil.