Impact of Physical Activity on Clinical Outcomes in Veterans Completing the VA's Traumatic Brain Injury Screening and Evaluation Program

Objective: Although the relationship between physical activity (PA) and clinical outcomes after traumatic brain injury (TBI) has been evaluated in the civilian TBI literature, few studies have examined these relationships in Veterans. We evaluated whether PA moderates the relationship between probable TBI and clinical outcomes in post-9/11 Veterans. Setting: This study used electronic health record data sourced from the VA's Corporate Data Warehouse through the VA Million Veteran Program (MVP) and MVP surveys. Participants: Participants included MVP-enrolled Veterans (n = 7217; 77.35% male) who were screened for possible deployment-related TBI through the TBI Screening and Evaluation Program. Design: Observational, cross-sectional, retrospective design using secondary data analysis. Main Measures: The TBI Screen was used to classify Veterans into 2 groups: “TBI Screen−” (n = 4921) or “TBI Screen+” (n = 2296). PA was assessed using self-reported frequency of engagement in vigorous exercise on an MVP survey and categorized as None (“No-PA”; n = 1373), Below Recommended (“Below Recommended-PA”; n = 2118), or Meets/Exceeds Recommended (“Meets/Exceeds Recommended-PA”; n = 3726). Clinical outcomes included self-reported assessments of posttraumatic stress disorder symptoms, depression/anxiety symptoms, subjective cognition, and health-related quality of life. Results: Linear regressions, adjusting for sociodemographics, evaluated interactions between TBI Screen status and PA on all outcomes. We observed significant main effects of TBI Screen ( P 's < .001) and PA ( P 's ≤ .001 to .003), and significant TBI Screen × PA interactions ( P 's = .001 to .016) on all outcomes except 1 health-related quality of life measure. Among both TBI Screen groups, a dose–response effect of PA frequency was observed, such that the “Meets/Exceeds Recommended-PA” group fared the best, followed by the “Below Recommended-PA” and then “No-PA” groups; however, this pattern was more pronounced among TBI Screen+ Veterans. Conclusions: Findings suggest a buffering effect of PA on clinical outcomes, particularly among Veterans with a probable TBI history. These results underscore the potential of PA as an accessible intervention for post-9/11 Veterans.