ORIGINAL PAPER Aquatics, health-promoting self-care behaviours and adults with brain injuries SIMON DRIVER 1 , KEELY REES 2 , JOHN O’CONNOR 3 , & CURT LOX 4 1 University of North Texas, TX, USA, 2 University of Wisconsin – LaCrosse, WI, USA, 3 Louisiana Tech University, LA, USA, and 4 Southern Illinois University Edwardsville, IL, USA (Received 1 April 2005; accepted 20 September 2005 ) Abstract Primary objective: To determine the effect of an aquatic programme on the health promoting behaviours of adults with brain injuries. Main outcomes and results: Eighteen individuals participated in the programme and were randomly assigned to an experimental (n ¼ 9) or control group (n ¼ 9). Health promoting behaviours, physical self-concept and self-esteem were measured pre- and post-intervention. Significant differences and large effect sizes were found between scores for the experimental group only, indicating an increase in health promoting behaviours, physical self-concept and self-esteem. Conclusions: Results have useful implications for health professionals as exercise prescription may enhance health promoting behaviours and decrease health care costs after a brain injury. Keywords: Physical, activity, health, behaviors, aquatics, brain, injuries Introduction With an estimated 1.5–2.5 million brain injuries occurring a year in the US, where 50 000–100 000 lead to permanent disability, brain injuries represent a serious public health issue [1–3]. The life expectancy of this population is also increasing due to an increase in medical support immediately post- brain injury [4]. However, the disabilities that an individual is faced with after an injury are diverse due to the neurologic damage and the subsequent deficits that accompany the initial insult to the brain [5–7]. Thus, damage to any part of the brain may lead to motor disorders, ranging from paralysis to poorly controlled movements including spasticity, hypoto- nia, ataxia and apraxia [8]. Secondary problems associated with brain injuries are often the result of immobility and include decreased vital capacity, strength, muscle tone, muscle function and increases in body fat [5, 9]. This loss of fitness, combined with decreased mobility, has been shown to raise the metabolic cost of functional activities such as walking [10, 11]. Consequently, an individual with brain injuries may have increased difficulty completing activities of daily living (ADLs), which influences their functional capacity and ability to complete other areas of the rehabilitation process indepen- dently [5, 12]. Therefore, the physical, social and environmental barriers that people with brain injuries are faced with leads to a downward spiral in overall health and well being [13]. Post-brain injury, numerous studies have indicated increases in depression [14, 15] and psychosocial parameters such as decreased self-esteem [16] and decreases in social contacts [17, 18]. A decrease in these mental and social states has been recognized to lead to an increase in the adoption of negative behaviours, such as inactivity, poor diet, isolation, smoking, alcoholism and drug addiction [14, 19]. Evidently, after a brain injury individuals are placed under a severe amount of stress due to the range and severity of the physical, cognitive and psychosocial disabilities. Stress is considered a dynamic transac- tion between the person and their environment as Correspondence: Dr Simon Driver, Department of Kinesiology, Health Promotion, and Recreation, PO Box 310769, Denton, TX 76203-0769, USA. E-mail: sdriver@coe.unt.edu ISSN 0269–9052 print/ISSN 1362–301X online # 2006 Taylor & Francis DOI: 10.1080/02699050500443822 Brain Injury, February 2006; 20(2): 133–141