Participants demonstrated high adherence with the program, suggesting that individuals with TBI are able to successfully engage in the program and achieve significant weight loss and changes in key physiologic outcomes.

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Weight gain and inactivity are common problems for individuals living with a traumatic brain injury (TBI). Yet, interventions to support a healthy lifestyle specific to individuals with TBI are lacking. The purpose of this study was to complete a program evaluation of a 12-month evidence-based healthy lifestyle intervention adapted for people with a TBI. Eighteen participants completed a brief interview after the yearlong intervention to determine their perceptions of the program effectiveness as well as barriers and facilitators in making lifestyle changes. Participants reported staff, tracking of dietary and activity behavior, and in-person meetings as most helpful aspects. Lack of motivation and difficulty preparing healthy meals were the primary barriers to a healthy lifestyle. Qualitative data revealed five themes that influenced healthy behaviors, including (1) self-regulation, (2) environmental resources, (3) knowledge of health behaviors, (4) TBI-related impairment and comorbidities, and (5) social support. Results suggest that future iterations of the healthy lifestyle intervention should emphasize self-regulation activities; require tracking of dietary and activity behaviors across 12 months; provide concurrent support for individual motivation issues; provide prepared meals; utilize web-based, telephonic, or hybrid approaches to delivery; further simplify the curriculum and learning tools; and include caregivers and peer accountability partners. Impact and ImplicationsThis program evaluation of an evidence-based weight loss intervention modified to meet the unique needs of people with traumatic brain injury (TBI) provides valuable quantitative and qualitative data on participants' perceived helpfulness, barriers, and supports to participation. Program evaluation results following the 12-month intervention suggest that self-regulation, environmental resources, knowledge of health behaviors, TBI-related impairment and comorbidities, and social support are important factors to consider for implementing lifestyle change with this population. Future adaptations of this evidence-based lifestyle intervention should consider emphasizing self-regulation and dietary tracking activities throughout the program, providing additional support for those with mood disorders, and addressing transportation and environmental barriers by providing prepared meals or web-based access for sessions to meet the needs of people with TBI.

Specialists are challenged to find modes of rehabilitation that improve the health of individuals with a brain injury. Pilot results from the PACE programme indicate that education about physical activity may play an important role in the rehabilitation process and lead to improved health outcomes.