Exercise & Training

Sex and Gender Differences in Physical Activity, Sedentary Behavior, and Sleep During Traumatic Brain Injury Recovery: A Narrative Review.

TL;DR

Biological sex and gender are critical yet under-investigated determinants of TBI recovery that interact with modifiable lifestyle behaviors—physical activity, sedentary behavior, and sleep—through both sex-specific biological mechanisms and gendered sociocultural contexts.

Key Findings

TBI is increasingly recognized as a chronic disorder rather than an acute event, with enduring cognitive, emotional, and physical impairments that contribute to diminished quality of life and elevated long-term health risks.

  • The paper describes TBI sequelae as extending 'well beyond the initial insult'
  • Consequences include cognitive, emotional, and physical impairments
  • These sequelae are associated with 'elevated long-term risks for adverse health outcomes'
  • TBI recovery is described as 'heterogeneous' and shaped by insufficiently understood individual-level determinants

Biological sex and gender are identified as critical but under-investigated influences on TBI outcomes and recovery trajectories.

  • Sex is defined as referring to 'chromosomal, hormonal, and anatomical attributes'
  • Gender is defined as encompassing 'socially constructed roles, identities, and norms that govern behavior, access to resources, and healthcare engagement'
  • Previous research has documented sex and gender disparities in TBI outcomes, but limited attention has been given to how these factors intersect with lifestyle behaviors during rehabilitation
  • The authors describe these dimensions as interacting 'in ways to influence not only TBI risk and presentation but also recovery trajectories'

Physical activity, sedentary behavior, and sleep are identified as modifiable lifestyle factors essential for optimizing neuroplasticity, reducing inflammation, and promoting TBI recovery.

  • These three behavioral domains are described as 'essential for optimizing neuroplasticity, reducing inflammation, and promoting recovery following TBI'
  • Engagement in and physiological responses to these behaviors are shaped by both sex-specific biological mechanisms and gendered sociocultural contexts
  • The review critically examines how each of these lifestyle factors influences TBI recovery with an emphasis on variation by sex and gender

Sex-specific biological mechanisms and gendered sociocultural contexts both independently and jointly shape engagement with and physiological responses to lifestyle behaviors during TBI recovery.

  • Biological sex influences include chromosomal, hormonal, and anatomical differences
  • Gender-based influences include socially constructed roles, identities, and norms
  • These factors affect 'behavior, access to resources, and healthcare engagement'
  • The paper emphasizes that recognizing and addressing these 'intersecting influences is crucial for advancing equitable and individualized rehabilitation strategies'

Current TBI rehabilitation strategies insufficiently account for sex and gender differences in lifestyle behavior engagement, representing a gap that limits equitable and individualized care.

  • The authors describe sex and gender as 'critical yet under-investigated influences on TBI outcomes'
  • Limited attention has been given to how sex and gender 'intersect with lifestyle behaviors during rehabilitation'
  • The review frames addressing these gaps as 'crucial for advancing equitable and individualized rehabilitation strategies'
  • The narrative review format was used to critically synthesize evidence across physical activity, sedentary behavior, and sleep domains in relation to sex and gender

What This Means

This research suggests that recovering from a traumatic brain injury (TBI) is not a one-size-fits-all process, and that a person's biological sex and social gender play important but poorly understood roles in shaping recovery outcomes. The researchers conducted a narrative review—a broad synthesis of existing scientific literature—focused specifically on how three key lifestyle behaviors (physical activity, sedentary behavior, and sleep) influence TBI recovery differently depending on sex and gender. They distinguish between biological sex (chromosomes, hormones, anatomy) and gender (socially constructed roles, identities, and norms), arguing that both independently and together affect how people engage with these health behaviors and how their bodies respond to them. The review highlights that physical activity, reducing sedentary time, and getting adequate sleep are all important for brain recovery because they support neuroplasticity (the brain's ability to reorganize and heal), reduce inflammation, and promote overall health. However, whether and how people engage in these behaviors during TBI recovery is shaped by biological factors like hormones as well as social factors like gender norms, access to healthcare, and cultural expectations around activity and rest. For example, hormonal differences between males and females may affect how the brain responds to exercise, while gender roles may influence whether someone feels able or encouraged to prioritize rest or physical rehabilitation. This research suggests that current TBI rehabilitation approaches may be missing important opportunities to tailor treatment based on sex and gender, potentially leading to unequal outcomes. The authors call for greater attention to these factors in both research and clinical practice, arguing that recognizing how sex and gender interact with lifestyle behaviors is essential for developing more equitable and effective rehabilitation strategies for TBI survivors.

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Citation

España-Irla G, Perko M, Tinney E, Nwakamma M, Anto-Ocrah M, Morris T. (2026). Sex and Gender Differences in Physical Activity, Sedentary Behavior, and Sleep During Traumatic Brain Injury Recovery: A Narrative Review.. European journal of sport science. https://doi.org/10.1002/ejsc.70248